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Echocardiography in systemic lupus erythematosus
S Kalke1, C Balakrishanan, G Mangat
1Rheumatology Division, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India.
Insights
Systemic lupus erythematosus (SLE) patients often exhibit asymptomatic diastolic dysfunction, particularly those with active disease. Echocardiography revealed significant diastolic abnormalities in active SLE, highlighting the need for cardiac monitoring.
Area of Science:
- Cardiology
- Rheumatology
- Systemic Lupus Erythematosus Research
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with potential multi-organ involvement.
- Cardiac complications are common in SLE, but subclinical dysfunction is not well-characterized.
Purpose of the Study:
- To investigate the prevalence and characteristics of cardiac involvement, specifically diastolic dysfunction, in patients with SLE.
- To assess the relationship between disease activity and diastolic function in SLE patients.
Main Methods:
- Two-dimensional echocardiography with Doppler examination was performed in 54 SLE patients.
- Diastolic function was assessed in 45 patients without major echocardiographic abnormalities.
- Patients were categorized by SLE disease activity (SLEDAI) and compared to controls.
Main Results:
- 17% of SLE patients had significant cardiac abnormalities.
- Patients with active SLE (SLEDAI > 5) demonstrated significant diastolic dysfunction compared to inactive patients and controls (increased peak A, decreased E/A ratio).
- No linear correlation was found between SLEDAI as a continuous variable and diastolic dysfunction.
Conclusions:
- Asymptomatic diastolic dysfunction is prevalent in SLE patients.
- Active SLE disease is associated with significant diastolic dysfunction.
- Echocardiography is crucial for detecting subclinical cardiac involvement in SLE.
Abstract:
Two dimensional echocardiography with doppler examination was performed in 54 patients with systemic lupus erythematosus (SLE). Nine (17%) had significant cardiac involvement (four left ventricular hypertrophy, one moderate pericardial effusion, one severe aortic regurgitation, and three ventricular systolic dysfunction). We further studied diastolic function in 45 patients who did not have a major abnormality in echo. SLE was graded as active in 16 patients (SLEDAI > 5) and inactive in 29 patients. Twenty age- and sex-matched subjects acted as controls. The data were compared using one way ANOVA test. Patients with active disease had significant diastolic dysfunction compared to inactive patients and controls as indicated by increased peak A (P < 0.01) and decreased E/A ratio (P < 0.01). There was no linear correlation between disease activity and diastolic dysfunction if SLEDAI was considered as a continuous variable (r=0.29 for E/A). Anticardiolipin antibodies (both IgG and IgM) were elevated in five patients (13 studied). One of them had severe mitral regurgitation, one had trace mitral and aortic regurgitation and one had diastolic dysfunction. We conclude that asymptomatic diastolic dysfunction is present in SLE patients.