BackgroundNeuropsychiatric systemic lupus erythematosus (NPSLE) is associated with increased morbidity and mortality.MethodsWe used Diffusion Tensor Imaging (DTI) to assess white matter abnormalities in seventeen NPSLE patients, sixteen SLE patients without NPSLE, and twenty age- and gender-matched controls.ResultsNPSLE patients differed significantly from SLE and control patients in white matter integrity of the body of the corpus callosum, the left arm of the forceps major and the left anterior corona radiata.ConclusionsSeveral possible mechanisms of white matter injury are explored, including vascular injury, medication effects, and platelet or fibrin macro- or microembolism from Libman-Sacks endocarditis.
Objective Several studies have examined abnormalities in cerebral blood flow (CBF) in patients with systemic lupus erythematosus (SLE). However, the majority of these studies have reported CBF relative to a region assumed to be normal in the brain. The purpose of the present study was to examine absolute differences in both regional CBF and cerebral blood volume (CBV) between SLE patients and healthy control subjects. Methods CBF and CBV were measured with dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI), a technique that provides an alternative to radionuclide perfusion studies and permits quantitative anatomic, CBF, and CBV imaging in a single scanning session. CBF and CBV were measured in both lesions and normal appearing tissue in the major cerebral and subcortical brain regions. Unlike most past perfusion studies on SLE, CBF and CBV values were not normalized to a region of brain assumed to be healthy. Results As expected, CBF and CBV within MRI-visible lesions were markedly reduced relative to surrounding normal appearing white matter. However, both CBF and CBV in normal appearing tissue were higher in SLE patient groups, with or without lesions, relative to the control group. Conclusion DSC MRI, without normalization to a region presumed to be healthy, revealed that CBF and CBV in normal appearing tissue in SLE patients is higher than CBF and CBV in control subjects. Since this finding was made in subgroups of patients with and with out lesions, the higher CBF and CBV appears to precede lesion pathology.
SUMMARY To assess aortic stiffness by transesophageal echocardiography (TEE) and to determine its clinical predictors and relation to age, blood pressure, renal function, and atherosclerosis, 50 patients with systemic lupus erythematosus (SLE), 94% women, with a mean age of 38 ± 12 years and 22 age and gender matched healthy controls underwent clinical and laboratory evaluations and multiplane TEE to assess stiffness, intima-media thickness (IMT), and plaques of the proximal, mid, and distal descending thoracic aorta. At each level and overall aortic stiffness by the pressure-strain elastic modulus was higher in patients than in controls after adjusting for age (overall, 8.25 ± 4.13 versus 6.1 ± 2.5 Pascal units, p = 0.01). Patients had higher aortic stiffness than controls after adjusting both groups to the same mean age, blood pressure, creatinine, and aortic IMT (p = 0.005). Neither IMT nor plaques were predictors of aortic stiffness. Moreover, normotensive patients, those without aortic plaques, and non-smokers had higher stiffness than controls (all p <0.05). Age of SLE diagnosis, non-neurologic damage score, and mean arterial pressure during TEE were the only independent predictors of aortic stiffness (all p ≤0.02). Thus, aortic stiffness may be a primary form of premature functional vasculopathy in SLE.
Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease that is atherogenic. Decreased arterial distensibility (AD) is a risk factor for cardiovascular disease, and this precursor may be associated with SLE. Accordingly, we tested the hypothesis that patients with SLE will have significantly (p < 0.05) decreased AD when compared to normal, healthy age, and gender matched controls. Noninvasive, high resolution ultrasound was performed on 30 patients with chronic SLE and 16 age and gender matched controls. All were female. Maximum systolic and minimum diastolic diameters (mm) and intima-media thickness (IMT, mm) in the right common carotid artery were measured from M-mode images. In vitro arterial models were used for quality control. With a single, blinded observer, the 95% confidence levels for accuracy and precision for noninvasive systolic and diastolic tonometric arm blood pressures (SBP, DBP) and carotid sonographic diameters were ~5 mmHg and ~0.10 mm, respectively. Derived measurements for strain (%), stiffness (units), and AD (units) were determined by published arterial mechanical models and algorithms. Results (mean/standard deviation) were as follows: (patients/controls; # =p<0.05) Age 39/11, 35/11 years; SBP 130/20, 117/8# mmHg; DBP 82/11, 74/9# mmHg; strain 11/4, 11/4 %); stiffness 19/10, 17/11 units; IMT 0.44/0.08, 0.41/0.06 mm; AD 3.10/1.49, 3.30/1.63 units. There were no statistically significant differences (p<0.05) in measurements of AD and IMT in the common carotid artery between relatively young SLE patients and well matched controls.
Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease that is atherogenic. Arterial distensibility (AD) is a risk factor and an independent predictor of cardiovascular morbidity and mortality. Importantly, AD can be easily determined noninvasively with hand held, portable, low power, and relatively inexpensive equipment. Operator training is required, but minimal. Nevertheless, an association between SLE and AD has not been reported. Accordingly, we tested the hypothesis that patients with SLE would have a significantly (p<0.05) decreased AD when compared to healthy controls. We used noninvasive, high spatial resolution, 10 MHz, image‐guided, M‐mode sonography to measure maximal systolic and minimal diastolic diameters and diastolic intima‐media thickness (IMT) at 3 sites in the right common carotid artery of 17 SLE patients and 51 healthy age and gender matched controls. In the one blinded observer, the 95% confidence levels for accuracy and precision for noninvasive tonometric blood pressures and sonographic diameters were ~5mmHg and ~0.15mm, respectively. The calculated values for AD were determined by standard arterial mechanical models and algorithms. Results are given as X/SD with *= p<0.05 versus controls:These preliminary data suggest that AD is significantly (p<0.05) decreased in young patients with SLE. Thus, arterial distensibility may be an efficient and inexpensive marker of clinically important atherosclerosis in young patients with systemic lupus eyrthematosus.(Funded, in part, by NIHRO1HL077422)
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