The ultrasound characteristics of the cardiovascular system in systemic lupus erythematosus in children

Abstract

Background. Systemic lupus erythematosus (SLE) is one of the most typical diffuse connective tissue diseases characterized by the involvement of many organs and systems in the pathological process. Cardiac involvement in SLE is one of the most common manifestations of visceritis in both adults and children. According to various authors, the frequency of heart involvement ranges widely from 40% to 90–95%, with changes being detected in 100% of patients during autopsy. Establishing an accurate diagnosis of cardiovascular system changes in SLE is challenging yet crucial for assessing disease activity and prognosis. This has become possible with the clinical application of modern objective functional methods of examination such as echocardiography and Doppler, which have significantly increased the detection rate of even subclinical forms of heart involvement. Purpose – of the study is to examine the structural and functional state of the heart in children with systemic lupus erythematosus using echocardiography. Materials and Methods. We analyzed echocardiography and Doppler data of 32 children aged from 11 to 18 years old with systemic lupus erythematosus who were examined and treated at the Institute for the Protection of Children’s and Adolescents’ Health of the National Academy of Medical Sciences of Ukraine. There were 7 boys (21.87%) and 25 girls (78.13%) among the patients. The diagnosis was confirmed through comprehensive clinical, laboratory, and instrumental examinations. Ultrasound scanning of the heart and major vessels was performed using «Siemens SL-1» and «Logic-400» General Electric pulse-wave devices with color mapping. Results. The study revealed that the most frequent signs of systemic connective tissue dysplasia diagnosed by echocardiography were the presence of abnormal chords in the left ventricle (in 24 patients – 75%) and mitral valve prolapse (in 12 patients – 37.50%). A typical sign of the disease was lupus carditis manifested by the reduction in the left ventricular diameter systolic contraction (22 patients – 68.75%) and thickening of the left ventricular myocardium and the thickness of the interventricular membrane in 15 patients (46.88%). Left ventricular contractile function was reduced (EF < 60%) in 15 patients (46.88%). In cases with a disease duration of up to two years and grade I activity of the pathological process, an increase in contractile function was observed in 3 patients (9.38%). Grade I/II mitral insufficiency was present in 2 patients (6.25%). Grade I aortic insufficiency was found in 1 patient (3.13%). Characteristic changes in the right ventricle were also observed in patients with systemic lupus erythematosus. The most common findings included enlargement of the right ventricular cavity and the outlet tract of the right ventricle (in 15 patients – 46.88%), hyperkinesia (in 3 patients – 9,38%) and myocardial thickening. Accumulation of fluid in the pericardial cavity during echocardiography was observed in 9 patients (28.13%) as a sign of polyserositis. The amount of liquid was small. Conclusions. The study established the polymorphism of pathological changes in the cardiovascular system of patients with systemic lupus erythematosus, which dictates the necessity of conducting echocardiography and Doppler both at the initial examination and during monitoring of the pathological process and treatment quality. The high frequency of diagnosed abnormal chords may indicate a congenital predisposition of connective tissue in patients with systemic lupus erythematosus to dysplasia. Echocardiography is especially valuable for identifying valve and pericardial lesions.