Subclinical cardiac involvement in systemic lupus erythematosus

ABSTRACT

Cardiovascular lesions are commonly found in children and adolescents with systemic lupus erythematosus [SLE] with relevant implication in mortality and morbidity. The purpose of the study was to verify whether there is any sign of cardiovascular involvement in childhood SLE without clinical manifestations using electrocardiography [ECG] and echocardiography [ECHO]. The study was carried out on 40 children with SLE who attended the outpatient clinics of Rheumatology, Pediatrics, Cardiology and Internal Medicine departments of Assiut and AI-Azhar universities. They were free of any clinically evident cardiac manifestations such as dyspnea, orthopnea and edema of the lower limbs. In addition, twenty apparently healthy children were taken as a control group. All subjects underwent complete history and physical examinations, x ray chest, ECG and two dimensional,M mode, continuous wave [CW], pulse wave [PW] and color flow Doppler examinations .The following investigations were done complete blood count [CBc], erythrocyte sedimentation rate[ESR], antistreptolysin O titre [A SOT], C reactive protein[CRP], C[3] complement, rheumatoid factor[RF],anfinuclear antibodies[ANA] and anti double strand DNA[anti ds DNA]. Minor ECG changes were detected in 15% of patients. ECHO showed pericarditis with effusion, aortic insufficiency, mitral regurgitation, mild tricuspid regurgitation and mild pulmonary hypertension in 15%, 20%, 25%, 15% and 20% of patients with SLE respectively. A significant reduction of ejection fraction [EF] and fraction shortening [FS] was found in our patients .Significant diastolic dys functions were manifested by decreased early diastolic flow velocity [E], early diastolic flow velocity/late diastolic flow velocity [E/A] ratio and increased E deceleration time [Edt], left ventricular posterior wall diameter in diastole [LVPWd], interventricular septum in diastole[.lVSd] and pulmonary artery systolic pressure [PASP]. Cardiovascular involvement in childhood SLE is Regular cardiac evaluation using [ECG] and [ECHO] is recommended to detect subclinical cardiac involvement