Background Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that affects multiple organs, with a broad spectrum of manifestations and a clinical status marked by periods of exacerbation and remission, with a variable course and prognosis. Cardiac abnormalities are common in lupus patients even when clinically asymptomatic from cardiac aspect. Echocardiography is an excellent non-invasive tool for cardiac evaluation.
Objectives The aim of this study is to investigate the relationship between echocardiographic parameters and mortality in lupus nephritis (LN) patients.
Methods A total of 258 LN patients who underwent echocardiography during year 1998–2015 were enrolled into this study. ln all patients a structural and functional cardiovascular alterations has been described. Association with all-cause and cardiac mortality were examined by the Cox proportional hazards model with adjustments for demographic factors, laboratory variables, medication use and echocardiographic parameters.
Results The median duration of follow-up was 191,72 ± 82,54 months. The frequency of heart complications in LN patients is quite variable and depends on follow-up period. Among 258 LN patients, 94 (36,43%) died during the follow-up period. Of them, 44 patients (46,81%) died of cardiac disease. Disease duration of SLE and proteinuria were risk factors associated with the descent of E/A (E: the peak velocity at rapid left ventricular filling; A: the peak velocity during left atrial contraction) ratio (p<0,05). In the multivariate analysis, the presence of cardiac manifestation, high systolic blood pressure (SBP) and serum level of C-reactive protein (CRP), low serum level of albumin, low estimated glomerular filtration rate (eGFR) and decreased left ventricular ejection fraction (LVEF) (p<0,05) were independently associated with increased all-cause mortality. Meanwhile, factors correlated independently with an increase in cardiac mortality included the presence of cardiac manifestation, low eGFR, increased left ventricular mass index (LVMI) (p<0,05) and decreased LVEF (p<0,05).
Conclusions Patients with LN have a higher risk of myocardial involvement, which can result in ventricular dysfunction. Decreased LVEF is associated with all-cause and cardiac mortality, whereas, increased LVMI is an independent risk factor for cardiac mortality in LN patients. These findings indicate the need for rigorous cardiac follow up in patients with LN.
Disclosure of Interest None declared