Heart involvement in systemic lupus erythematosus

Abstract

Background. The clinical correlations of cardiac lesions detected by echocardiography in systemic lupus erythematosus (SLE) are not definitively established. Methods. Forty six patients (41 females, 41 ±13 years old, SLE duration 8.8 ±4.1 years), recruited in active phase of SLE, were evaluated and followed up from 1988-1997 by transthoracic echocardiography (every 6 months or during flare up), and serum auto antibody levels were measured. Results. At the end of the study, pericardial and valvular lesions had occurred in 65% and 43% of cases, respectively. Libman-Sacks (L-S) endocarditis was diagnosed in 15 patients, myocarditis in 4, and left ventricular hypertrophy (LVH) in 13. Acute L-S endocarditis, valvular thickening, and myocarditis incidence did not change as illness duration increased, whereas healed L-S endocarditis increased from 7%-22% and LVH from 14%-32%. Pericardial effusion (PE) was more frequent in the first year than after 5 years of disease (29% vs. 12%), while pericardial thickening (PT) incidence increased from 21%-54%. No class of antibody was significantly prevalent for any kind of cardiac involvement. SLE activity score was significantly correlated to PE and myocarditis presence. At multiple regression analysis, SLE activity score was significantly correlated (r=0.64, p<0.0001) to PE, PT, acute and healed L-S endocarditis, myocarditis, and LVH. Conclusions. Echocardiography appears to be reliable in the clinical management of SLE patients.