ABSTRACT
Systemic lupus erythematosus [SLE] is an inflammatory disease characterized by deposition of autoantibodies and pathogenic immune complexes in cells and tissues causing lesions. Cardiac involvement in patients with SLE has been described since the early 20th century. Echo-cardiography is time main instrument for investigating the anatomical and functional involvement of the heart in the great majority of systemic diseases. Antiphospholipid syndrome is an autoimmune disease characterized by antiphospholipid antibodies and at least one clinical manifestation, the most common being venous or arterial thrombosis and recurrent fetal loss. Anticardiolipin IgG antibodies have been linked to several cardiac manifestations in patients with SLE. -to study the cardiac abnormalities in Egyptian patients with SLE, to determine its relation to other clinical features of SLE and its association with anticardiolipin antibodies [IgG]. This study involved thirty patients with SLE. Patients were classified into two groups according to having any abnormal finding on echocardiography into Echo positive patients [23 patients] and echo negative patients [7 patients]. Patients were also classified into two groups according to ACL IgG seropositivity into Group I: ACL positive patients [18 patients] and Group II. ACL negative patients [12 patients]. Group I with ACL +ve were further classified according to ACL titer of antibodies into: Group IA: with high titer [10 patients] and Group IB: with low titer [8 patients]. The study involved also a control group of 15 age and sex matched apparently healthy individuals. For each one detection of anticardiolipin antibodies IgG, transthoracic echocardiography in addition to liver and renal function tests were done. Results were subjected for statistical analysis. This study revealed that cardiac involvement in SLE is very common and it is not related to other clinical features of lupus, age, disease duration or to activity of disease. 23 patients had echocardiographic abnormalities [76.60%], 11 patients had pericardial effusion [36.60%], 1 patient had LV diastolic dysfunction [3.3%], 3 patients had LV systolic dysfunction [10%], 3 patients had Pulmonary hypertension [10%] and 16 patients had Valvular abnormalities [53.30%]. The valvular abnormalities were affecting the mitral valve in 16 patients [53.3%], aortic valve in 2 patients [6.6%] and tricuspid valve in 7 patients [23.3%]. No pulmonary valve affection was detected. Valvular involvement - especially regurgitation and thickening of the mitral valve - is the most encountered forum of heart disease in SLE followed by pericardial effusion. Comparative study between anticardiolipin positive and negative groups regarding echocardiographic abnormalities showed no statistical significance [P > 0.05]. ACL shows a tendency towards a statistical significance with MV thickening [P = 0.06]. Comparative study between patients of ACL +ve SLE patients according to titer of anticardiolipin antibodies IgG revealed statistically significant difference between both groups as regards BUN, PTT creatinine clearance, SLAM score and number of valve regurgitation in each patient [P < 0.05] as well as echo abnormalities in general [P < 0.05]. Cardiac involvement in SLE specially valvular affection followed by pericardial effusion - is very common although, clinical involvement is not very common and it is not related to other clinical features of lupus. ACL IgG antibodies play a role in the pathogenesis of the severity of cardiac affection in general and valvular lesions in particular and in time pathogenesis of lupus nephropathy