SAT0654 Association of prednisone and antimalarials and echocardiographic findings in asymptomatic cardiovascular patients with sle
Authors: I. Jochims, L.M.H. Mota, L. Muniz, D.F. Vasconcelos, L.L. Santos-Neto
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease that presents with increase of cardiovascular risk. Echocardiogram can detect morphofunctional cardiac changes and predict clinical outcomes in patients with SLE¹. <h3>Objectives</h3> To evaluate echocardiographic morphofunctional parameters in women with SLE, using conventional echocardiogram and to relate the echocardiographic findings to disease-related factors and therapeutics. <h3>Methods</h3> We have selected 51 women with SLE, without cardiovascular symptoms, under regular medical follow-up. Patients who had limitations to do echocardiography, smokers, and those with a creatinine level higher than 1.5 mg/dL were excluded. 51 patients were divided into two groups, patients with SLEDAI &lt;6 (n=30) and with SLEDAI ≥6 (n=21). They were submitted to clinical evaluation, laboratory tests and a traditional echocardiogram. <h3>Results</h3> Patients presented an average age of 34.5 years and average time of diagnosis of SLE of 7.2 years. In the comparison between groups, patients with SLEDAI ≥6 had a higher daily dose of prednisone (p=0.0016), more hospitalizations in the last 12 months (p=0.0173), and a higher cumulative dose of pulse therapy with methylprednisolone (p=0.008). Patients with SLEDAI &lt;6 had a longer average time of antimalarials (AM) use (p=0.0309). Regarding the echocardiographic parameters, group with SLEDAI ≥6 presented greater left ventricular mass (LVM, p=0.0156), thickness of ventricular septum (p=0.0106) and left ventricular posterior wall (LVPW, p=0.0273). In multivariate analysis the LVM presented a positive association with age (p=0.0160), current daily dose of prednisone (p=0.0009) and time of AM use (p=0.0026), r² 0.3625. Regarding the thickness of the interventricular septum, there was a positive association with age (p&lt;0.0001), current dose of prednisone (p&lt;0.0001), SLEDAI (p=0.02), SLICC (p=0.0093) and pulse with methylprednisolone (p=0.0062), with r² 0.6983. There is a positive association of daily dose of prednisone with the parameters LVPW, LVM and septum thickness and AM was a predictor of greater LVM. <h3>Conclusions</h3> Several factors may contribute to cardiac morphofunctional changes in SLE. Ventricular hypertrophy in asymptomatic cardiovascular patients was not related to the use of prednisone or time of AM use in other studies, however these factors should be taken into account. There are no adequate study designs in literature to evaluate the effect of high doses of corticosteroids and time of AM use on cardiac morphology and function. AM induced cardiomyopathy is a rare, probably under-recognised, complication of prolonged AM treatment, it presents as a hypertrophic, restrictive cardiomyopathy with or without conduction abnormalities. Early recognition and drug withdrawal are critical with a survival rate of almost 55%². Longitudinal studies are needed to determine the effect of prednisone and AM use in subclinical echocardiographic findings to avoid unfavourable cardiovascular outcomes. <h3>References</h3> [1]Chen J, et al. Heart involvement in systemic lupus erythematosus:a systemic review and meta-analysis. Clin Rheumatol2016;35:2437–48. [2] Tselios K, et al. Antimalarial-induced cardiomyopathy: a systematic review of the literature. Lupus2017;0:1–9. <h3>Disclosure of Interest</h3> None declared