Proximal Aortic Stiffness Is Increased in Systemic Lupus Erythematosus Activity in Children and Adolescents

Gamal, Yehia Mohamad El; Elmasry, Ola A.; Hadidi, Iman Saleh El; Soliman, Ola Kamel

doi:10.1155/2013/765253

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Ongoing inflammation may have an effect on the increased aortic stiffness etiology in patients with CD. El Gamal et al 24) investigated patients with systemic lupus erythematous, an autoimmune disorder like CD, and asserted that increased aortic stiffness was associated with disease activity and inflammation rather than the atherosclerotic process. In another study, Barbulescu et al 25) found that increased aortic stiffness was associated with levels of the inflammatory markers: C-reactive protein and interleukin-6.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Aortic Elasticity in Patients with Celiac Disease

et al. 2016

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Background and ObjectivesCeliac disease (CD) is a chronic autoimmune disorder induced by dietary gluten intake by individuals who are genetically sensitive. Many studies report an increased risk of cardiovascular diseases in such patients. The aim of this study is to assess aortic elasticity properties in patients with CD that may be associated with an increased risk of cardiovascular disease.Subjects and MethodsEighty-one patients diagnosed with CD by antibody test and biopsy and 63 healthy volunteers were included in this prospective study. Electrocardiographic and echocardiographic examinations were performed.ResultsThe CD group did not have any differences in the conventional echocardiographic parameters compared to the healthy individuals. However, patients in the CD group had an increased aortic stiffness beta index (4.3±2.3 vs. 3.6±1.6, p=0.010), increased pressure strain elastic modulus (33.6±17.0 kPa vs. 28.5±16.7 kPa, p=0.037), decreased aortic distensibility (7.0±3.0×10-6 cm2/dyn vs. 8.2±3.6×10-6 cm2/dyn, p=0.037), and similar aortic strain (17.9±7.7 vs. 16.0±5.5, p=0.070) compared to the control group. Patients with CD were found to have an elevated neutrophil/lymphocyte ratio compared to the control group (2.54±0.63 vs. 2.24±0.63, p=0.012). However, gluten-free diet and neutrophil/lymphocyte ratio were not found to be associated with aortic elasticity.ConclusionPatients with CD had increased aortic stiffness and decreased aortic distensibility. Gluten-free diet enabled the patients with CD to have a reduction in the inflammatory parameters whereas the absence of a significant difference in the elastic properties of the aorta may suggest that the risk of cardiovascular disease persists in this patient group despite a gluten-free diet.

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Section: Discussionmentioning

confidence: 99%

Assessment of Aortic Elasticity in Patients with Celiac Disease

et al. 2016

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“…Likewise, Ghosh et al observed increased fibromuscular dysplasia (FMD) and cIMT in 60 Indian patients with SLE who showed impaired FMD and abnormal IMT [48]. Our group has a greater proportion of African American patients than other paediatric studies [22][23][24][25][26][27], and this may have affected the results.…”

Section: Discussionmentioning

confidence: 71%

“…Although these authors showed an increased burden of traditional and non-traditional CV risk factors among the cohort, such as HTN, these did not correlate with changes in vascular measures. When subdivided by disease activity, El Gamal et al [26] showed increased PWV in hypertensive patients with active SLE when compared to controls, but no difference between controls and patients with inactive disease as defined by SLEDAI.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the wealth of data available on CVD risk in adults with SLE, there is a dearth of information about CVD risk in children with juvenile-onset SLE (JSLE), and most of our knowledge is extrapolated from adult studies. Although childhood lupus is often a more aggressive disease than its adult form, the greater plasticity of children's vessels may protect them from vascular disease, making extrapolations from adult studies difficult; published studies [22][23][24][25][26][27] to date have reported conflicting results. The cross-sectional study reported here was designed to establish the baseline CV risk of a cohort of children with JSLE prior to subsequent longitudinal follow-up studies.…”

Section: Introductionmentioning

confidence: 99%

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The vascular phenotype of children with systemic lupus erythematosus

et al. 2015

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“…In the study by El Gramal, et al [ 69 ], 16 adolescent patients with active SLE (mean age 15 ± 2.42 years; 16 females), 14 patients with inactive SLE (mean age 15.7 ± 1.89 years; 4 males, 10 females), and 16 age and sex-matched healthy adolescents (15.5 ± 1.71 years; 4 males, 12 females) underwent echocardiography for assessment of proximal aortic PWV [defined as Ao distance/Ao wave transit time in the aortic arch]. Patients with active SLE had significantly higher PWV values than controls (p<0.05), while no difference was found between patients with inactive SLE and controls.…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Aortic Atherosclerosis in Systemic Lupus Erythematosus

Roldan

Ratliff

Snider

et al. 2013

Rheumatology (Sunnyvale)

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Aortic atherosclerosis (AoA) defined as intima-media thickening or plaques and aortic stiffness (AoS) also considered an atherosclerotic process and defined as decreased vessel distensibility (higher pulse pressure to achieve similar degree of vessel distension) are common in patients with SLE. Immune-mediated inflammation, thrombogenesis, traditional atherogenic factors, and therapy-related metabolic abnormalities are the main pathogenic factors of AoA and AoS. Pathology of AoA and AoS suggests an initial subclinical endothelialitis or vasculitis, which is exacerbated by thrombogenesis and atherogenic factors and ultimately resulting in AoA and AoS. Computed tomography (CT) for detection of arterial wall calcifications and arterial tonometry for detection of increased arterial pulse wave velocity are the most common diagnostic methods for detecting AoA and AoS, respectively. MRI may become a more applicable and accurate technique than CT. Although transesophageal echocardiography accurately detects earlier and advanced stages of AoA and AoS, it is semi-invasive and cannot be used as a screening method. Although imaging techniques demonstrate highly variable prevalence rates, on average about one third of adult SLE patients may have AoA or AoS. Age at SLE diagnosis; SLE duration; activity and damage; corticosteroid therapy; metabolic syndrome; chronic kidney disease; and mitral annular calcification are common independent predictors of AoA and AoS. Also, AoA and AoS are highly associated with carotid and coronary atherosclerosis. Earlier stages of AoA and AoS are usually subclinical. However, earlier stages of disease may be causally related or contribute to peripheral or cerebral embolism, pre-hypertension and hypertension, and increased left ventricular afterload resulting in left ventricular hypertrophy and diastolic dysfunction. Later stages of disease predisposes to visceral ischemia, aortic aneurysms and aortic dissection. Even earlier stages of AoA and AoS have been associated with increased cardiovascular and cerebrovascular morbidity and mortality of SLE patients. Aggressive non-steroidal immunosuppressive therapy and non-pharmacologic and pharmacologic interventions for control of atherogenic risk factors may prevent the development or progression of AoA and AoS and may decrease cardiovascular and cerebrovascular morbidity and mortality in SLE.

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Proximal Aortic Stiffness Is Increased in Systemic Lupus Erythematosus Activity in Children and Adolescents

Cited by 14 publications

References 21 publications

Assessment of Aortic Elasticity in Patients with Celiac Disease

Assessment of Aortic Elasticity in Patients with Celiac Disease

The vascular phenotype of children with systemic lupus erythematosus

Aortic Atherosclerosis in Systemic Lupus Erythematosus

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