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

Summary

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