Background Althogh pulmonary arterial hypertension (PAH) is a severe manifestation of systemic lupus erythematosus (SLE), the pathogenesis of PAH associated with SLE is yet unclear.
Objectives In this study, we evaluated the carotid atherosclerosis, elastic properties of the common carotid artery (CCA), reflected by the values of strain of the carotid artery wall based on the speckle tracking imaging, and investigated the association between the parameters of carotid arterial stiffness and clinical, laboratory parameters of systemic inflammatory activity in SLE patients accompanied with PAH.
Methods Measurement of carotid artery strain parameters and Doppler echocardiography was performed in 50 patients with SLE. Fifty healthy volunteers (52.1 ± 12.0 years, women) from the health screening center were selected as control group. Exclusion criteria for both groups were smoking (in the last 5 years), diabetes mellitus (DM), hypertension, hypercholesterolemia, pregnancy, renal failure, chronic hepatopathy, nephrotic syndrome, and hypothyroidism. We also excluded patients with symptoms or signs of right heart failure and patients with pulmonary hypertension associated with left-sided heart disease, pulmonary thromboembolism, hypoxemia, or known other causes of secondary pulmonary hypertension. PAH was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 40 mmHg. All patients were subjected to full history taking, laboratory studies and chest x-ray. SLE activity was assessed by SLE disease activity index (SLEDAI).
Results In 50 SLE patients, PAH was detected in 6 patients (16 %). Patients with PHT showed reduced RV function represented by higher RV myocardial performance index and reduced RV strain. Significantly higher frequency of anti-cardiolipin antibodies were found in patients with PAH versus those without (P = 0.008). BaPWV and positive ACL were significantly associated with occurrence of PAH in SLE (P = 0.007, P = 0.006 respectively). No significant correlations were found between pulmonary artery pressure, disease duration, SLE Disease Activity Index (SLEDAI), ESR, and anti-ds DNA titers.
Conclusions Patients with SLE have an increased risk of PAH. Positive anti-cardiolipin antibodies and was significant predictors of pulmonary hypertension in our study. The significant association of LAC and presence of APS in PAH cases suggests that thrombosis may play an important role in PAH with SLE.
Disclosure of Interest None Declared
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