Cardiovascular Manifestations in Systemic Lupus Erythematosus : SYMPOSIUM ON SECONDARY MYOCARDIAL DISEASE : 44th Scientific Session of the Japanise Circulation Society

Abstract

Cardiovascular manifestations in 48 patients with systemic lupus erythematosus were investigated by means of echocardiography and other non-invasive cardiac function tests. During the mean follow-up period of 17 months, 94 per cent of the patients showed abnormalities in the cardiac function tests. Pericardial effusion, a most frequent abnormality, was noted in 53 per cent of the patients at the active phese and in 12 per cent at the inactive phase. In the normotensive patients, echocardiographic values and ratio of pre-ejection period to left ventricular ejection time (PEP/LVET) changed toward normal range with change from the active phase to the inactive, and remained unchanged after a long-term corticosteroid therapy. In the hypertensives, on the other hand, these values changed toward more abnormal range after a long-term corticosteroid therapy. It was suggested that hypertension accerelates the cardiac lesions initiated by the autoimmune process. The patients who had manifested pericardial effusion showed more marked cardiac abnormalities than those without effusion at the both active and inactive phases, suggesting that some cardiac muscle involvement (lupus carditis) underlied behind the pericarditis. The patients who manifested Raynaud's phenomenon showed the significantly greater right ventricular dimension at the active phase than in those without this sign. As a mechanism for this result, the association of Raynaud's phenomenon and pulmonary vascular involvement was considered. Hence, the present study suggests 3 major mechanisms for the cardiac abnormalities in SLE: 1) lupus carditis, 2) pulmonary vascular involvement, and 3) systemic hypertension. The effects of corticosteroid therapy on these factors were discussed. A comparison between SLE and other allied diseases due to the auto-immune mechanism revealed that overlap syndrome is characterized by high incidence of increased right ventricular dimension and pulmonary hypertension.