AB0544 ECHOCARDIOGRAPHIC CHANGES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS BEFORE TO INITIATION OF IMMUNOSUPPRESSIVE THERAPY

Abstract

Background: Cardiovascular diseases are becoming the leading cause of death among SLE patients due to increasing life-spans. Transthoracic echocardiography (TTE) is a routine and widely available modality in everyday clinical practice useful to identify specific pathological cardiac changes and predictors of heart failure (HF). Objective(s): Obtaining of specific TTE findings in SLE patients prior to initiation of pathogenic immunosuppressive therapy was the objective in this study. Method(s): Thirty four pts (91% females, aged 30[26-34]years (median [interquartile range 25%-75%]) with "non-treated" SLE (ACR 1997 and SLICC 2012 criteria) were included. None of pts was treated either with prednisone or cytotoxic drugs at the moment of inclusion. Result(s): Median SLE duration was 18[6-60]months, SLEDAI-2K - 13[8-19], SLICC/DI - 0[0-0]scores. Leading SLE clinical manifestations included: hematological changes (74%), kidney involvement (59%), joints (50%) and skin involvement (50%). Immunological abnormalities were detected in all patients and were as follows: ANA positivity - in 100%, anti-dsDNA antibodies - in 76% of SLE patients. Concurrent antiphospholipid syndrome was found in 2(6%) patients. Valve insufficiency with varying degree of regurgitation was the commonest pathology found in "non-treated" SLE patients based on TTE data: mitral valve insufficiency - in 31(91%), tricuspid valve - in 31(91%), pulmonary valve insufficiency - in 21(62%), aortic valve insufficiency - in 4(12%) patients. Endocarditis was a rare pathology found in 5(15%) patients, while mitral and tricuspid valves prolapse was seen more often - in 16(47%), while not a single case of valve stenosis was found. Pericardial pathology was detected in 16(47%) patients: exudative - in 9(26%), and adhesive (thickening, hardening and separation of leaflets) - in 7(21%). There were no cases of CAD or MI, although there were 2(6%) documented cases of cerebral stroke in past history, and 1(3%) case of confirmed CHF. Most common TRF were dyslipidemia and hypertension - in 15(44%) and 11(32%) SLE patients respectively. Median LVEF was 64[59-67]%, LV end-systolic dimension- 30[27-32]mm, LV end-diastolic dimension - 48[45-51]mm, pulmonary artery systolic pressure - 24[22-32]mm Hg. LV diastolic disfunction (LVDD) was found in 10 (29%), systolic dysfunction (LVSD) - in 4(12%), LV myocardial hypertrophy (LVH) - in 5(15%); left atrium dilatation (LAD) was found in 4(12%), and increased dimensions of right atrium was detected in 3(9%) SLE patients. Conclusion(s): Most common cardiac abnormalities in "non-treated" SLE patients with high activity (SLEDAI-2K 13 scores) were valve dysfunction (insufficiency with regurgitation), mitral and tricuspid valve prolapse and pericarditis. Of importance is the presence of early subclinical features of HF almost in 1/3 of naive to treatment SLE patients: LVDD (29%), LVH (15%), and LAD (12%). SLE patients should be thoroughly monitored both for adequate control of SLE activity, and cardiac pathology with correction of TRF, regular assessments by a cardiologist, TTE, and early administration of cardio-protection therapy in view of increased HF risk in SLE patients, predetermining unfavorable prognosis.