Abstract

Background: Systemic Lupus Erythematous (SLE) is an autoimmune disease damaging to organs, tissues and cells mediated by antibodies and immune complexes. The higher occurrence of SLE in females may be because of hormonal changes and effects. Due to lack of awareness, many women undergo screening during the fifth decade of their life and may be diagnosed to have SLE. One of the many possible reasons could be late diagnosis, referral bias, optimal health care facilities, tuberculosis and predisposing genetic factors. Leading causes of early mortality and poor prognosis are because of disease activity and autoimmune infections. Whereas, later mortality is due to cardiovascular disease. Echocardiography to assess cardiac function has been a great tool of use. With use of Echocardiography, patients with SLE can be monitored for cardiac anomalies. Many studies in the past have suggested that increasing prevalence of dyslipidaemia in patients having SLE and their association with atherosclerotic cardiovascular disease, which leads to mortality. Dyslipidaemia is seen to be modifiable risk for cardiovascular diseases, but has been a great scope of research in patients having SLE.

Aim: To study the echocardiographic abnormalities in patients having SLE. Furthermore, association of these findings with anticardiolipin antibodies. In the end, learning the association of the results with serum lipids.

Methods: An observational, Randomised, cross sectional study was conducted with 40 patients diagnosed with SLE according to modified ACR criteria. In the chosen population, 2D Echo findings, anticardiolipin antibodies and lipid profile was studied in the under criteria of inclusion and exclusion on the certain criteria.

Results: The demography of patients included in study were in the ratio of 1:7, meaning 5 males and 35 females. The mean age of the male patients was 30 ± 14.13 years, where as that of females were 29.11 ± 9.57 years. The mean duration of the disease was found to be 2.19 ± 1.99 years, thus concludes that majority of the patients had less than 2 years of disease duration.

Out of the 40 patients, 30 patients had abnormal echocardiographic study, which was categorised into pericardial, myocardial and valvular. On categorisation, it was found that 6 patients had pericardial involvement likely pericardial effusion, 13 patients had myocardial involvement like left ventricular diastolic dysfunction (LVDD) and left ventricular hypertrophy (LVH). 23 patients were reported having valvular regurgitation or thickenings. On comparing the echo findings of males and females, there was no statistically significant difference between males and females. In addition, there was no significant difference in echo with regard to duration of disease. Anticardiolipin antibody was found positive only in 6 patients with the distribution of IgG of 12.5% and IgM of 2.5%. Thus, these findings of anticardiolipin did not implicate the positive complications of SLE. It was also reported that 24 out of 40 patients had abnormal serum lipid values. Serum triglycerides were high in 21 of 40 patients, which showed no significant correlation between TG’s and echocardiographic abnormalities. High cholesterol levels were noted in 4 out of 40 patients and showed no significant correlation between TC’s and echocardiographic abnormalities. 1 patient had very high LDL-C levels, whereas 39 patients had normal ranged values. Out of the lipid profiles mean values, TGs showed abnormally high of 172.45 ± 61.41 mg/dl. Thus, there was no statistically significant and correlation between pericardial, Valvular and Myocardial abnormalities in the studied patients.

Discussion: In the study conducted we could find that valvular incompetence as most common form of valvular involvement. Furthermore, we could find that, myocardial abnormality to be second biggest factor for cardiac involvement of SLE. There was no statistical significance between echo findings and the anticardiolipin antibodies in the give IgG and IgM. Thus, it could not positively implicate the echocardiological manifestations. The most common abnormality was found to be was high serum triglycerides. Furthermore, we also found that there was no significantly correlation between high serum lipids and echocardiographic findings of the pericardial, myocardial and valvular in the 40 cases of SLE.

Conclusion: Most of the SLE patients associated with cardiac disease had no symptoms of cardiac disease. Thus, a high degree of suspension can be there to rule out the cases of SLE with cardiac abnormalities. Routine checks up or screening for cardiac diseases during the SLE to diagnose the cardiac abnormalities. Thus, diagnostic tool for such cases can be Transthoracic 2D echo can help to rule out the causes of cardiac cases. In the screened cases, high possibility of valvular associated abnormalities was indicated. To conclude, prevalence of SLE can be significantly reduced by routine cardiac examination and modify the lifestyle or proper medical management to prevent aggravated response of SLE.

Keywords: Systemic Lupus Erythematous (SLE); Serum Lipids; Dyslipidaemia

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Citation

Citation: Manish Juneja., et al. “Echocardiographic Abnormalities in Systemic Lupus Erythematosus and its Association with Anticardiolipin Antibodies and Serum Lipids". Acta Scientific Cardiovascular System 1.5 (2022): 03-18.

Copyright

Copyright: © 2022 Manish Juneja., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.