AB0422 LEFT VENTRICULAR ABNORMALITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS FOLLOWED BY SEQUENTIAL ECHOCARDIOGRAPHY
Authors: T. Kuga, M. Matsushita, K. Tada, K. Yamaji, N. Tamura
Journal: Annals of the Rheumatic Diseases (2020)

Background: Cardiovascular disease (CVD) is detected in up to 50% of systemic lupus erythematosus (SLE) patients 1 and major cause of death 2 . Even clinically silent SLE patients can develop left ventricular (LV) diastolic dysfunction 3 . Proper echocardiographic follow up of SLE patients is required. Objectives: To clarify how the prevalence of LV abnormalities changes over follow-up period and identify the associated clinical factors, useful in suspecting LV abnormalities. Methods: 29 SLE patients (24 females and 5 men, mean age 52.8±16.3 years, mean disease duration 17.6±14.5 years) were enrolled. All of them underwent echocardiography as the baseline examination and reexamined over more than a year of follow-up period(mean 1075±480 days) from Jan 2014 to Sep 2019. Patients complicated with pulmonary artery hypertension, deep venous thrombosis or pulmonary embolism and underwent cardiac surgery during the follow-up period were excluded. Left ventricular(LV) systolic dysfunction was defined as ejection fraction (EF) &lt; 50%. LV diastolic dysfunction was defined according to ASE/EACVI guideline 4 . LV dysfunction (LVD) includes one or both of LV systolic dysfunction and LV diastolic function. Monocyte to HDL ratio (MHR) was calculated by dividing monocyte count with HDL-C level. Prevalence of left ventricular abnormalities was analysed at baseline and follow-up examination. Clinical characteristics and laboratory data were compared among patient groups as follows; patients with LV dysfunction (Group A) and without LV dysfunction (Group B) at the follow-up echocardiography, patients with LV asynergy at any point of examination (Group C) and patients free of LV abnormalities during the follow-up period (Group D). Results: At the baseline examination, LV dysfunction (5/29 cases, 13.8%), LV asynergy (6/29 cases, 21.7%) were detected. Pericarditis was detected in 7 patients (24.1%, LVD in 3 patients, LV asynergy in 2 patients) and 2 of them with subacute onset had progressive LV dysfunction, while 5 patients were normal in echocardiography after remission induction therapy for SLE. At the follow-up examination, LV dysfunction (9/29 cases, 31.0%, 5 new-onset and 1 improved case), LV asynergy (6/29 cases, 21.7%, 2 new-onset and 2 improved cases) were detected. Though any significant differences were observed between Group A and Group B at the baseline, platelet count (156.0 vs 207.0, p=0.049) were significantly lower in LV dysfunction group (Group A) at the follow-up examination. Group C patients had significantly higher uric acid (p=0.004), monocyte count (p=0.009), and MHR (p=0.003) than Group D(results in table). Conclusion: LV dysfunction is progressive in most of patients and requires regular follow-up once they developed. Uric acid, monocyte count and MHR are elevated in SLE patients with LV asynergy. Since MHR elevation was reported as useful marker of endothelial dysfunction 5 , our future goal is to analyse involvement of monocyte activation and endothelial dysfunction in LV asynergy of SLE patients. References: [1]Doria A et al. Lupus. 2005;14(9):683-6. [2]Manger K et al. Ann Rheum Dis. 2002 Dec;61(12):1065-70. [3]Leone P et al. Clin Exp Med. 2019 Dec 17. [4]Nagueh SF et al. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314. [5]Acikgoz N et al. Angiology. 2018 Jan;69(1):65-70. Numbers are median (interquartile range), Mann-Whitney u test were performed, p value less than 0.05 was considered statistically significant. Disclosure of Interests: : None declared