[Cardiac abnormalities in systemic lupus erythematosus and their association with antiphospholipid antibodies]

An echocardiographic study was performed in 60 unselected patients affected with Systemic Lupus Erythematosus (SLE) and in 30 age- and sex-matched control subjects, to evaluate the incidence of cardiac abnormalities and the possible correlation with the presence of antiphospholipid antibodies. 33 patients (55%) had major cardiac abnormalities as valvular stenosis and/or regurgitation (35%), pericardial effusion or thickening (26%), left ventricular hypertrophy (21%), regional or global left ventricular dysfunction (10%). Some patients presented more than one cardiac dysfunction: five patients had one major and one minor lesion, 11 presented with two major lesions, and in five of them a pancarditis was found. Minor cardiac abnormalities as mitral valve prolapse, valvular thickening without valvular dysfunction, calcification of the mitral annulus were demonstrated in nine patients (15%). Increased levels of antiphospholipid antibodies were found in 25 out of 60 patients (41.6%). No clear correlation was evident between endocardial or pericardial involvement and such autoantibodies. In fact, valvular heart diseases were present in 36% of the patients with antiphospholipid antibodies and in 34% of the patients without antiphospholipid antibodies; pericardial involvement was evident in 24% and in 28% of patients with and without them, respectively. On the contrary the demonstration of antiphospholipid antibodies in five out of six patients with regional or global left ventricular dysfunction could suggest a pathogenetic role of these autoantibodies in myocardial hypokinesis. Therefore, antiphospholipid antibodies could represent only one of the pathogenetic factors of the cardiac lesions in SLE patients, together with immunologic and iatrogenic factors. The involvement of other systems as renal, vascular and pulmonary certainly play an important role in predisposing to the development of secondary cardiac manifestations.