Possibilities of early detection of severe cardiovascular manifestations of SLE

Overview

Objective:
the aim of the study was to determine particular cardiovascular manifestations in systemic lupus erythematosus (SLE), to describe their type and severity, find out a relationship with particular SLE characteristics and suggest possibilities for early detection of those complications.

Methods:
Twenty-nine patients with SLE and 15 healthy controls were investigated. Patients had extensive echocardiographic evaluation including exercise stress testing evaluation after 6 minutes of walk as well as Holter monitoring. Basic demographic data, type of immunosuppressive treatment and time-course of its administration, the dose of glucocorticoids, presence of autoantibodies (anti-dsDNA, anti-Ro, La, Sm, aCL), haemostatic parameters, lipid spectrum, presence of organ manifestations, pulmonary functions as well as activity of the disease according the SLEDAI score were evaluated. The association between particular cardiovascular pathologies and SLE parameters was studied.

Results:
Presence of cardiovascular manifestations in our group was relatively small. The difference between standard and exercise stress testing echocardiography was found. After the 6 minute-walk test, several heart pathologies appeared. No significant changes were found during echocardiographic examination. Higher levels of Tei index significantly differentiated between control individuals and patients with SLE. Moderate difference, however not statistically significant, was also observed between SLE patients with high and low disease activity. PG max on tricuspidal valve according to echocardiography and systolic excursion (TAPSE) were not different from those in healthy controls. Those values did not differ also between patients with different disease activity of SLE. Biochemistry and haemostatic parameters revealed statistically significant differences between healthy controls and SLE patients for D-dimers that are significantly increased in SLE patients and correlate with the disease activity. The value of DLCO, on the contrary, decreases with the disease activity of SLE patients. The significance of evaluating the ratio of FVC/DLCO index for the diagnosis of pulmonary hypertension was not confirmed. Significantly lower values of DLCO were associated with increased PG max in the exercise stress testing. DLCO was of greater importance than the FVC/DLCO index. Exercise stress testing echocardiography was beneficial for the diagnosis of early forms of pulmonary hypertension particularly in the evaluation of PG max on tricuspidal valve that increased after the exercise up-to the borderline levels of detectable pulmonary hypertension. Increase of Tei after the exercise stress testing did not correlate with the increase of PG max in patients with the risk of pulmonary hypertension. Pericardial effusion was diagnosed in 17.3 % of patients.

Conclusion:
Exercise stress testing echocardiography demonstrated benefit for the detection of potential onset of pulmonary hypertension. Patients with SLE and higher risk of cardiovascular manifestation should be regularly monitored by echocardiography. More specific examination for cardiovascular pathologies is exercise stress testing echocardiography. Another reasonable and beneficial examination is DLCO.

Key words:
SLE, cardiovascular manifestation, echocardiography, exercise stress testing echocardiography, pulmonary hypertension, SLE activity