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Early echocardiographic detection of left ventricular diastolic dysfunction in patients with systemic lupus erythematosus asymptomatic for cardiovascular disease

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Abstract

Cardiovascular disease (CVD) is a major complication of systemic lupus erythematosus (SLE) and is now a leading cause of death for these patients. In this study, 23 SLE patients asymptomatic for CVD underwent a comprehensive echocardiographic examination to detect subclinical cardiac involvement. According to their SELENA-SLEDAI score, they were divided into two groups: SELENA-SLEDAI ≤ 12 (n = 13, 12 females) and SELENA-SLEDAI > 12 (n = 10, all females), indicative of mild-to-moderate and severe SLE, respectively. Patients in the latter group had significant increases in left ventricular (LV) mass, LV end-diastolic volume, left atrial volume and right heart parameters (pulmonary arterial pressure, tricuspid regurgitation velocity and diameter of the inferior cava) compared to the mild-to-moderate group. Alterations of the early to late diastolic trans-mitral flow velocity (E/A) were found in 39% of patients, equally distributed between the two groups. The Framingham score of all patients correlated directly with LV mass, interventricular septum thickness and posterior wall thickness, but did not significantly differ between patients with severe and mild-to-moderate SLE. These findings reveal the presence of early-stage, and thus clinically silent, diastolic dysfunction in patients with severe SLE. They demonstrate the poor predictive value of the Framingham score in CVD risk stratification of patients with SLE, thus highlighting the crucial role of echocardiography in the diagnostic workup of these patients.

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Funding

This work was supported by the Italian Association for Cancer Research (AIRC) through an Investigator Grant (No. 20441) to VR.

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  1. Patrizia Leone and Sebastiano Cicco have contributed equally to this work.

Authors and Affiliations

  1. Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine “Guido Baccelli”, University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy

    Patrizia Leone, Sebastiano Cicco, Marcella Prete, Antonio Giovanni Solimando, Nicola Susca, Lucilla Crudele, Alessio Buonavoglia, Franco Dammacco, Angelo Vacca & Vito Racanelli

  2. Department of Cardiology, University Hospital Policlinico, Bari, Italy

    Paolo Colonna

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  1. Patrizia Leone
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Contributions

PL, SC and VR planned the study and prepared the draft of the manuscript. MP contributed to the study design. AGS, NS, LC, AB and PC cared for the patients, collected data and contributed to data analyses and interpretation. FD, AV and VR provided critical revisions of the manuscript related to its intellectual content. All authors reviewed and approved the manuscript and accept their accountability for all aspects of this study.

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Correspondence to Vito Racanelli.

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The authors have no potential conflict of interest to declare with respect to the research, authorship and/or publication of this article.

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The study protocol was approved by the Ethics Committee of the University of Bari Medical School and conformed to the good clinical practice guidelines of the Italian Ministry of Health and the ethical guidelines of the Declaration of Helsinki, as revised and amended in 2004.

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All study patients provided written informed consent.

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Leone, P., Cicco, S., Prete, M. et al. Early echocardiographic detection of left ventricular diastolic dysfunction in patients with systemic lupus erythematosus asymptomatic for cardiovascular disease. Clin Exp Med 20, 11–19 (2020). https://doi.org/10.1007/s10238-019-00600-8

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