AB0307 IS THERE ANY INFLUENCE OF THE ANTIRHEUMATIC THERAPY ON ECHOCARDIOGRAPHIC FINDINGS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS?
Authors: T. Panafidina, T. Popkova, L. Kondrateva, A. Volkov, E. Nasonov, A. Lila
Journal: Annals of the Rheumatic Diseases (2021)

Background: Cardiovascular diseases are becoming the leading cause of death among SLE patients due to increasing life-spans. Transthoracic echocardiography (TTE) is a routine and widely available modality in everyday clinical practice useful to identify specific pathological cardiac changes and predictors of heart failure. Objectives: The goal was to identify potential abnormalities in the TTE findings in SLE patients, with and without antirheumatic therapy. Methods: This is a prospective cross-sectional study including 91pts (91% females, aged 32[28-41]years (median [interquartile range 25%-75%]) with SLE (SLICC 2012 criteria). All patients were divided into 2 groups: the 1st group was composed of “untreated” patients and the 2nd – of patients receiving antirheumatic therapy. The 1st group included 43pts (93% females) aged 31[27–40]years who were not receiving steroids, immunosuppressants and biological agents at the time of enrollment, 5(12%) of them were on hydroxychloroquine (HCQ) therapy 200 mg/day. The 2nd group is represented by 48pts (89% females) with median age 34[28-45]years. Out of them 47(98%) patients were on prednisone therapy at 10[8-15]mg/day, 10(21%)- on cyclophosphamide, 6(13%)-azathioprine, 4(8%)-mycophenolate mofetil, 4(8%)-methotrexate, 37(71%)–HCQ, and 9(19%)–on biologic (rituximab, belimumab). Both groups were matched by age and gender. Patients receiving antirheumatic therapy (group 2) had longer disease duration (96 vs 18 months, p&lt;0,00001), lower disease activity (SLEDAI-2K 4 vs 11 scores, p&lt;0,001), higher SLICC/DI (1 vs 0 score, p&lt;0,001); lower percentage of them had skin lesions (11 vs 57%, p&lt;0,0001), arthritis (22 vs 52%, p&lt;0,05) and hematological disorders (24 vs 74%, p&lt;0,0001) than “untreated” patients from the 1st group. Results: Valve insufficiency with varying degree of clinically insignificant regurgitation and pericarditis were the commonest pathology found in “untreated” and “treated” SLE patients based on TTE data. No differences in rates of valve insufficiency (95% and 83%), pericarditis (43% and 47%) (both exudative and adhesive), endocarditis (26% and 33%), median left ventricular (LV) ejection fraction (64[59-68]% and 64[61-69]%), LV end-systolic dimension (30[27-32]mm and 29[25-31]mm), LV end-diastolic dimension (48[45-50]mm and 45[42-49]mm), pulmonary artery systolic pressure (25[22-31]mm Hg and 23[22-30]mm Hg), LV diastolic disfunction (26% and 21%) and LV systolic dysfunction (9% and 6%), LV myocardial hypertrophy (14% and 21%) and left atrium dilatation (9% and 21%) were found between the “untreated” SLE patients and patients receiving antirheumatic therapy (p&gt;0,05 for all cases). Higher rates of mitral and tricuspid valves prolapse was seen more often in “treatment-naїv” SLE patients: 16(47%) vs 10(21%), p&lt;0,01. Conclusion: Valvular dysfunction (insufficiency with clinically insignificant regurgitation), pericarditis, endocarditis and LVDD were the most common cardiac TTE abnormalities in SLE patients. Antirheumatic therapy seems not to worsen structural and functional cardiac abnormalities based on TTE findings in SLE patients. Only mitral and tricuspid valves prolapse was seen more often in “treatment-naїv” SLE patients. Disclosure of Interests: None declared