Cardiac abnormalities in systemic lupus erythematosus: a prospective M-mode, cross-sectional and Doppler echocardiographic study

doi:10.1016/0167-5273(90)90294-F

International Journal of Cardiology

Volume 27, Issue 3, June 1990, Pages 367-375

https://doi.org/10.1016/0167-5273(90)90294-F Get rights and content

Abstract

A prospective M-mode, cross-sectional and Doppler echocardiographic study was performed on 75 patients with systemic lupus erythematosus and 60 sex- and age-matched control subjects. Compared with the control group, patients with lupus had an increased prevalence of echocardiographic abnormalities. These included pericardial effusion and/or thickening (37%), left ventricular hypertrophy (12%), global left ventricular hypokinesis (5%), segmental abnormalities of left ventricular wall motion (4%), right ventricular enlargement (4%), focal verrucous valvar thickening (12%), gross valvar thickening and dysfunction (8%), mitral regurgitation (25%) and aortic regurgitation (8%). Two patients with gross mitral valvar thickening and dysfunction subsequently underwent valvar replacement. Correlation between echocardiographic abnormalities and clinical parameters showed that pericardial effusion was significantly associated with pericardial pain (P < 0.05) and active disease (P < 0.001), and left ventricular hypertrophy with systemic hypertension (P < 0.05). Thus, there was a high prevalence of cardiac abnormalities, especially pericardial and valvar lesions, in patients with systemic lupus erythematosus. Echocardiography is invaluable in identifying these abnormalities and should be used routinely for cardiac evaluation of these patients.

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Cited by (50)

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Citation Excerpt :
Ischemia due to atherosclerosis, although occurring earlier in SLE patients than in the normal population, affects more frequently older SLE patients, with long-standing disease, long period of corticosteroid intake, and, usually, quiescent disease at the time of the cardiovascular event. Ischemic cardiopathy could be due to APS (Asherson et al., 1989; Murpy and Leach, 1989; Leung et al., 1990a,b; MacGregor et al., 1992; Kattwinkel et al., 1992), and in this case could develop at any age and in any stage of the disease course. Urowitz et al. (1976) described a bimodal distribution of the causes of death in SLE: an “early” peak due to SLE severity/activity or infections and a “late” peak due to atherosclerotic CAD; this trend has been confirmed in other studies too (Rubin et al., 1985; Abu-Shakra et al., 1995).
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology, characterized by the production of autoantibodies by autoreactive B cells, which are capable of inducing inflammatory changes in various organs and systems by several mechanisms. In patients with SLE, all the cardiac structures can be involved. Pericarditis is the most common cardiac abnormality, but lesions of the valves, myocardium, and coronary vessels may also occur. Nowadays, cardiac manifestations can be frequently recognized by echocardiography and other noninvasive tests, such as cardiac computed tomography or cardiac magnetic resonance imaging. Echocardiography is a nonexpensive, sensitive, and specific technique in detecting cardiac abnormalities, particularly mild pericarditis, valvular lesions, and myocardial dysfunction. Premature atherosclerosis is the most frequent cause of coronary artery disease in SLE patients. Efforts should be made to control traditional risk factors as well as all other factors, which could contribute to atherosclerotic plaque development.
Cardiovascular evaluation in patients with systemic lupus erythematosus - A cross sectional study
2008, Indian Journal of Rheumatology
More than 50% of patients with SLE experience clinical cardiovascular involvement during the course of the illness. We studied the relationship between disease duration, SLE disease activity index (SLEDAI), steroid use and cardiovascular abnormalities, and documented the extent of dyslipidaemia in SLE.
Eighty-two consecutive patients suffering from SLE were recruited in this cross sectional study. Lipid parameters, SLEDAI, ECG and echocardiography were obtained in all patients, and treadmill test (TMT) and coronary angiogram (CAG) were performed in selected patients. Chi-square test and Fisher's exact test was applied to determine the relation between cardiovascular status and steroid dose. Mann-Whitney U test and unpaired T test were applied in other cases.
We did not find any influence of disease duration (P = 0.129), SLEDAI (P = 0.429) or steroid use (P = 0.287) on the cardiovascular abnormalities observed in ECG, echocardiogram, CAG or TMT. Steroid doses influenced the serum triglycerides (P = 0.000029) and HDL-C (P = 0.00826) but not LDL-C (P = 0.3720) or total cholesterol (P = 0.2488) levels. There was high prevalence of dyslipidaemia (60%) and cardiovascular abnormalities (58.5%) in patients with SLE.
Proper clinical evaluation and investigations can unveil cardiac abnormalities in most patients with SLE who do not have symptoms at early stage of disease. Further studies are needed to determine the risk factors.
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Citation Excerpt :
Echocardiography is a useful procedure (Feldman et al., 2000), because it is able to show findings that, although not specific, are indicative of myocardial inflammation and/or dysfunction. The most relevant findings are global, regional, or segmental wall motion abnormalities, decreased ejection fraction, increased chamber size, and prolonged isovolumic relaxation time (Klinkhoff et al., 1985; Doherty et al., 1988; Crozier et al., 1990; Leung et al., 1990a,b; Nihoyannopoulos et al., 1990; Sturfelt et al., 1992; Giunta et al., 1993). Obviously echocardiography cannot distinguish the causes of myocardial inflammation and/or dysfunction.
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with a still undefined etiology, characterized by the production of autoantibodies and autoreactive T cells which can trigger an inflammatory process in various organ systems. Among these, the most affected ones are skin, musculoskeletal, hematopoietic and nervous system, kidney, lung, blood vessels, and heart. All the cardiac structures can be involved: pericardium, endocardium and valves, myocardium, coronary arteries, and conduction tissue. Pericarditis is one of the most characteristic manifestations of the disease and is included in the American Rheumatism association (ARA)/American College of Rheumatism (ACR) classification criteria for SLE. The prevalences of valvular verrucae and thickening observed in transthoracic and transesophageal echocardiography are reported in the chapter. There are two major pathogenetic hypothesis. The primum movens could be represented by a thrombus. According to this hypothesis, antiphospholipid antibodies (aPL) and anti-endothelium antibodies could bind to endothelial cells, which lead to their activation and, in turn, platelet aggregation and thrombus formation. Alternatively, the primum movens could be immune complex deposition between the endothelium and the basal membrane, followed by the inﬁltration of inﬂammatory cells.
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Original studyCardiac abnormalities in systemic lupus erythematosus: a prospective M-mode, cross-sectional and Doppler echocardiographic study

Abstract

Am Heart J

Sem Arthritis Rheum

Am J Cardiol

Am J Cardiol

Am J Med

Am J Med

J Thorac Cardiovasc Surg

Cardiovascular abnormalities in systemic lupus erythematosus

J Clin Ultrasound

Original study
Cardiac abnormalities in systemic lupus erythematosus: a prospective M-mode, cross-sectional and Doppler echocardiographic study