EXTENDED REPORT

Cardiac dysfunction in patients with systemic lupus erythematosus and antiphospholipid syndrome

Daphna Paran¹, Dan Caspi¹, David Levartovsky¹, Ori Elkayam¹, Ilana Kaufman¹, Irena Litinsky¹, Gad Keren², Bella Koifman²

¹ Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
² Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Correspondence to:
Dr D Paran
Department of Rheumatology, Tel-Aviv Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel; Parand{at}netvision.net.il

Objective: To comparatively assess the parameters of systolic and diastolic cardiac function in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

Methods: Consecutive patients (n = 74) who were free of cardiovascular symptoms were divided into four groups: (1) SLE (n = 23); (2) SLE with antiphospholipid antibodies (aPL; n = 18); (3) SLE with APS (n = 20); and (4) primary antiphospholipid syndrome (PAPS; n = 13). Pulsed, continuous, colour Doppler echocardiography, and M-mode and B-mode studies were performed.

Results: Left ventricular end diastolic and end systolic dimensions were higher in SLE as compared with patients with PAPS (p = 0.022 and 0.022, respectively), with a trend towards a lower fractional shortening in SLE (p = 0.07), suggesting systolic dysfunction. Parameters of diastolic function were more impaired in patients with APS, reflected by lower left ventricular and right ventricular E wave to A wave (E:A) ratios in patients with APS (groups 3, 4) compared with those without APS (groups 1, 2; 1.15 (0.40) v 1.49 (0.43), p = 0.001 and 1.19 (0.31) v 1.49 (0.41), p = 0.001, respectively) and a more prolonged left ventricular isovolumic relaxation time (IVRT; 94.2 (24.6) v 84.4 (17) ms, respectively, p = 0.055). Patients with APS were older than those without APS (47.12 (14.86) v 34.29 (12.6), p = 0.0001). Patients with SLE were younger than those with PAPS (38.19 (14.68) v 48.53 (13.97), p = 0.023).

Conclusion: Abnormal echocardiographic findings were detected frequently in asymptomatic patients with SLE or PAPS. Although patients with SLE were younger, left ventricular systolic function was more impaired in patients with SLE compared with those with PAPS, whereas left ventricular and right ventricular diastolic function, as reflected by IVRT and E:A ratios, were significantly more impaired in patients with APS.

Abbreviations: aPL, antiphospholipid antibodies; APS, antiphospholipid syndrome; IVRT, isovolumic relaxation time; PAP, pulmonary arterial pressure; PAPS, primary antiphospholipid syndrome; SLE, systemic lupus erythematosus; SLEDAI, systemic lupus erythematosus disease activity index

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