Noninvasive cardiac assessment in children of women with systemic lupus erythematosus

Abstract

Neonatal lupus is an autoimmune disease due to passive acquisition of maternal antibodies during pregnancy 1,2 . These antibodies remain in the fetal and newborn circulation causing skin, hematological, and cardiologic abnormalities, and other conditions that imitate adult systemic lupus erythematosus 1,3,4 . These abnormalities are transient if in tissues capable of continuous regeneration, such as the skin and the hematopoietic system, and irreversible in the cases of impairment of the cardiac conduction system 1 . In healthy pregnant women, the frequency of anti-Ro/ SSA antibodies through immunodiffusion or contraimmunoelectrophoresis varies around 0.4 and 1%, respectively, and of anti-La/SSB antibodies around 0.7% 5 . In patients with systemic lupus erythematosus, the frequency of antiRo/SSA antibodies is approximately 40% and that of antiLa/SSB antibodies is 15 to 20% 5 . In patients with Sjögren's syndrome, the frequency of anti-Ro/SSA antibodies is 40 to 45% and that of anti-La/SSB antibodies is 15 to 20% 5 . The general prevalence of neonatal lupus in newborns of mothers with systemic lupus erythematosus ranges from 1 to 3% 5 , and the general estimate of a child with congenital total atrioventricular block is 1:60, which increases to 1:20 9 if the mother has circulating anti-Ro/SSA antibodies 5-8 . In 1993, Goble et al 8 reported that newborns from mothers with systemic lupus erythematosus who developed the disease before or during pregnancy had an increase in heart rate (corrected for age) and in the PR interval in the electrocardiogram corrected for heart rate. Other disorders of cardiac electrical conduction in children of women with anti-Ro/SSA antibodies have been reported, and the classification of these disorders as manifestations of neonatal lupus is still controversial 9,10 . This study aimed at comparing, from the cardiovascular point of view, children of women with systemic lupus erythematosus and children of healthy women through physical examination, electrocardiography, 2-dimensional Doppler echocardiography, color flow Doppler, and signalaveraged electrocardiography. Objective -