THU0256 CARDIAC INVOLVEMENT IN NEWLY DIAGNOSED SPANISH PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: DATA FROM THE RELES COHORT

Abstract

Background:Cardiac involvement is one of the most important causes of disability and mortality in patients with systemic lupus erythematosus (SLE). Transthoracic echocardiography (TTE) is a sensitive and specific technique in detecting cardiac abnormalities, particularly mild pericarditis, valvular lesions and myocardial dysfunction in SLE.Objectives:Using data of patients from the inception cohort Registro Español de Lupus Eritematoso Sistémico (RELES), we aimed to analyse the echocardiographic features of cardiac involvement of systemic lupus erythematosus (SLE).Methods:Prospective observational study on a multicenter Spanish inception cohort. Patients with SLE, diagnosed by the American College of Rheumatology (ACR) criteria, since January 2009, who had at least one TTE performed were selected. Demographic data, diagnostic criteria, follow-ups, treatments and SLEDAI were analyzed.Results:We included 289 patients diagnosed with SLE with TTE performed. The mean age was 40.5 ± 1.9 years, of which 86.9% (251) were women and 82.4% (238) Caucasian. The ACR score at diagnosis was 4.98 ± 0.1. Most frequent SLE manifestations were arthritis (59.2%), photosensitivity (49.5%), malar rash (39.1%) and serositis (31.1%). The main immunological findings were: ANA (97.6%), anti-DNA (66.4%), hypocomplementemia (58.7%), antiphospholipid antibodies (31.5%). One third (31.5%) of the TTE performed were pathological. Of these, 13.8% had pericardial effusion, 13.3% valvulopathy, 6.5% myocardial dysfunction, 5.2% pulmonary hypertension and 3.2% myocardiopathy. Regarding valvulopathies, 9,5% presented valvular dysfunction, 3.2% valvular thickening and 0.6% vegetation. The most frequently injured valve was the mitral (9.1%), followed by the aortic (2.8%). The majority of patients (88.26%) were asymptomatic at the time of TTE. However, patients with pathological TTE had more dyspnea than those in the normal TTE group (24.7% vs. 5.8%, p<0.001). Presenting a pathological TTE was associated with higher SLICC score (p<0.001), greater number of admissions (p<0.001) and mortality (p=0.002). A higher SLEDAI was also associated with higher mortality (p<0.001).Conclusion:Cardiac involvement in SLE is not only related to damage accrual but can also be an early manifestation (beyond pericarditis), especially in active SLE. TTE assessment should be considered as a part of routine examination for SLE due to the high prevalence of heart disease even in asymptomatic patients.