Cardiac dysfunction in patients with systemic lupus erythematosus and antiphospholipid syndrome

Paran, Daphna; Caspi, Dan; Levartovsky, David; Elkayam, Ori; Kaufman, Ilana; Litinsky, Irena; Keren, Gad; Koifman, Bella

doi:10.1136/ard.2005.044073

Cited by 41 publications

(39 citation statements)

References 24 publications

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“…The association of antiphospholipid syndrome (APS) and DD has been previously documented [27,28]. APS causes myocardial hypoperfusion by small vessel vasculopathy/ microvascular thrombosis [29] which affect myocardial compliance [30].…”

Section: Discussionmentioning

confidence: 99%

Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants.

et al. 2016

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Aims: Myocardial damage is frequent and often silent in systemic lupus erythematosus (SLE). The aim of the study was to determine the prevalence of myocardial damage by novel ultrasound techniques and to systematically assess the relationship between subclinical cardiac dysfunction and SLE-related clinical parameters. Material and methods: Seventy-five consecutive SLE patients without evidence of cardiac disease and seventy-three controls underwent standard transthoracic echocardiography using classical and novel ultrasound techniques: tissue Doppler imaging and speckle tracking echocardiography. Patient characteristics, cumulative organ damage and laboratory data were retrieved by medical chart review. Results: Within the cohort, 89.3% of the patients were female; mean±SD age and median (IQR) disease duration were 43.2±12.5 years and 8.03(6.3) years, respectively. SLE patients exhibited a significant decrement in endocardial longitudinal strain (-18.4% vs 19.3%, p=0.001) compared with controls. Diastolic dysfunction was detected in 34 (45.3%) of SLE patients. Major determinants of systolic and diastolic dysfunction were hypertension (p=0.023 and p<0.001, respectively), associated antiphospholipid syndrome (APS) (p<0.001 and p<0.001, respectively), cumulative damage accrual (p<0.001 and p=0.003, respectively), and disease duration (p=0.03 and p<0.001, respectively). Notably, anti-Ro antibodies were present in 37% of the SLE patients who had better systolic longitudinal performance. Neither disease activity, nor specific organ involvement, were associated with myocardial impairment. Conclusion: Systolic longitudinal and diastolic performance impairments are frequent findings in SLE patients without overt cardiovascular disease. Cumulative organ damage, disease duration, APS, and hypertension are major determinants for early heart involvement in SLE patients.

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Section: Discussionmentioning

confidence: 99%

Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants.

et al. 2016

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“…In patients with both SLE and APS a lower than normal CD4+/ CD8+ ratio in BAL was seen, suggesting subclinical ILD in patients who were asymptomatic regarding respiratory symptoms [164].…”

Section: Bronchoalveolar Lavagementioning

confidence: 99%

Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement: Table 1—

Antoniou¹,

Margaritopoulos²,

Economidou³

et al. 2009

Eur Respir J

151

122

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The connective tissue disorders (CTDs), also called collagen vascular diseases (CVDs), represent a heterogeneous group of immunologically mediated inflammatory disorders with a large variety of affected organs. Individuals with a CTD (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, polymyositis/dermatomyositis and mixed connective tissue disease) are susceptible to respiratory involvement. When the lungs are affected, an increasing mortality and morbidity in CVDs occurs. Interstitial lung disease (ILD) is established as a clinical corollary across the spectrum of CTDs, with an overall incidence estimated at 15%.Therefore, pivotal clinical dilemmas remain in the evaluation and management of ILD involvement in CVDs. Critical questions are the presence of fibrosis and whether the disease is clinically significant. Moreover, the clinician has to decide if treatment is warranted and which is the best therapeutic approach. The use of additional tests, such as pulmonary function tests, high-resolution computed tomography scan, bronchoalveolar lavage fluid and surgical lung biopsy, deserves better discussion. The present review focuses on establishing the diagnosis of ILD in CTD, and on evaluating disease activity and prognosis. This will provide the basis for therapeutic decisions that will be discussed, including an overview of recent advances.

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“…Paran et al (24) reported abnormal echocardiographic findings in asymptomatic patients with SLE or antiphospholipid syndrome (APS). The SLE patients were younger and LV systolic function was more impaired in patients with SLE than in PAPS; meanwhile, LV and RV diastolic function, as reflected by the E/A ratios, were significantly more impaired in patients with APS.…”

mentioning

confidence: 99%

The implication of tissue Doppler echocardiography and cardiopulmonary exercise in early detection of cardiac dysfunction in systemic lupus erythematosus patients

Elnady

et al. 2016

Eur J Rheumatol

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Objective: Systemic lupus erythematosus (SLE) can present limitations to exercise capacity and quality of life (QoL) because of various clinical conditions, such as pulmonary disease or heart disease. Tissue Doppler echocardiography (TDE) offers the promise of an objective measurement to quantify regional and global ventricular function through the assessment of myocardial velocity data. This study aimed to assess the intensity of left ventricular (LV) and right ventricular (RV) systolic and diastolic dysfunction in SLE patients by means of TDE and cardiopulmonary exercise (CPX) testing to determine their impact on QoL.Material and Methods: Overall, 56 SLE patients within two tertiary healthcare centers as well as 50 healthy controls were examined with TDE after the exclusion of cardiovascular risk factors. TDE was performed for maximal systolic (S), early diastolic (E`), and late diastolic (A`) velocities of the mitral and tricuspid annulus. Pulsed wave (PW) Doppler of mitral and tricuspid valve inflow was performed in addition to the estimation of the left ventricle ejection fraction and assessment of right ventricle systolic function by tricuspid annular plane systolic excursion (TAPSE). Disease activity was assessed by the Systemic Lupus Activity Measure (SLAM), and the damage index was assessed by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). CPX tests according to the modified Bruce protocol were performed.Results: SLE patients in both subgroups had more or less similar laboratory data and statistically higher values of ESR, CRP, and anticardiolipin (aCL) antibodies compared to the control group. LV function showed statistically insignificant EF compared to the control group, being lower in the patient group. Tissue Doppler image revealed that E` and A` of the mitral annulus were lower in the patient group than in the control group. Concerning RV, TAPSE in the patient group was statistically lower than in the control group, and there was a statistical difference between SLE groups Ia and Ib; also, S wave was lower in group Ib than in group Ia. RV diastolic dysfunction in the form of lower E` and A` values was observed for the SLE group compared to the control group, especially in the medial annulus of the tricuspid valve. A higher A wave velocity with PWD of mitral and tricuspid inflows was observed in the patient group compared to the control group.Conclusion: SLE patients have an increased prevalence of subclinical systolic and diastolic LV and RV dysfunction. This result advocates for regular follow-up and early screening of SLE patients. Accordingly, treatment focused on improving diastolic heart function may have a role in enhancing QoL and improving the prognosis of SLE patients.

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Cardiac dysfunction in patients with systemic lupus erythematosus and antiphospholipid syndrome

Cited by 41 publications

References 24 publications

Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants.

Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants.

Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement: Table 1—

The implication of tissue Doppler echocardiography and cardiopulmonary exercise in early detection of cardiac dysfunction in systemic lupus erythematosus patients

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