Background/Purpose: To determine the prevalence of unsuspected echocardiographic abnormalities (excluding pericardial effusion) and to identify associated clinical and laboratory features in a large SLE cohort.

Methods: The sample comprised 243 patients with SLE treated between 1980 and 2013 at a tertiary university hospital that does not attend pediatric populations. Patients were registered in a specific database (ACHILLES project). Ninety-one patients who were free of cardiovascular symptoms and had been examined at least once with a transthoracic Doppler echocardiogram (TTE) were selected for analysis. In patients with more than one TTE, only data from the last examination were included in the analysis. Each study investigated the presence of myocardial systolic dysfunction, diastolic myocardial dysfunction, valve disease, segmental wall motion abnormalities suggestive of ischemic heart disease and pulmonary arterial hypertension (PAH) defined as a systolic pulmonary artery pressure (PAP) of 40 mmHg and tricuspid regurgitation velocity (TRV) greater than 2.5 m/s.

Results: The mean age of patients (75 women) was 50 ± 12 years (range, 27-77) and median duration of disease at the time of the echocardiographic study was 83 months (range, 12 – 156). The main findings were:

– Systolic dysfunction in 1.1% (1/91) of patients.

– Diastolic dysfunction in 5.5% (5/91) of patients; all had arterial hypertension and two had positive antiphospholipid antibodies (aPL).

– Segmental wall motion abnormalities suggestive of ischemic heart disease: 3.3% (3/91) of patients.

– Subclinical valve disease: 46.2% (42/91) of patients, including 27 cases of tricuspid insufficiency (30%), 26 mitral regurgitation (29%), 5 aortic insufficiency (5.5%), 4 aortic stenosis (4.4%) and 1 verrucous Libman-Sacks endocarditis in mitral valve (1.1%). Some patients presented several different types of injury. Valve dysfunction was mild in all cases.

– Pulmonary arterial hypertension: 7.7% (7/91) of patients. Mean PAP was 46.8 ± 4 mmHg (range, 40-56) and mean TRV was 3 ± 0.3 m/s (range, 2.7-3.4). Pulmonale was observed in two patients; neither had dilated inferior vena cava or pericardial effusion. Six out of seven patients (86%) of patients with PAH also had some kind of valve disease.

Of the patients with subclinical valvular disease, 40.5% (17/42) were positive for one or more of the aPL (cardiolipin antibodies Ig or IgM, anti-beta2-glycoprotein IgG or IgM, lupus anticoagulant).  Five out of seven patients with PAH (71.4%) were positive for aPL. In the comparative study of 49 SLE controls without valve disease or PAH, there were no statistically significant differences in aPL positivity (45% positivity in controls; p> 0.05). No significant differences were observed in the frequency of Raynaud’s phenomenon between patients with PAH and controls.

Conclusion: Echocardiographic abnormalities were frequently detected in asymptomatic patients with SLE. Valve disease (46%) was the most common finding. TTE screening may be indicated in patients with SLE.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-subclinical-echocardiographic-abnormalities-in-patients-with-systemic-lupus-erythematosus-sle/