Relationship Between Systemic Lupus Erythematosus Disease Activity Index Scores and Subclinical Cardiac Problems

Abstract

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune connective-tissue disease involving multiple organs and systems. Some evidence has demonstrated that disease activity could be associated with increased risk of organ damage.ObjectivesThe aim of this study was to determine the association between systemic lupus erythematosus Disease Activity Index (SLEDAI) scores and subclinical cardiac involvement.MethodsThis cross-sectional study was conducted on 45 SLE patients (88% female; mean age: 31.2 ± 8.2 years) from 2011 to 2013 in Mashhad, Iran. The patients had no clinical signs and symptoms of cardiac problems or risk factors for cardiovascular disease and were selected consecutively. All patients underwent complete echocardiographic examinations (using two dimensional (2D) tissue Doppler and 2D speckle tracking). Disease activity was evaluated by using the SLEDAI.ResultsPatients with higher SLEDAI scores had higher pulmonary artery pressure rates (r = 0.34; P = 0.024; 95% CI (0.086 to 0.595)) and SLE durations (r = 0.43; P = 0.004; 95% CI (0.165 to 0.664). The correlation between disease duration and left ventricular mass was also significant (r = 0.43; P = 0.009; 95% CI (0.172 to 0.681)), even after adjusting for age (r = 0.405; P = 0.016). There was no correlation between SLEDAI scores or disease duration and the left/right ventricle systolic function parameters. This was true while assessing the right ventricle’s diastolic function. A statistically significant correlation was found between mitral E/E’ as an index of left ventricle diastolic impairment and the SLEDAI scores (r = 0.33; P = 0.037; 95% CI (0.074 to 0.574)) along with disease duration (r = 0.45; P = 0.004; 95% CI (0.130 to 0.662); adjusted for age: r = 0.478; P = 0.002).ConclusionsEchocardiography is a useful noninvasive technique for screening subclinical heart problems in SLE patients. Although disease activity in general should suggest a closer follow-up, regular scanning would enable earlier detection of cardiovascular involvement and should not be confined to cases with higher SLEDAI indices or longer disease durations.

Echocardiographic and Electrocardiographic Findings in Patients with Ankylosing Spondylitis without Cardiovascular Risk Factors

“…Echocardiographic examinations have been increasingly implemented in patients with different rheumatologic diseases with the aim of evaluating cardiac functions and structures. 37 - 39 The systolic and diastolic functions of the heart have been found to be impaired in patients with AS in addition to classic aortopathies and arrhythmias. Kiris et al 13 found that their patients with AS had LV systolic asynchrony, which might lead to cardiovascular events.…”

Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review

“…Using this guideline in patients with RA, SPA, and SLE is complicated by the poor functional capacity of many patients prior to THA and TKA, when poor functional capacity is defined as the inability to achieve at least 4 Metabolic Equivalents (METS), achieved by light shoveling, dancing, or gardening, defining "light" as when the activity results in "only minimal perspiration and only a slight increase in breathing above normal" [69]. Moreover, patients with RA with cardiovascular disease may not have symptoms [48,70,71]. Using the classic Framingham risk equation (based on age, sex, total cholesterol level, high density lipoprotein cholesterol level, smoking history, and systolic blood pressure), patients with RA, SPA, and SLE may fall into a low risk category, leading some to add the presence of a systemic inflammatory disease such as RA, SPA, and SLE to the list of traditional cardiovascular risk factors, or to add a multiplication factor of 1.4 to the calculation of cardiac risk, recognizing that the current risk assessment tools are unreliable and underestimate cardiac risk in patients with RA, SPA, and SLE [51,[72][73][74][75][76].…”

Value of speckle tracking echocardiography for early detection of left ventricular dysfunction in patients with systemic lupus erythematosus

“…Mirfeizi et al . [ 21 ] found that patients with higher disease severity index and longer disease duration had higher pulmonary artery pressure rates ( r = 0.34, P = 0.024) and ( r = 0.43, P = 0.004), but there was no correlation found between disease severity index or disease duration and left ventricular systolic function parameters. This may be attributed to the differences in clinical demographics, disease duration, and severity index from our study.…”