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Early Echocardiographic Detection of Left Ventricular Diastolic Dysfunction in Patients with Systemic Lupus Erythematosus Asymptomatic for Cardiovascular Disease

Patrizia Leone, Sebastiano Cicco, Marcella Prete, Nicola Susca, Lucilla Crudele, Alessio Buonavoglia, Paolo Colonna, Franco Dammacco, Angelo Vacca and Vito Racanelli

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-moderate group. Diastolic dysfunction, evaluated as the early/late (E/A) and early/septal velocity (E/e’) ratios, was not detected in either group. The Framingham scores of all patients correlated directly with LV mass and indirectly with both the E/A ratio, thus evidencing subclinical myocardial involvement in patients with severe SLE. Overall, our results demonstrate the presence of early-stage, and thus clinically silent, diastolic dysfunction in patients with severe SLE. This study underscores the importance of echocardiography for the early detection of LV diastolic dysfunction as it may progress to global systolic dysfunction. Echocardiography should therefore be included in the routine examination of SLE patients.