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Gegenava M, Kirtava Z, Kong WKF, Gegenava T. Left ventricular systolic function assessed by standard and advanced echocardiographic techniques in patients with systemic lupus erythematosus: A systemic review and meta-analysis. Arch Rheumatol 2024; 39:149-158. [PMID: 38774698 PMCID: PMC11104758 DOI: 10.46497/archrheumatol.2024.10131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/11/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives Aim of the study was to perform a systemic review and meta-analysis of the current case-control studies based on the assessment of the left ventricular (LV) systolic function with standard and advanced echocardiographic methods. Materials and methods Objectives of the study, methods of statisticalanalysis, literature search strategy, inclusion andexclusion criteria, and outcome measurementswere defined according to Cochrane Collaborationsteps, 13 including recommendations for metaanalysisof observational studies in epidemiology (MOOSE). Results A total of 850 papers were collected. Of those, eight papers (10 groups) including 174,442 SLE patients and 45,608,723 controls with heart failure (HF), 20 papers including 1,121 SLE patients and 1,010 controls with an evaluated LV ejection fraction (LVEF), and eight studies (nine groups) including 462 SLE patients and 356 controls with a measured LV global longitudinal strain (LVGLS) met the predefined inclusion criteria. HF rate in SLE patients was 2.39% (4,176 of 174,442 patients with HF), and SLE patients showed a 3.4 times higher risk for HF compared to controls. SLE patients had a lower LVEF compared to controls. LVGLS was more impaired in SLE patients compared to controls, irrespective of two-dimensional or three-dimensional speckle tracking echocardiography. Conclusion Heart failure rate in SLE patients is high, and SLE patients showed a 3.4 times higher risk in patients with SLE compared to controls. LV systolic function, as measured by LVEF and LVGLS, is significantly affected in SLE patients, and LVGLS potentially represents a new tool for the early assessment of LV function.
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Affiliation(s)
- Maka Gegenava
- Department of Internal Medicine №2, Tbilisi State Medical University, Tbilisi, Georgia
| | - Zviad Kirtava
- Department of Internal Medicine, Caucasus School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia
| | - William KF Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Tea Gegenava
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine №1, Tbilisi State Medical University, Tbilisi, Georgia
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Płazak W, Drabik L. SARS-CoV-2 infection and SLE: endothelial dysfunction, atherosclerosis, and thrombosis. Clin Rheumatol 2023; 42:2691-2702. [PMID: 36622519 PMCID: PMC9827021 DOI: 10.1007/s10067-022-06497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
An increased risk of atherosclerotic and thrombotic complications characterizes connective tissue diseases. Endothelial dysfunction is the basis for the initiation and progression of atherosclerosis and thrombosis. We present systemic lupus erythematosus (SLE) as a model rheumatic disease with endothelial dysfunction and discuss its mechanisms, factors that influence the early onset and rapid progression of atherosclerosis, and the increased risk of thromboembolic events. We focus on established methods to improve endothelium function, including statins, antiplatelet, and antithrombotic therapy. Hypercoagulable and hypofibrinolitic states and a hyperinflammatory response characterize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Several pathogenic mechanisms are typical for an acute phase of Covid-19 post-Covid syndrome and connective tissue diseases: endothelial dysfunction, elevated antiphospholipid antibody titer, activation of the complement system, and formation of extracellular neutrophil traps (NET). The current review discusses the mechanisms underlying SLE and the COVID-19 in the context of endothelial function, atherosclerosis, and thrombosis (Graphical abstract). Key Points • The pathophysiology of systemic lupus erythematosus (SLE) and Covid-19 shows some similarities, such as endothelial cell activation and dysfunction, the activation of complementary systems, the presence of antiphospholipid antibodies, and the formation of extracellular neutrophil traps. • Autoimmunity in both diseases creates the basis for hyperinflammatory, hypercoagulable, and hypofibrinolitic states and their thromboembolic complications. • This paper presents our perspective on the mechanisms behind the cardiovascular manifestations of SLE and COVID-19, with a particular emphasis on endothelial dysfunction. Covid-19 and systemic lupus erythematosus-potential similarities in pathophysiology. Figures of the panel illustrate the clinical manifestations of endothelial dysfunction, atherosclerosis, and thromboembolism, including coronary artery disease ([A] coronary angiography with left anterior descending artery stenosis and [B] scintigraphy with reduced perfusion in the myocardial apical segments), stroke ([C] carotid angiography, left carotid artery occlusion) and pulmonary embolism ([D]computed tomography with thrombus in the right pulmonary artery).
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Affiliation(s)
- Wojciech Płazak
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.
| | - Leszek Drabik
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
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AlTwajery M, AlMane W, Al-Mayouf SM. Electrocardiographic disturbances in children with systemic lupus erythematosus. Int J Pediatr Adolesc Med 2018; 5:127-130. [PMID: 30805547 PMCID: PMC6363268 DOI: 10.1016/j.ijpam.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022]
Abstract
Background Conduction disturbances other than heart block related to neonatal lupus are rarely explored and reported in children with systemic lupus erythematosus (SLE). Objective To report the electrocardiographic (ECG) abnormalities in children with SLE and assess whether anti-Ro/SSA antibodies and hydroxychloroquine are associated with the rhythm disturbances. Methods This cross-sectional retrospective study comprised patients with SLE who had regular follow-up in the Pediatric Lupus Clinic at King Faisal Specialist Hospital and Research Center-Riyadh. All enrolled patients were evaluated with regard to demographics, age at disease onset, disease duration, clinical and laboratory variables including autoantibodies, disease activity using SLEDAI disease activity index, and medications. An expert pediatric cardiologist reviewed the ECG findings of all enrolled patients independently without knowing the clinical status of the patients. Results A total of 41 (35 females, 6 males) unselected patients with SLE with a mean age of 12.8 (2.5) years and mean follow-up duration of 4 (3) years completed the evaluation. The most frequent manifestations were renal disease (65.8%), followed by musculoskeletal (46.3%), hematological (41.5%), and cardiac involvement (19.5%). Thirty-two had active disease (SLEDAI >4), and the mean of SLEDAI was 9.2 (6.2). ECG abnormalities were seen in 12 patients (29.3%); these changes included ST-T changes (9.8%), right bundle branch block (7.3%), 4 prolonged QT interval (9.8%), and low QRS voltage (2.4%). Thirty-seven (90.3%) patients were on hydroxychloroquine, and 9 patients (22%) had positive anti-Ro/SSA antibodies. ECG abnormalities were associated significantly with anti-Ro/SSA antibodies (P < .05) and a low platelet count (P < .5) but had no association with other autoantibodies, hydroxychloroquine, or SLEDAI score. Conclusion Children with SLE with anti-Ro/SSA antibodies are probably prone to heart conduction abnormalities. However, the heart rate and QT interval were affected by hydroxychloroquine. A larger prospective study is required to allow more definitive conclusions.
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Affiliation(s)
- Mohammed AlTwajery
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed AlMane
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Luo R, Cui H, Huang D, Sun L, Song S, Sun M, Li G. Early Assessment of Right Ventricular Function in Systemic Lupus Erythematosus Patients using Strain and Strain Rate Imaging. Arq Bras Cardiol 2018; 111:75-81. [PMID: 29898016 PMCID: PMC6078377 DOI: 10.5935/abc.20180091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background Right ventricular function is a crucial factor of the prognosis of systemic
lupus erythematosus (SLE). Objectives To evaluate the right ventricular function in SLE patients with different
degrees of pulmonary hypertension (PH) by strain and strain rate
imaging. Methods A total of 102 SLE patients and 30 healthy volunteers were studied between
October 2015 and May 2016. Patients were divided into three groups according
to pulmonary artery systolic pressure (PASP) estimated by echocardiography:
group control (A); PASP ≤ 30 mmHg (group B, n = 37); PASP 30-50 mmHg
(mild PH; group C, n = 34); and PASP ≥ 50 mmHg (moderate-to-severe
PH; group D, n = 31). Longitudinal peak systolic strain (ε) and
strain rate (SR), including systolic strain rate (SRs), early diastolic
strain rate (SRe) and late diastolic strain rate (SRa) were measured in the
basal, middle and apical segments of the right ventricular free wall in
participants by two-dimensional speckle tracking echocardiography (2D-STE)
from the apical four-chamber view. A p < 0.05 was set for statistical
significance. Results The parameters of ε, SRs, SRe, and SRa were significantly decreased in
groups C and D compared with groups A and B. The ε of each segments
was significantly lower in group D than in group C, while there were no
differences in SRs, SRe and SRa between groups C and D. Conclusions Strain and strain rate imaging could early detect the right ventricular
dysfunction in SLE patients with PH, and provide important value for
clinical therapy and prognosis of these patients.
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Affiliation(s)
- Runlan Luo
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
| | - Hongyan Cui
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
| | - Dongmei Huang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
| | - Lihua Sun
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
| | - Shengda Song
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
| | - Mengyao Sun
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
| | - Guangsen Li
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning - China
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Ruiz D, Oates JC, Kamen DL. Antiphospholipid Antibodies and Heart Valve Disease in Systemic Lupus Erythematosus. Am J Med Sci 2017; 355:293-298. [PMID: 29549933 DOI: 10.1016/j.amjms.2017.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/05/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
Evaluation of antiphospholipid antibodies (aPL) and correlation with heart valve abnormalities among patients with systemic lupus erythematosus (SLE). Nested case-control study was conducted with 70 patients with SLE selected from a longitudinal database based on levels of aPL and presence or absence of valve disease by echocardiogram. Valvular abnormalities observed were regurgitation (52), other (14), artificial valves (4), stenosis (2), thickening (2) and no Libman-Sacks endocarditis (0). The mitral valve was the most commonly affected (30 abnormalities), followed by the tricuspid (20 abnormalities). Multivariate logistic regression for those with and without an aPL value ≥20 units/mL, adjusted for disease duration and age, showed significant differences for any valve abnormality (odds ratio [OR] = 3.1; 95% CI: 1.0-8.9; P = 0.041) and individually for the tricuspid valve (OR = 3.3; 95% CI: 1.0-11.1; P = 0.052) but not for the mitral valve (OR = 2.1; 95% CI: 0.68-6.45; P = 0.195). Levels of aPL ≥20 units/mL showed no association with aortic (P = 0.253), pulmonic (P = 1.000), tricuspid (P = 0.127), or mitral (P = 0.249) valve abnormalities. Levels of aPL correlate with certain valvular abnormalities among patients with SLE.
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Affiliation(s)
- Daniel Ruiz
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jim C Oates
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, SC.
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Vivero F, Gonzalez-Echavarri C, Ruiz-Estevez B, Maderuelo I, Ruiz-Irastorza G. Prevalence and predictors of valvular heart disease in patients with systemic lupus erythematosus. Autoimmun Rev 2016; 15:1134-1140. [PMID: 27639157 DOI: 10.1016/j.autrev.2016.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We aimed to study the frequency, severity and predictors of valvular heart disease (VHD) in our lupus cohort. MATERIAL AND METHODS 211 patients were included. A transthoracic echocardiogram was used for this study. Significant valvular lesions were classified into two groups: valvular thickening and valvular dysfunction. Univariate logistic regression was performed in order to find associations with valvular thickening and dysfunction. Those variables with a p value ≤0.1 in the univariate analysis were subsequently included in multiple logistic regression models. RESULTS Significant valve lesions were found in 53 patients (25%). The independent predictors of valvular thickening were the age at the time of the echocardiogram (OR 1.05, 95% CI 1.02-1.7), lymphopenia (OR 3.6, 95%CI 1.4-9.5), thrombocytopenia (OR 2.65, 95%CI 1.24-5.72), and anti-Sm antibodies (OR 3.28, 95%CI 1.44-7.33). The independent predictors of valvular dysfunction were age at the time of the echocardiogram (OR 1.045, 95%CI 1.009-1.083), thrombocytopenia (OR 5, 95%CI 1.66-14.86), hypertension (OR 6.2, 95%CI 2.1-18.4) and aPL (OR 6.2, 95%CI 2.1-18.4). Regarding the latter, the independent relation with valvular dysfunction was only seen for the double positivity aCL/LA, (OR 13.2, 95%CI 3.8-45.2, p<0.0001). CONCLUSIONS Our study confirms the high prevalence of significant VHD in SLE patients. Clinical variables related with persistent inflammatory activity were associated with VHD. The association between VHD and aPL positivity was confirmed. Double-positive aCL/LA patients were most likely to suffer from valvular dysfunction.
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Affiliation(s)
- Florencia Vivero
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain; Autoimmune Diseases Unit, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Cristina Gonzalez-Echavarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain
| | - Beatriz Ruiz-Estevez
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain; Department of Internal Medicine, Hospital Puerta del Mar, Cadiz, Andalucia, Spain
| | - Irene Maderuelo
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain; Department of Internal Medicine, Hospital San Agustin, Aviles, Asturias, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain.
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Kim KJ, Baek IW, Yoon CH, Kim WU, Cho CS. Association of Anemic Hypoxia and Increased Pulmonary Artery Systolic Pressure in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016; 67:1702-11. [PMID: 26018410 DOI: 10.1002/acr.22630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare but serious complication of systemic lupus erythematosus (SLE). Chronic hypoxia is known to cause PAH resulting from pulmonary vascular remodeling. We investigated the association between anemic hypoxia and PAH in SLE patients. METHODS Systolic pulmonary artery pressure (PAP) was measured in 132 SLE patients by echocardiography. Increased PAP was defined as resting PAP > 40 mm Hg. Oxygen delivery (DO2) was estimated as the product of cardiac output and arterial oxygen content. RESULTS Of 132 patients, 17 (12.9%) had increased PAP, and these patients had significantly lower DO2 values than patients with normal PAP (P = 0.002). The DO2 values inversely correlated with PAP values (γ = -0.308, P < 0.001) and plasma N-terminal pro-brain natriuretic peptide levels (γ = -0.323, P = 0.001), but positively correlated with hemoglobin levels (γ = 0.402, P < 0.001). Compared to those with normal PAP, patients with increased PAP had significantly longer durations of anemia over the preceding 6-24 months. Patients with anemia of longer durations (≥3 months) in the preceding 6 months had a higher risk of increased PAP compared to those with shorter durations (P < 0.001). When SLE patients were divided into 3 groups according to hemoglobin and PAP, serum interleukin-6 (IL-6) levels increased across groups with higher PAP (P = 0.001 for trend), but decreased across tertiles of hemoglobin levels (P = 0.008 for trend). CONCLUSION Our data indicate an association between chronic anemic hypoxia and increased PAP in SLE patients and suggest that increased IL-6 might participate in this process.
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Affiliation(s)
- Ki-Jo Kim
- St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - In-Woon Baek
- Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chong-Hyeon Yoon
- Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Wan-Uk Kim
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul-Soo Cho
- Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Barutcu A, Aksu F, Ozcelik F, Barutcu CAE, Umit GE, Pamuk ON, Altun A. Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies. Lupus 2015; 24:1019-28. [DOI: 10.1177/0961203315570164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Abstract
The aim of this study was to use transthoracic Doppler echocardiographic (TTE) imaging methods to identify cardiac dysfunction, an indicator of subclinical atherosclerosis in asymptomatic systemic lupus erythematosus (SLE) patients in terms of cardiac effects. This study involved 80 patients: a study group ( n = 50) and control group ( n = 30). They were categorized into four subgroups: anticardiolipin antibodies (aCL) (+) ( n = 14) and aCL (−) ( n = 36); systemic lupus erythematosus disease activity index (SLEDAI) ≥ 6 ( n = 15) and SLEDAI < 6 ( n = 35); disease period ≥ 5 years ( n = 21) and disease period < 5 years ( n = 29); major organ involvement (+) ( n = 19), major organ involvement (−) ( n = 31). The ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E′) for the study group was found to be higher than the control ( p < 0.01). Systolic septal motion velocity (Ssm) was lower in the study group compared with the control ( p < 0.01). Left atrium (LA) dimension was greater in the study group than the control ( p < 0.01). Ssm was found to be lower in the aCL (+) patients compared with the control and aCL (−) groups ( p < 0.01, p < 0.05, respectively). LA dimension was greater in the aCL (+) and (−) groups compared with the control, ( p < 0.01, p < 0.05, respectively) and aCL groups compared with each other ( p < 0.05). The E/E′ ratio for the aCL (+) and (−) groups was found to be greater than the control ( p < 0.05). In the study, both the Ssm and the late diastolic septal velocity (sA′) was found to be lower in the SLEDAI ≥6 group compared with SLEDAI<6 group, ( p < 0.001, p < 0.05, respectively). LA dimension was statistically greater in the SLEDAI ≥6 group compared with the SLEDAI <6 group ( p < 0.001). E′ and early diastolic septal velocity (sE′) were statistically lower in the disease period >5 years group compared with the disease period <5 years group ( p < 0.01, p < 0.05, respectively). Carrying out regular scans with TTE image of SLE patients is important in order to identify early cardiac involvement during monitoring and treatment. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates.
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Affiliation(s)
- A Barutcu
- Department of Cardiology, Faculty of Medicine, çanakkale Onsekiz Mart University, çanakkale, Turkey
| | - F Aksu
- Istanbul Medeniyet University , Cardiology Goztepe Training and Research Hospital, Istanbul, Turkey
| | - F Ozcelik
- Department of Cardiology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - C A E Barutcu
- Department of Internal Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - G E Umit
- Department of Internal Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - O N Pamuk
- Department of Rheumatology, Faculty ofMedicine, Trakya University, Edirne, Turkey
| | - A Altun
- Department of Cardiology, Faculty of Medicine, Baskent University, Istanbul Hospital, Istanbul, Turkey
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Leal GN, Silva KF, França CMP, Lianza AC, Andrade JL, Campos LMA, Bonfá E, Silva CA. Subclinical right ventricle systolic dysfunction in childhood-onset systemic lupus erythematosus: insights from two-dimensional speckle-tracking echocardiography. Lupus 2014; 24:613-20. [DOI: 10.1177/0961203314563135] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/15/2014] [Indexed: 01/07/2023]
Abstract
Objective The objective of this article is to evaluate right ventricle strain imaging by two-dimensional speckle-tracking (2DST) in childhood-onset systemic lupus erythematosus (c-SLE). Methods Thirty-five c-SLE patients with no signs or symptoms of heart failure and 33 healthy volunteers were evaluated by standard echocardiogram and 2DST. Conventional parameters included tricuspid annular plane systolic excursion (TAPSE), RV tissue-Doppler-derived Tei index and systolic pulmonary artery pressure. Global peak longitudinal systolic strain (PLSS) and strain rate (PLSSR) of RV were obtained by 2DST. Demographic/clinical features, SLEDAI-2K/SLICC/ACR-DI and treatment were also assessed. Results The median current age was similar in patients and controls (14.75 vs. 14.88 years, p = 0.62). RV PLSS was significantly reduced in c-SLE (−24.5 ± 5.09 vs. −27.62 ± 3.02%, p = 0.003). Similar findings were observed after excluding patients with pulmonary hypertension (−24.62 ± 4.87% vs. −27.62 ± 3.02%, p = 0.0041). RV PLSS was positively correlated with TAPSE ( r = +0.49, p = 0.0027) and negatively correlated with Tei index ( r = −0.34, p = 0.04) in c-SLE. RV PLSSR was not different comparing patients and controls (−0.65 s−1 ± 0.47 vs. −1.87 ± 0.49 s−1, p = 0.07). Further analysis of c-SLE patients revealed higher frequencies of neuropsychiatric manifestations (39% vs. 0%, p = 0.007) and antiphospholipid antibodies (55% vs. 18%, p = 0.035) in those with RV PLSS ≤ −23.7% vs >−23.7%. No differences were evidenced in demographic data, disease activity/damage or treatments ( p > 0.05). Conclusions The present study, using a new and more sensitive technique, revealed subclinical RV systolic dysfunction in c-SLE patients that may have future prognostic implications. The novel association of asymptomatic RV dysfunction with neuropsychiatric manifestations and antiphospholipid antibodies may suggest common physiopathological pathways.
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Affiliation(s)
- G N Leal
- Radiology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - K F Silva
- Radiology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C M P França
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - A C Lianza
- Radiology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - J L Andrade
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L M A Campos
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E Bonfá
- Department of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C A Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Majka DS, Chang RW. Is preclinical autoimmunity benign?: The case of cardiovascular disease. Rheum Dis Clin North Am 2014; 40:659-68. [PMID: 25437283 DOI: 10.1016/j.rdc.2014.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although there are many examples of autoantibodies in disease-free individuals, they can be a preclinical phenomenon heralding future autoimmune rheumatic disease. They may be a marker for autoreactive B-cell activation and other inflammatory autoimmune processes. The increased prevalence of cardiovascular disease (CVD) in autoimmune rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus, and the increased risk of CVD in patients with rheumatic disease with autoantibodies, suggest that CVD may have autoimmune features. Autoantibodies might be risk markers for subclinical and clinical CVD development not only in patients with rheumatic diseases but in the general population as well.
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Affiliation(s)
- Darcy S Majka
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 East Huron, M300, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Rowland W Chang
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 East Huron, M300, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
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11
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Garcia MA, Alarcon GS, Boggio G, Hachuel L, Marcos AI, Marcos JC, Gentiletti S, Caeiro F, Sato EI, Borba EF, Brenol JCT, Massardo L, Molina-Restrepo JF, Vasquez G, Guibert-Toledano M, Barile-Fabris L, Amigo MC, Huerta-Yanez GF, Cucho-Venegas JM, Chacon-Diaz R, Pons-Estel BA. Primary cardiac disease in systemic lupus erythematosus patients: protective and risk factors--data from a multi-ethnic Latin American cohort. Rheumatology (Oxford) 2014; 53:1431-8. [DOI: 10.1093/rheumatology/keu011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Swadzba J, Sydor WJ, Kolodziejczyk J, Musial J. Summary of the 9th meeting of the European Forum on Antiphospholipid Antibodies. Lupus 2014; 23:395-9. [PMID: 24474705 DOI: 10.1177/0961203314520841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The 9th meeting of the European Forum on Antiphospholipid Antibodies (Euro aPL Forum) was held in Krakow, Poland, on 16-18 May 2013. This was an excellent occasion for the exchange of information on current research in the area of antiphospholipid syndrome (APS), as well as a starting point for many new research projects. About 120 physicians and researchers from various medical specialities representing 15 European countries, USA, Argentina and Israel attended the event. This report summarizes the major studies and new research projects presented during the Forum.
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Affiliation(s)
- J Swadzba
- 1Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Vassileva CM, Swong MN, Boley TM, Markwell SJ, Hazelrigg SR. Influence of Systemic Lupus Erythematosus on Procedure Selection and Outcomes of Patients Undergoing Isolated Mitral Valve Surgery. J Card Surg 2012; 27:29-33. [DOI: 10.1111/j.1540-8191.2011.01393.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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