SAT0198 PROBABILITY OF PULMONARY HYPERTENSION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS ACCORDING TO ESC GUIDELINE 2015
Authors: H. Baharuddin, N. F. Abdul Manaf, Z. Ismail, K. S. Ibrahim, M. Mohd Zain, S. S. Ch’ng
Journal: Annals of the Rheumatic Diseases (2020)

Background: The prevalence of pulmonary hypertension (PH) in systemic lupus erythematosus (SLE) varied according to the definitions and investigations used. Echocardiography should always be performed when PH is suspected, based on symptoms and signs, 1 which may be difficult to be assessed in patients with SLE because early symptoms of PH, including shortness of breath, fatigue, weakness, angina and syncope can be part of disease manifestation. Objectives: To investigate the probability of PH in patients with SLE based on 2015 ESC Guideline, regardless of symptoms. Methods: A cross-sectional study was conducted in a rheumatology centre in Malaysia which included patients aged 18 years and above, who fulfilled SLICC2012 criteria. Exclusion criteria were diagnosis of overlap syndrome and pregnancy. Demographic data and immunology profile were obtained from electronic medical records. TTE was performed by one technician who was blinded to other clinical details. Low, intermediate or high probability of PH was determined based on 2015 European Society of Cardiology (ESC) echocardiography criteria of PH. Results: A total of 60 patients with SLE were recruited. The mean age was 41.6±10.9 years and SLE disease duration was 11.5±9.4 years. The cardiovascular co-morbidities were hypertension (38.3%), dyslipidaemia (25%), diabetes mellitus (5.0%) and ischemic heart disease (1.6%). Based on 2015 ESC echocardiography criteria for PH, 50 (83.3%) patients had low probability of PH, 8 (13.3%) had intermediate probability of PH and 2 (3.3%) with high probability of PH. (Table 1). Further analysis revealed that two patients with high PH probability were asymptomatic at the time of study. They were treated for active SLE after PH was diagnosed from TTE performed within a year of study period and subsequent RHC confirmed pulmonary arteria hypertension (PAH). Among patients with intermediate probability of PH, one patient had intermittent palpitation and chest pain, while others were asymptomatic including one patient with PAH based on RHC. The most prevalent auto-antibodies among patients with intermediate and high probability of PH were anti-Ro (8 patients), anti-nuclear antibodies (7 patients) and anti-dsDNA (5 patients). Table 1. The details of echocardiographic signs of PH in patients with SLE. Echocardiographic ‘signs’ of PH PH probability (no of patients ) Low, n=50 Intermediate, n=8 High, n=2 Peak tricuspid regurgitant velocity, m/s • ≤2.8 • 2.9-3.4 • &gt;3.4 50 0 0 1 7 0 0 0 2 Ventricles • Right/ left ventricle basal diameter ratio &gt;1.0 • Flattening of interventricular septum 0 0 1 0 2 2 Pulmonary artery • Right ventricular outflow Doppler acceleration time &lt;105ms and/or mid-diastolic notching • Early diastolic pulmonary regurgitation velocity &gt;2.2m/s • PA diameter &gt;25mm 28 0 4 5 0 2 2 2 2 Inferior vena cava and right atrium • Inferior cava diameter &gt;21mm with decreased inspiratory collapse • Right atrial area &gt;18cm 2 0 0 0 0 0 2 Conclusion: We found 16.6% patients with SLE who had intermediate and high probability of PH, based on 2015 ESC echocardiography criteria for PH. All except one patient had symptoms suggestive of PH at the time of study. RHC performed subsequently on two patients with high PH probability confirmed PAH. References: [1]Galie N, Humbert M, Vachiery JL, et al. European Heart Journal, 2016; 37(1):67-119 Acknowledgments : We are thankful to Mrs Maisarah, our dedicated echocardiography technician. Disclosure of Interests: Hazlyna Baharuddin Speakers bureau: Sanofi, J&amp;J, Nur Farhana Abdul Manaf: None declared, Zaliha Ismail: None declared, Khairul Shafiq Ibrahim: None declared, Mollyza Mohd Zain: None declared, Shereen Suyin Ch’ng Speakers bureau: Novartis, Pfizer, GSK