role of thrombocytopenia as an independent predictor of cardiovascular and renal damage in patients with systemic lupus erythematosus

Systemic lupus erylhematosus [SLE] is an auioimmunc disorder in which the body's immune system incorrectly attacks the body's own tissues and organs, leading to inflammation and damage. Thrombocylopenia [defined as platelet count less than 100 x 10[9]/liter] is rather common in SLE. The incidence ranges from 15-50% and it represents a predictor of a worse prognosis. To study the role of thrombocytopenia as an independent predictor of organ damage [renal and cardiac] in SLE patients. Our study was conducted on 40 SLE Patients from Ain Shams University Hospitals, classified into 2 groups; group I including 20 patients with thrombocytopcnia and group II including 20 patients without thrombocytopenia. All patients were subjected to medical history, clinical examination, laboratory investigations including, scrological markers antinuclear antibody [ANA], anti-double stranded DNA [anti ds-DNA], renal biopsy. Transthoracic echocardiography for assessment of cardiac affection, evaluating cardiac function, valvular lesion and presence of any pericardial disease. We found that there was no significant statistical difference between the two groups as regard their ages. Echocardiography was done for all patients, there were significant cchocardiographic findings in group 1 compared to group II [p. value 0.027]. As 40% of the patients in group 1 had pericardial effusion, 35% had mitral regurgitation, 10% had mitral stenosis, 20% had aortic regurgitation and 15% hadtricuspid regurgitation. Among the patients in group H, 20% had pericardial effusion, 25% had mitral regurgitation, 10% had tricuspid regurgitation and no one of them had aortic valve disease. As regard renal damage, we found that 50% of thrombocytopenic SLE patients had proteinuria >3.5 gm/24h, in contrast to non thrombocytopenic patients in which only 25% of them had proteinuria. Also in thrombocytopenic patients 5% had ESRD, while no ESRD was found between non thrombocytopenic groups. While comparing the two groups regarding the pathological pattern of kidney affection assessed by renal biopsy according to WHO classification system, we found no significant statistical differences among the two groups [p.value=0.38]. We concluded that thromhocytopenia emerged as one of the most important predictors of damage also it is a qualitative marker of impending damage in lupus patients and that thrombocytopenic SLE patients are at high risk of developing protcinuria, pericardial and valvular disease

18 years follow-up results of mitral balloon valvuloplasty in 531 consecutive patients and predictors of long-term outcome

Long-term echocardiographic follow-up studies of mitral balloon valvuloplasty [MBV] are scarce. The study aim was to assess the long-term results [up to 18 years] of MBV and to identify predictors of restenosis and event-free survival. The immediate and long-term clinical and echocardiographic results for 531 consecutive patients [mean age 31 +/- 11 years] who underwent successful MBV for severe mitral stenosis [MS] and were followed up for a mean of 8.5 +/- 4.8 years [range: 1 .5 to 18 years] after MBV are reported. Immediately after MBV, the mitral valve area [MVA] was increased from 0.92 +/- 0.17 cm[2] to 1.95 +/- 0.29 cm[2] [p< 0.0001]. Restenosis occurred in 165 patients [31%], and was less frequent [19%] in patients with a low mitral echo score [MES 8 [p< 0.001]. Event-free survival [death, redo MBV, mitral valve replacement, NYHA class III or IV] at 10, 15 and 18 years was 88 +/- 1%, 53 +/- 4%, and 21 +/- 5% respectively, and was significantly higher for patients with MES 8 [p< 0.0001] and previous surgery [p= 0.043] as predictors of restenosis, and MES >8 [p< 0.0001] and baseline atrial fibrillation [p=0.03] as predictors of combined events. MBV provides excellent long-term results for selected patients with MS. The long-term outcome of this procedure can be predicted from the baseline clinical and echocardiographic characteristics of the mitral valve