Cardiovascular Complications in Systemic Lupus Erythematosus

Two-dimensional speckle-tracking echocardiography in left ventricular systolic function in patients with systemic lupus erythematosus

OBJECTIVES

To investigate whether two-dimensional speckle-tracking echocardiography (2DSTE) can be considered a criterion for early left ventricular (LV) systolic impairment in patients with systemic lupus erythematosus (SLE) and to further explore the association with each other.

METHODS

We included 38 patients with SLE and assessed the degree of disease activity according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring criteria, together with 38 healthy controls who were matched by sex and age. Routine LV systolic function evaluation parameters were obtained by echocardiography as well as 2DSTE measurement of LV strain parameters to obtain global longitudinal strain (GLS) values, respectively.

RESULTS

(I) On routine LV function parameters such as ejection fractions (EF) and left ventricular end-diastolic internal diameter (LVIDd), the SLE group and the control group did not reflect differences. In contrast, on the LV strain parameter obtained from 2DSTE measurements, the GLS values in all cardiac planes were lower in the SLE group than in the control group and showed statistically significant differences. (II) Correlation analysis showed that there was a correlation between SLEDAI and GLS, especially a meaningful correlation with GLS Avg and GLS A4C, with correlation coefficients of 0.35 and 0.47, respectively.

CONCLUSIONS

The use of 2DSTE can detect early impaired LV systolic function in SLE patients, and GLS is progressively gaining attention as an indicator of subclinical myocardial injury and LV function in SLE patients. The correlation that exists between GLS and SLEDAI might contribute to a better assessment of cardiac involvement in SLE patients. Key Points • Cardiac involvement has become one of the major factors in the poor prognosis of SLE patients, which directly affects the mortality of SLE patients. Traditional echocardiography is difficult to detect early left ventricular function impairment, thus affecting clinicians' judgment and diagnosis. • 2DSTE can recognize subclinical myocardial injury in SLE patients at an early stage, and its derived strain parameters may be used as an indicator to evaluate myocardial involvement and reflect disease activity in SLE patients.

Lupus-Induced Accelerated Heart Failure in a Young African American Female: Cardiovascular and Systemic Complications of Noncompliance to Maintenance Therapy and the Social Determinants of Cardiovascular Disease

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder characterized by dysregulations of the immune system with intermittent and remitting symptoms. SLE affects multiple organs and systems, including the cardiovascular system. This condition is associated with an increased risk of cardiovascular disease, particularly in younger patients. Our case report describes a patient who rapidly developed structural, functional, and electrophysiological cardiac abnormalities due to lupus-induced cardiomyopathy. The accelerating cardiac events were the result of medication noncompliance. Myocarditis and other potentially fatal cardiac complications associated with SLE have been the subject of numerous studies. This presentation appears to be the first to emphasize the rarity of lupus-induced cardiomyopathy, the importance of treatment adherence, the adverse cardiac effects of targeted therapeutic interventions, and the influence of social determinants of cardiovascular health on a patient's prognosis.

Exploring cardiovascular implications in systemic lupus erythematosus: A holistic analysis of complications, diagnostic criteria, and therapeutic modalities, encompassing pharmacological and adjuvant approaches

Systemic lupus erythematosus (SLE) poses a diagnostic challenge due to its heterogeneity. This study examines the cardiac complications of SLE comprehensively, covering pericarditis, myocarditis, pleural effusion, valvular disease, atherosclerosis, and cardiac arrhythmias. Nearly one-third of SLE-related deaths are attributed to cardiovascular diseases, necessitating a deeper understanding of cardiac pathophysiology. The impact of SLE on the cardiovascular system manifests in various ways, including recurrent and resistant pericarditis, severe myocarditis, and pleural effusion. Valvular diseases, atherosclerosis, and cardiac arrhythmias are prevalent, with immune complex deposition playing a role in atherosclerosis. Diagnostic criteria involve clinical features, laboratory findings, and autoantibodies, emphasizing the need for early diagnosis and a multidisciplinary diagnostic approach. The review explores pharmacological and non-pharmacological modalities for managing cardiac manifestations in SLE. Recommendations include NSAIDs, colchicine, and proton pump inhibitors for acute pericarditis, while selective immunosuppressive therapy is emerging for myocarditis. Valvular diseases require individualized treatment approaches, and careful corticosteroid management is crucial to avoid increased cardiovascular events. Anti-malarial therapy, particularly hydroxychloroquine, shows promise in mitigating cardiovascular risk factors. Non-pharmacological modifications, such as diet, exercise, and smoke cessation, significantly contribute to cardiovascular health in SLE patients. Adjuvant therapies involving glutathione and glutathione peroxidase focus on redox balance, offering potential interventions. This integrated approach combines diagnostic insights with diverse treatment modalities, providing a holistic strategy for managing cardiac complications in SLE. Ongoing research is essential to refine these strategies and optimize individualized treatment plans for improved patient outcomes.

An Incidental Finding of Libman-Sacks Endocarditis ‎in a Young Female With Systemic Lupus Erythematosus Who Presented With Pleuritic Chest Pain

Libman-Sacks endocarditis (LSE) is a rare disease found incidentally in ‎postmortem autopsies, characterized by microscopic to large ‎verrucous vegetation on the cardiac valves, the most affected site is ‎the mitral valve followed by the aortic valve. Females of reproductive age ‎were observed as the most affected individuals as found in studies. ‎Most individuals with LSE are asymptomatic and ‎generally discovered lately when they presented with ‎thromboembolic disorders such as stroke, cognitive disabilities, and death. ‎Malignancy and autoimmune diseases involving systemic lupus ‎erythematosus (SLE) and antiphospholipid syndrome (APS) are ‎considered the primary etiology of LSE. As recognized, the majority of LSE cases are ‎asymptomatic, it tends to be challenging to spot the condition ‎at the early pathway of the disease. In this paper, we describe a ‎young female who is known to have SLE on medications, she presented ‎to the emergency department (ED) due to chest pain and exertional ‎dyspnea for a few days, laboratory investigations showed ‎anemia, raised inflammatory marker, and anti-DsDNA. Imaging ‎studies showed bilateral pleural effusion on the chest X-ray ‎and a large vegetation on the posterior mitral valve with moderate regurgitation and normal wall ‎motion in transesophageal echocardiography. The patient was managed by pulse steroid therapy, anticoagulation ‎therapy, and a low dose of diuretic, the patient improved dramatically and ‎discharged home with close follow-up in the clinic. The primary ‎treatment of LSE is anticoagulant therapy, however, surgical ‎intervention should be considered in case of large vegetation ‎recurrent thromboembolism despite anticoagulant therapy. As ‎the prognosis in LSE is considered very poor and there is no definitive laboratory investigation ‎exists to confirm the diagnosis, we highlight the importance of ‎considering LSE as a serious and crucial differential diagnosis ‎when dealing with SLE patients who presented with dyspnea and pleural effusion secondary to valvular dysfunction, mainly the mitral valve.

Systemic Lupus Erythematosus and Cardiovascular Diseases: A Systematic Review

Systemic lupus erythematosus (SLE) is an autoimmune condition characterized by multi-organ involvement. The clinical presentation often varies from mild to moderate to severe. The cardiovascular system may also be affected, often portending a poor prognosis for patients. Although the relationship between SLE and cardiovascular disorders has been extensively explored through case reports and literature reviews, few systematic reviews explicitly focusing on this association have been conducted. In light of this, this systematic review aims to analyze the extent of the association between SLE and cardiovascular diseases (CVDs), by exploring the risk of developing CVDs, including myocardial infarction (MI), atherosclerosis, myocarditis, pericarditis and arrhythmias, in SLE patients vs. non-SLE patients. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform the systematic review. A detailed search was done covering the period from March 2003 to March 2023 using three databases: PubMed, Google Scholar, and Cochrane. The PubMed search identified 597 articles, while Google Scholar and Cochrane searches yielded 559 and three articles, respectively. Of the 1159 articles retrieved, we chose eight for final consideration, after excluding papers that did not discuss the role of SLE in CVDs, papers published earlier than 2003, and papers with incomplete data. The eight studies chosen included two narrative reviews, two systematic reviews, and four observational studies. In this systematic review, SLE was proven to have a strong relationship with diverse CVDs, including rare ones scarcely discussed in the literature, such as vasculitis and aortic dissection. All eight of the final papers indicated a connection between SLE and CVDs, based on the systematic analysis of these articles, which revealed that most recent research supports a higher risk of peripheral arterial occlusive disease (PAOD), MI, pericarditis, myocarditis, and other cardiovascular disorders in individuals with SLE. These associations may have certain gray areas, as patient characteristics and comorbidities often affect the extent of illness and long-term prognosis. Larger-scale studies are required to probe this relationship further and research the etiopathogenesis involved in order to improve patient outcomes. The effects of SLE on the heart are, however, unequivocal.

Cardiac Tamponade, an Unusual First Presentation of Systemic Lupus Erythematosus: A Case Report in a Rural Tertiary Hospital

Systemic lupus erythematosus (SLE) is a condition that manifests in a variety of ways. Although pericarditis and pericardial effusion are frequent cardiac manifestations of SLE, cardiac tamponade is rarely reported, especially as the initial manifestation of the disease. We describe a 38-year-old Nigerian lady who presented with three months of progressive dyspnea. She had intermittent fever, tachycardia, tachypnea, hypotension, jugular vein distension, and muffled heart sounds. Echocardiography confirmed cardiac tamponade. The ANA, anti-dsDNA, and anti-Sm antibodies were positive. She had a high ESR and low levels of blood complements. The diagnosis of SLE was established based on the 2019 EULAR/ACR classification criteria. She was treated with intravenous methylprednisolone, oral prednisolone, and hydroxychloroquine after undergoing an emergency echo-guided pericardiocentesis. She responded well to treatment, and she is currently being followed up on an outpatient basis. Clinicians should consider SLE as a differential when evaluating patients with pericardial effusion, as an accurate and timely diagnosis could be lifesaving.