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Kardiovaskuläres Monitoring von Patienten mit systemischem Lupus erythematodes

Cardiovascular monitoring of patients with systemic lupus erythematosus

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Zusammenfassung

Eine frühzeitig einsetzende und beschleunigt fortschreitende Atherosklerose beeinflusst signifikant die Morbidität und Mortalität von Patienten mit systemischem Lupus erythematodes (SLE). Kardiale SLE-Manifestationen sind häufig, eine pulmonale Hypertonie tritt vielfach im Verlauf der Erkrankung auf. Die Häufigkeit kardiovaskulärer Komplikationen könnte prinzipiell ein regelmäßiges Monitoring von SLE-Patienten zur frühzeitigen Diagnosestellung und Therapie rechtfertigen. Diagnostische Verfahren zum Nachweis einer Koronarinsuffizienz, die Bestimmung von Surrogatmarkern der Atherosklerose und die Echokardiographie zeigen bei SLE-Patienten häufig auffällige Befunde. Bisher gibt es jedoch keine ausreichende Evidenz für den Nutzen eines routinemäßig durchgeführten kardiovaskulären Monitorings. In Anlehnung an Empfehlungen zu anderen Erkrankungen mit kardiovaskulären Folgen schlagen wir deshalb bei asymptomatischen SLE-Patienten eine Risikofaktorevaluation und echokardiographische Kontrollen in jährlichen Abständen vor. Bei Vorliegen von mindestens 2 Risikofaktoren empfehlen wir ein Belastungs-EKG. Der Nutzen eines solchen kardiovaskulären Monitorings für SLE-Patienten ist prospektiv zu untersuchen.

Summary

Accelerated atherosclerotic cardiovascular disease is increasingly recognized as a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cardiac manifestations of SLE are frequent and can involve almost all components of the heart. Pulmonary hypertension often develops during the course of SLE. The high incidence of cardiovascular complications may justify a screening of SLE patients in order to ensure early diagnosis and therapy. Results of diagnostic procedures that detect coronary insufficiency, surrogates of atherosclerotic burden and echocardiographic findings are often abnormal in SLE. However, evidence to support a routine screening for cardiovascular disease is currently not available. Therefore, based on the recommendations that have been proposed for other conditions associated with cardiovascular disease, we suggest assessment of risk factors and the performance of echocardiography at least annually in asymptomatic SLE patients. If two or more risk factors are present, an exercise ECG is recommended. The benefit, however, of screening SLE patients for cardiovascular disease has to be confirmed in prospective studies.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik B, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48129, Münster, Germany

    H. Schotte, H. Becker, W. Domschke & M. Gaubitz

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  1. H. Schotte
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  2. H. Becker
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  3. W. Domschke
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  4. M. Gaubitz
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Correspondence to H. Schotte.

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Schotte, H., Becker, H., Domschke, W. et al. Kardiovaskuläres Monitoring von Patienten mit systemischem Lupus erythematodes. Z. Rheumatol. 64, 564–575 (2005). https://doi.org/10.1007/s00393-005-0668-x

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  • DOI: https://doi.org/10.1007/s00393-005-0668-x

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