Background/Purpose: early identification of subclinical cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) patients is mandatory to reduce morbidity and mortality. Endothelial dysfunction (ED) is one of the first steps of the process leading to atherosclerosis and has been associated with further CVD development. Aim of the study was to assess the prevalence of ED by a non invasive procedure in SLE patients with early disease without CVD and risk factors, and correlate ED with nailfold capillary morphology and angiogenic T (angT) cells. AngT cells are a T cell subpopulation, involved in repair mechanisms of the endothelium, cooperating with endothelial progenitors cells.

Methods: all the consecutive SLE patients, according to SLICC Classification Criteria, with a disease duration less than 5 years, evalued from december 2014 to march 2016 were proposed to participate to the study. Exclusion criteria were represented by history of CVD, diabetes, chronic renal disease (creatinine clearance<60 ml/min), not controlled systemic arterial hypertension, current or past smoking (in the last 3 years), hypercholesterolemia (total cholesterol>240 mg/dl), obesity (body mass index > or =30), statin or beta-blocker use. Each patient underwent a clinical and serological evaluation, a transthoracic doppler echocardiogram, endothelial function study by endoPAT technique, nailfold videocapillaroscopy (NVC) and T cell subpopulation study. Characteristics of patients with ED (ED+), defined as reactive hyperemic index < or= 2, were compared to those of patients without ED (ED-) and normal controls, matched for age, sex and CV exclusion criteria, by Fisher, T student or Mann-Whitney tests as appropriate.

Results: Among 46 screened SLE patients, 20 patients were enrolled (100% female, 80% caucasian) with a median disease duration of 14 months (0-68), a mean age of 42 years (±15), and a mean age at diagnosis of 40 years (±16). Arthritis, cutaneous and hematological features were found in 70%, 55% and 65% of cases, respectively. ANA, antidsDNA and anti-ENA were found in 100%, 50% and 50% of cases. Anti-cardiolipin and antibeta2glycoprotien I antibodies in 20% and 10%. ED was found in 8 patients (40%). ED didn’t correlate with any demographic-clinical-serological-echocardiographic features. A significantly higher prevalence of ED (p:0.003), vascular stiffness (p:0.02), left ventricular concentric remodelling (p:0.003), grade I diastolic dysfunction (p:0.04) were found in SLE patients compared to controls.

ED+ patients more frequently showed minor NVC abnormalities (i.e. tortuous,/crossed/enlarged) (p: 0,007), lower capillary number/mm (p: 0,01) and wider intercapillary distance (p: 0,06) compared to controls. AngT cells were significantly reduced in SLE patients compared to controls (p: 0,045), but they were increased in ED+ SLE compared to ED- (p: 0,04).

Conclusion: A significant proportion of SLE patients showed signs of ED despite a recent disease and the absence of cardiovascular risk factors. ED correlates with microvascular alterations by videocapillaroscopy and increased ang T cells, as marker of endothelium repair.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/endothelial-dysfunction-in-systemic-lupus-erythematosus-patients-without-cardiovascular-events-and-risk-factors-correlation-with-microvascular-alterations-and-angiogenic-t-cells/