Background/Purpose: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by systemic inflammation and accelerated atherosclerosis, leading to increased cardiovascular (CV) risk. While CV disease typically affects older individuals, SLE patients may develop subclinical CV damage at a younger age due to chronic inflammation. Emerging echocardiographic techniques, including left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and pulmonary artery systolic pressure (PASP), enable early detection of CV dysfunction before clinical manifestations arise. This study aimed to evaluate subclinical CV alterations in young SLE patients compared to older healthy controls.

Methods: A cross-sectional study was conducted, enrolling patients aged ≤39 years who met the 2019 ACR/EULAR classification criteria for SLE, and a control group of healthy adults aged ≥40 years without rheumatic disease, recruited from a preventive cardio-rheumatology clinic. Individuals with a history of CV disease were excluded. Demographic data, CV risk factors (hypertension, diabetes, dyslipidemia, and body mass index), and echocardiographic parameters were collected. All echocardiograms were performed by a single board-certified echocardiographer using standardized protocols, including B-mode, M-mode, spectral Doppler, color Doppler, and tissue Doppler imaging. Cardiac geometry, systolic and diastolic function were assessed and classified according to the 2016 ASE/EACVI guidelines. Data normality was evaluated using the Kolmogorov–Smirnov test. Between-group comparisons were conducted using Student’s t-test, Chi-square test, or Mann–Whitney U test, as appropriate. A p-value of ≤0.05 was considered statistically significant.

Results: A total of 140 participants were included: 64 young SLE patients and 76 older healthy controls. Median age was 25.00 years in the SLE group and 55.00 years in controls (p < 0.001), with a higher proportion of women among SLE patients (90.62% vs. 64.47%; p < 0.001). SLE patients also had a lower body mass index (p < 0.001), and a lower prevalence of diabetes mellitus (p < 0.001), dyslipidemia (p < 0.001), and smoking (p = 0.034). HbA1c was also lower in SLE (p = 0.012), while erythrocyte sedimentation rate was higher (p = 0.050). Echocardiography revealed reduced LVEF (59.04 vs. 62.53, p = 0.006) and impaired GLS (–18.99 vs. –20.84, p = 0.010) in SLE patients, while LVMI (p < 0.001) and RWT (p = 0.023) were higher in controls. Diastolic function assessment showed a higher E′ wave in SLE patients (p = 0.002), with lower E/e′ ratio (p < 0.001) and deceleration time (p < 0.001). TAPSE (p = 0.004) and PASP (24.03 vs. 19.60 mmHg, p = 0.028) were also higher in SLE.

Conclusion: Our findings indicate that young SLE patients may exhibit early echocardiographic alterations compared to older healthy individuals, including reduced myocardial strain, elevated pulmonary pressures, and impaired diastolic function. Notably, these differences were present despite a lower burden of traditional metabolic risk factors. These findings underscore subclinical CV impairment in young SLE patients and reinforce the need for routine CV monitoring in this population.

Table 1. Demographic and Cardiovascular Risk Characteristics

Table 2. Echocardiographic Parameters

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evidence-of-early-cardiovascular-dysfunction-in-young-systemic-lupus-erythematosus-patients-compared-to-older-healthy-controls/