The heart and systemic lupus erythematosus - abstract

ABSTRACT

A prospective clinical, serological and echocardiographic study of consecutive patients with systemic lupus erythematosus (SLE) and cardiopulmonary symptoms (Group 1) and 10 asymptomatic SLE patients (Group 11) was carried out. Both groups were then subsequently compared to 45, age and sex matched controls taken from the general population. The most common cardiac manifestation of SLE was pericardial effusion (5 patients; 24 percent). Other echocardiographic findings were enlarged left ventricle (3 patients; 14 percent), large right ventricle (2 patients; 10 percent) myocarditis (2 patients; 10 percent), Libman Sacks endocarditis (1 patient; 5 percent). Doppler studies showed a 19 percent incidence of mitral regurgitation (4 patients), 14 percent tricuspic regurgitation (3 patients), 10 percent pulmonary hypertension (2 patients). Echocardiographic measurements in Groups 1 and 11 showed no statistically significant difference in left ventricular diastolic (LVDD) and systolic (LSVD) dimensions, and in end diastolic (EDV) and end sytolic volumes (ESV). There was increased heart rate and decreased stroke volume and cardiac index in Group 1. Indeed, there was no echocardiographic abnormality in Group 11. When both groups were compared to Group 111, there was stastically significantly lower ejection fraction and fractional shortening, greater septal and posterior wall thickness and smaller right ventricular diastolic dimension (RVDD) in the combined SLE group. The left ventricular mass in the SLE group was not increased but there were decreased stroke output and systolic function compared to the normal controls. Only one patient was positive for antiphospholipid antibody and she was in group 1. All SLE patients were antinuclear antigen positive (ANA) and antidouble stranded DNA antibodies were the most frequently found ANA in both groups 1 and 11. There was no statiscally significant difference in the prevalence of any ANA specificity between groups or between those patients with valvular abnormality and those without. Echocardiography was a more sensitive indicator of pericarditis/pericardial effusion than chest roentgenogram or electrocardiogram (AU)