Possibilities of early detection of severe
cardiovascular manifestations of SLE
Tegzová D.1, Ambrož D.1, Jansa P.1, Paleček T.1, Dušek L.2
Revmatologický ústav Praha, 1II. interní klinika kardiologie a angiologie VFN 1. LF UK v Praze, 2Institut biostatistiky a analýz v Brně |
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Summary:
Objective: the aim of the study was to determine particular cardiovascular manifestations in systemic
lupus erythematosus (SLE), to describe their type and severity, find out a relationship with particular SLE
characteristics and suggest possibilities for early detection of those complications. Methods: Twenty-nine
patients with SLE and 15 healthy controls were investigated. Patients had extensive echocardiographic evaluation
including exercise stress testing evaluation after 6 minutes of walk as well as Holter monitoring.
Basic demographic data, type of immunosuppressive treatment and time-course of its administration, the
dose of glucocorticoids, presence of autoantibodies (anti-dsDNA, anti-Ro, La, Sm, aCL), haemostatic parameters,
lipid spectrum, presence of organ manifestations, pulmonary functions as well as activity of the disease
according the SLEDAI score were evaluated. The association between particular cardiovascular pathologies
and SLE parameters was studied. Results: Presence of cardiovascular manifestations in our group was relatively
small. The difference between standard and exercise stress testing echocardiography was found. After
the 6 minute-walk test, several heart pathologies appeared. No significant changes were found during echocardiographic
examination. Higher levels of Tei index significantly differentiated between control individuals
and patients with SLE. Moderate difference, however not statistically significant, was also observed between
SLE patients with high and low disease activity. PG max on tricuspidal valve according to echocardiography
and systolic excursion (TAPSE) were not different from those in healthy controls. Those values did
not differ also between patients with different disease activity of SLE. Biochemistry and haemostatic parameters
revealed statistically significant differences between healthy controls and SLE patients for D-dimers that are significantly increased in SLE patients and correlate with the disease activity. The value of DLCO,
on the contrary, decreases with the disease activity of SLE patients. The significance of evaluating the ratio
of FVC/DLCO index for the diagnosis of pulmonary hypertension was not confirmed. Significantly lower values
of DLCO were associated with increased PG max in the exercise stress testing. DLCO was of greater importance
than the FVC/DLCO index. Exercise stress testing echocardiography was beneficial for the diagnosis of
early forms of pulmonary hypertension particularly in the evaluation of PG max on tricuspidal valve that increased
after the exercise up-to the borderline levels of detectable pulmonary hypertension. Increase of Tei
after the exercise stress testing did not correlate with the increase of PG max in patients with the risk of pulmonary
hypertension. Pericardial effusion was diagnosed in 17.3 % of patients. Conclusion: Exercise stress
testing echocardiography demonstrated benefit for the detection of potential onset of pulmonary hypertension.
Patients with SLE and higher risk of cardiovascular manifestation should be regularly monitored by
echocardiography. More specific examination for cardiovascular pathologies is exercise stress testing echocardiography.
Another reasonable and beneficial examination is DLCO.
Key words:
SLE, cardiovascular manifestation, echocardiography, exercise stress testing echocardiography,
pulmonary hypertension, SLE activity
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