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Alghareeb R, Hussain A, Maheshwari MV, Khalid N, Patel PD. Cardiovascular Complications in Systemic Lupus Erythematosus. Cureus 2022; 14:e26671. [PMID: 35949751 PMCID: PMC9358056 DOI: 10.7759/cureus.26671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 12/14/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an auto-immune disease of a relapsing-remitting nature that can cause multiorgan damage depending on several factors, mainly the disease activity. Young age women are the most likely to be affected by the disease and the female-to-male prevalence ratio is approximately 1:10. As the number of SLE patients has been increasing in the last few decades, the annual number of deaths due to the disease and its complications has increased as well, and one of the most important systems to which high mortality is attributed is the cardiovascular system, leading to premature atherosclerosis and other events such as endocarditis and valve disease. In addition to the classical cardiovascular risk factors, studies have found a positive correlation between SLE and other cardio-harmful diseases such as metabolic syndrome and dyslipidemia. Moreover, some of the medications used in the treatment of SLE place a heavy burden on the heart. The article reviews the shared pathophysiology of SLE and cardiovascular disease along with the most common SLE- associated cardiac risks, events, and management.
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Sairam S, Sureen A, Gutierrez J, Dang TQ, Mishra K. Cardiovascular Outcomes in Systemic Lupus Erythematosus. Curr Cardiol Rep 2022; 24:75-83. [PMID: 35028818 DOI: 10.1007/s11886-021-01626-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF THE REVIEW To review cardiovascular outcomes (CVE) in systemic lupus erythematosus (SLE) that evolves over time. RECENT FINDINGS Inception cohorts now report long-term data, and large population registries add to our knowledge. Mortality and cardiovascular morbidity remain high with a risk ratio of 2-3. SLE disease activity-related inflammation accounts for higher CVE incidence ratio in the first year following diagnosis with accelerated atherosclerosis contributing to CVE in about a quarter to a third of the patients later in the disease course. Immunomodulation and disease control are associated with improved cardiovascular outcomes. Validation of modified risk stratification tools and studies evaluating primary prevention with aspirin and hydroxychloroquine are reported. Increased awareness of high mortality associated with cardiac inflammation, improved outcomes with early disease control, aggressive management of risk factors, hypertension, obesity, and high cholesterol with modifying risk stratification will result in more favorable outcomes in SLE patients.
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Affiliation(s)
- Shrilekha Sairam
- Division of Rheumatology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech Health Sciences Center El Paso, El Paso, TX, USA.
| | - Amit Sureen
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
| | - Jesus Gutierrez
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
| | - The Q Dang
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
| | - Kunal Mishra
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
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Farag SI, Bastawisy RB, Hamouda MA, Hassib WA, Wahdan HA. Value of Speckle Tracking Echocardiography for Early Detection of Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus. J Cardiovasc Echogr 2021; 30:140-145. [PMID: 33447504 PMCID: PMC7799066 DOI: 10.4103/jcecho.jcecho_12_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/13/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Cardiac dysfunction due to systemic lupus erythematosus (SLE) may be subclinical, but those patients are at high risk for developing clinical heart failure. Aim: The aim of this study is to assess the role of speckle tracking echocardiography (STE) in the early detection of systolic dysfunction in SLE patients. Patients and Methods: This was a case–control study. Participants were subdivided into two groups: Group 1 included 50 SLE patients and Group 2 included 50 healthy controls. Clinical evaluation, echocardiography, tissue Doppler, and STE were performed. Results: Global longitudinal strain (GLS) was significantly reduced in SLE group (−18.95 ± 2.02 vs. −21.4 ± 2.1, P < 0.001). However, there was no significant difference in left ventricular ejection fraction between both groups (P = 0.801). There was a significant positive correlation between the disease duration and age (r = 0.480, P < 0.001), pulmonary artery systolic pressure (PASP) (r = 0.628, P < 0.001), and GLS (%) (r = 0.417, P = 0.012). There was also a significant positive correlation between the disease activity index and GLS (%) (r = 0.7, P < 0.001) and PASP (r = 0.522, P < 0.001). Conclusion: SLE group had GLS % lower than the control group, and this was statistically significant, denoting early systolic dysfunction. Longer duration and high SLE activity index significantly affect GLS. GLS is an excellent noninvasive tool for early detection of subclinical left ventricular systolic dysfunction in SLE patients.
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Affiliation(s)
| | - Reda Biomy Bastawisy
- Department of Cardiology, Faculty of Medicine, Kafer Elsheikh University, Kafer Elsheikh, Egypt
| | | | - Wael Anwer Hassib
- Department of Cardiology, Faculty of Medicine, Kafer Elsheikh University, Kafer Elsheikh, Egypt
| | - Hala Ahmed Wahdan
- Department of Cardiology, Faculty of Medicine, Kafer Elsheikh University, Kafer Elsheikh, Egypt
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Sayhi S, Gueddich N, Dhahri R, Bousetta N, Arfaoui B, Abdelhafidh NB, Ajili F, Louzir B. Non-coronary cardiac manifestations of systemic lupus erythematosus in adults: a comparative study. Pan Afr Med J 2019; 33:156. [PMID: 31565118 PMCID: PMC6756817 DOI: 10.11604/pamj.2019.33.156.18697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/23/2019] [Indexed: 11/11/2022] Open
Abstract
Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.
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Affiliation(s)
- Sameh Sayhi
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Nour Gueddich
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Rym Dhahri
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Najeh Bousetta
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Bilel Arfaoui
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Nadia Ben Abdelhafidh
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Faida Ajili
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Bassem Louzir
- Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia
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Nikdoust F, Bolouri E, Tabatabaei SA, Goudarzvand M, Faezi ST. Early diagnosis of cardiac involvement in systemic lupus erythematosus via global longitudinal strain (GLS) by speckle tracking echocardiography. J Cardiovasc Thorac Res 2018; 10:231-235. [PMID: 30680083 PMCID: PMC6335988 DOI: 10.15171/jcvtr.2018.40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) myocarditis occurs in between 5% and 10%
of patients with lupus. Global longitudinal strain (GLS) via speckle tracking echocardiography
can detect cardiac involvement in patients suffering from SLE. We decided to determine the
echocardiographic features and subsequent early diagnosis of cardiac involvement in patients
with SLE utilizing the GLS index via speckle tracking echocardiography.
Methods: In this cross-sectional study, we compared female patients with SLE of at least 2 years’
duration and healthy controls in terms of the left ventricular (LV) GLS via speckle tracking
echocardiography. After data collection in both groups, the GLS index and the ejection fraction
were evaluated.
Results: We analyzed and compared the LV echocardiographic parameters of 33 patients with
SLE (mean age=25.45±0.63 years) with those of 35 healthy controls (mean age=27±0.45 years).
The apical 2-chamber view indicated a significant decrease in the LV GLS in the case group by
comparison with the healthy controls (P=0.005). The LV GLS in the apical 3-chamber view was
significantly lower in the case group than in the control group (P=0.006). The LV GLS in the
apical 4-chamber view revealed no significant difference between the case and healthy control
groups (P=0.2). While there was a significant difference between the case and control groups visà-
vis the LV GLS (P=0.02), the LV ejection fraction measured with the Simpson method showed
no significant difference between the 2 groups (P=0.96).
Conclusion: GLS speckle tracking echocardiography is a noninvasive method with diagnostic and
prognostic values; it may, therefore, be a sensitive marker for the diagnosis of myocarditis and
other cardiac involvements in patients with SLE.
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Affiliation(s)
- Farahnaz Nikdoust
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Bolouri
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Goudarzvand
- Department of Physiology and Pharmacology, School of medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyedeh Tahereh Faezi
- Department of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Noubiap JJ, Agbor VN, Ndoadoumgue AL, Nkeck JR, Kamguia A, Nyaga UF, Ntsekhe M. Epidemiology of pericardial diseases in Africa: a systematic scoping review. Heart 2018; 105:180-188. [PMID: 30415206 DOI: 10.1136/heartjnl-2018-313922] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/21/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This scoping review sought to summarise available data on the prevalence, aetiology, diagnosis, treatment and outcome of pericardial disease in Africa. METHODS We searched PubMed, Scopus and African Journals Online from 1 January 1967 to 30 July 2017 to identify all studies published on the prevalence, aetiologies, diagnosis, treatment and outcomes of pericardial diseases in adults residing in Africa. RESULTS 36 studies were included. The prevalence of pericardial diseases varies widely according to the population of interest: about 1.1% among people with cardiac complaints, between 3.3% and 6.8% among two large cohorts of patients with heart failure and up to 46.5% in an HIV-infected population with cardiac symptoms. Tuberculosis is the most frequent cause of pericardial diseases in both HIV-uninfected and HIV-infected populations. Patients with tuberculous pericarditis present mostly with effusive pericarditis (79.5%), effusive constrictive pericarditis (15.1%) and myopericarditis (13%); a large proportion of them (up to 20%) present in cardiac tamponade. The aetiological diagnosis of pericardial diseases is challenging in African resource-limited settings, especially for tuberculous pericarditis for which the diagnosis is not definite in many cases. The outcome of these diseases remains poor, with mortality rates between 18% and 25% despite seemingly appropriate treatment approaches. Mortality is highest among patients with tuberculous pericarditis especially those coinfected with HIV. CONCLUSION Pericardial diseases are a significant cause of morbidity and mortality in Africa, especially in HIV-infected individuals. Tuberculosis is the most frequent cause of pericardial diseases, and it is associated with poor outcomes.
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Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Valirie Ndip Agbor
- Ibal Sub-divisional Hospital, Oku, Cameroon.,Department of Clinical Research, Health Education and Research Organization (HERO), Cameroon
| | | | - Jan René Nkeck
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Arnaud Kamguia
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Ngaïdé AA, Ly F, Ly K, Diao M, Kane A, Mbaye A, Lèye M, Aw F, Sarr SA, Dioum M, Ndao CT, Gaye ND, Ndiaye MB, Bodian M, Bah MB, Ndiaye M, Cissé AF, Kouamé I, Tabane A, Mingou JS, Thiombiano P, Kane A, Bâ SA. [Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]. ACTA ACUST UNITED AC 2016; 109:345-352. [PMID: 27822774 DOI: 10.1007/s13149-016-0529-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/04/2016] [Indexed: 10/20/2022]
Abstract
Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.
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Affiliation(s)
- A A Ngaïdé
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal.
| | - F Ly
- Service de dermatologie de l'Institut d'hygiène sociale de Dakar, Dakar, Sénégal
| | - K Ly
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - M Diao
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - Ad Kane
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - A Mbaye
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - M Lèye
- Clinique cardiologique du Centre hospitalier national de Fann de Dakar, Dakar, Sénégal
| | - F Aw
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - S A Sarr
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - M Dioum
- Clinique cardiologique du Centre hospitalier national de Fann de Dakar, Dakar, Sénégal
| | - C T Ndao
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - N D Gaye
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - M B Ndiaye
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - M Bodian
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - M B Bah
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - M Ndiaye
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - A F Cissé
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - I Kouamé
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - A Tabane
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - J S Mingou
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - P Thiombiano
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
| | - A Kane
- Clinique cardiologique de l'Hôpital général de Grand Yoff de Dakar, Dakar, Sénégal
| | - S A Bâ
- Clinique cardiologique de l'Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal
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