The incidence of cardiovascular manifestations detected by echocardiography in systemic lupus erythematosus


Authors: D. Tegzová;  P. Jansa 1;  D. Ambrož 1;  T. Paleček 1;  L. Dušek 2
Authors‘ workplace: Revmatologický ústav v Praze ;  II. interní klinika kardiologie a angiologie Všeobecné fakultní nemocnice a 1. LF UK v Praze 1;  Institut biostatistiky a analýz Masarykovy univerzity v Brně 2
Published in: Čes. Revmatol., 15, 2007, No. 2, p. 64-71.
Category: Original Papers

Overview

Objective.
The aim of our study was to evaluate incidence of particular cardiovascular manifestations of systemic lupus erythematosus (SLE) detected by echocardiography, to describe their different types, severity, and to find possible relation to particular characteristics of SLE.

Methods.
Fifty six patients with SLE were evaluated. All patients underwent echocardiographic examination consisting of structure and function evaluation of left ventricle to screen for diastolic function assessed by tissue Doppler echocardiography. Furthermore, structure and function of heart valves, right ventricular structure and systolic function as well as pulmonary pressures and pericardial changes were performed (parameters: IVST (interventricular septum thickness), PWT (posterior wall thickness), LVD (left ventricular dimension), LVDD (left ventricular diastolic dimension), LVEDD (left ventricular end-diastolic dimension), LVESD (left ventricular end-systolic dimension), CO (cardiac output), the dimension of particular heart atrium and ventricle measured by single-dimension imaging, presence of significant tricuspidal regurgitation, and its outflow gradient – Tei index). Basic demographic data, type and duration of immunosuppressive treatment, dose of glucocorticoids, presence of autoantibodies (anti ds DNA, anti Ro, La, aCL), presence of organ manifestations and activity of the disease measured by SLEDAI were performed during clinical examination. The association between particular pathological findings assessed by echocardiography and SLE parameters was investigated.

Results.
Different types of valve regurgitations have been found in 13 patients and pericardial effusion in 8 patients. There was no evidence of pulmonary hypertension. Cardiac manifestations were not affected by gender. Occurence of pericardial effusion as well as of valve regurgitations were associated with the age of patient. Higher occurence was found in patients older than 45 years. Disease duration of SLE patients was not significantly associated with the occurence of abovementioned manifestations, and this fact was also demonstrated for all other examined SLE parameters. Significant correlation has been found between occurence of pericarditis and pulmonary involvement, which was not influenced by either disease duration or age of the patients. Occurence of valve regurgitation has been significantly increased in patients with internal organs involvement, specifically with pulmonary and central nervous system involvement. No association with renal involvement has been found. Statistically less valve regurgitations have been observed in patients with skin or joint involvement. Pericarditis correlated positively with the Tei-index. Higher PG max on tricuspidal valve correlated with pulmonary manifestation of SLE and with increased SLE activity (SLEDAI > 5).

Discussion.
SLE manifests with several cardiovascular complications. In our group, there has been an accumulation of pathologies detected by echocardiography (mostly valve regurgitation a pericardial effusion) in patients with organ involvement and in active SLE (mostly with affected pulmonary interstitium), regardless of the disease duration. Significantly increased values of Tei index were found in older patients with pulmonary involvement and longstanding SLE. Increased PG max on tricuspidal valve were presented in active SLE patients with pulmonary involvement. No correlations between intensity and severity of SLE and other echocardiographic parameters were demonstrated in this analysis.

Key words:
systemic lupus erythematosus, cardiovascular manifestations, echocardiography, pericarditis, pulmonary hypertension


Sources

1. Dostál C, Vencovský J. Postižení srdce a cév, 93–93. Systémový lupus erythematodes, Medprint, 1997.

2. Gordon C. Long-term complications of systemic lupus erythematosus. Rheumatology 2002; 41: 1095–1100.

3. Schattner A, Liang MH. The cardiovascular burden of lupus. Arch Intern Med 2003, 163(13): 1507–1510.

4. Petri M, Spence D, Bone RI, et al. Coronary artery disease risk factors in the John Hopkins lupus cohort Prevalence, recognition by patients and prevention practices. Medicina (Baltimore)1992; 71: 91–302.

5. Urowitz MB, Gladman DD. How to improve morbidity and mortality in systemic lupus erythematosus. Rheumatology 2000; 39: 238–244.

6. Manger K, Manger B, Repp R, et al. Definition of risk factors for death, and stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus. Ann Rheum Dis 2002, 61: 1065–1070.

7. Svenungsson E, Sensen-Urstad K, Heimbuerger M, et al. Risk factors for cardiovascular disease in systemic lupus erythematosus. Circulation 2001; 104: 1887–1893.

8. Gaine SP. Pulmonary hypertension. JAMA 2000; 284: 3160–3168.

9. Manzi S. Systemic lupus erythematosus: a model for atherogenesis? Rheumatology 2000; 39: 353–359.

10. Selzer F, Sutton-Tyrrell K, Fitzgerald S, et al. Vascular stiffness in women with systemic lupus erythematosus. Hypertension 2001; 37: 1075–1082.

11. Nuttall SL, Heaton S, Piper MK, et al. Cardiovascular risk in systemic lupus erythematosus – evidence of increased oxidative stress and dyslipidaemia. Rheumatology 2003; 42: 758–762.

12. Nowak J, Nilsson T, Sylvén C, et al. Potential of carotid ultrasonography in the diagnosis of coronary artery disease. Stroke 1998; 29: 439–446.

13. Altman DG. Practical Statistics for Medical Research. London: Chapman and Hall, 619p, 1991.

14. Zar JH. Biostatistical Methods. 2nd ed. London: Prentice Hall, 556p, 1984.

15. Cervera R, Font J, Peare C, et al. Cardiac disease in SLE. Prospective study od 70 pts. Ann Rheum 1991, 51“156–9.

16. Sturfelt G, Eskillson J, Nived O. Cardiovascular disease in SLE. A study of 75 pts from a defined population. Medicine (Baltimore), 1992: 216–23.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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