# Update: Heart Failure in Systemic Lupus Erythermatosus
## 1 Introduction  
Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan manifestation. Tissue damage attributed to SLE is caused by the presence of autoantibodies and immune complex deposition, which occurs primarily in the kidneys, heart, blood vessels, central nervous system, skin, lungs, muscles, and joints. Cardiac involvement is the second most common organic manifestation of SLE, after lupus nephritis, diagnosed in almost half of patients. The most well-known SLE cardiac manifestations are pericarditis and Libman-Saks endocarditis. Therefore, cardiovascular diseases are responsible for significant morbidity and mortality in patients with SLE [1, 2]. Generally, patients with an SLE diagnosis have a higher overall cardiovascular risk compared with the general population. However, the correlation between SLE and heart failure (HF) remains unknown.  
It has been extensively suggested that SLE patients may be burdened with a higher incidence of HF than the general population [3, 4, 5, 6, 7, 8]. However, the increased prevalence of HF does not explain the occurrence of myocarditis, which is a rare comorbidity in SLE [9, 10]. It is estimated that the incidence of HF in SLE may be up to 5 times higher than in the general population [3, 4]. Moreover, reduced left ventricular ejection fraction (LVEF) in patients with SLE compared to the control groups has been observed in previous studies [11, 12]. Although the exact pathogenesis of HF in SLE is not entirely understood, chronic inflammation, immune dysfunction, and cardiovascular risk factors play a significant role in the development of heart failure. What is more, HF may be the first manifestation of SLE. Treatment is another important issue, as cardiac involvement in SLE may present as end-stage heart failure, requiring orthotopic heart transplantation (OHT) [13]. Althoughcardiovascular diseases are one of the leading causes of death in patients with SLE, myocardial dysfunction is often asymptomatic or presents with nonspecific signs. Finally, the difficulties in identifying disease in its early stages using standard techniques preclude detection of early subclinical cases.  
In summary, due to the complex pathogenesis of SLE, early detection of cardiac problems may prove burdensome, which leads to delayed introduction of targeted treatment. There is a strong need for a better understanding of the mechanisms leading to heart failure in SLE. Furthermore, more effective diagnostic and therapeutic methods are being sought. The existing literature on heart failure in SLE is scarce. Notwithstanding the growing number of studies, there is still a lack of guidelines for the management of SLE-related HF, which makes optimization of the treatment in this group demanding. Thus, further studies focused on the increased risk of HF in patients with SLE are needed [14; 15; 16; 17]. This article summarizes the latest reports on the epidemiology, symptoms, and potential treatment methods of heart failure in patients with SLE. A detailed review of the scientific databases Clinical Key, PubMed, and EMBASE was performed to prepare the manuscript. Particular attention was paid to the reports from the last decade (2014-2024).