Department of Cardiac and Vascular Diseases, The John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.
Lupus. 2011 Aug;20(9):936-44. doi: 10.1177/0961203311399607. Epub 2011 Jun 2.
Conventional risk factors of coronary artery disease fail to explain the increased frequency of cardiovascular morbidity in patients with systemic lupus erythematosus (SLE). The study was conducted to determine possible association between the heart structure and function abnormalities with established prognostic value assessed by non-invasive imaging techniques and markers of autoimmune and inflammatory phenomena typical for SLE. Echocardiography and single photon emission computerized tomography (SPECT; Tc-99m-MIBI) at rest were performed in 60 SLE patients in a stable clinical condition of their disease. Laboratory evaluation included serum levels of C-reactive protein (CRP), complement C3c and C4 components and antiphospholipid antibodies (aPL). The latter included serum anticardiolipin (aCL) and anti-β2-glycoprotein I (antiβ2GPI) antibodies, both of IgG and IgM class, and lupus anticoagulant (LA) in plasma. Echocardiography revealed pathologic thickening of valvular leaflets and/or pericardium in more than 60% of patients. Right ventricular systolic pressure (RVSP) was elevated (>30 mmHg) in 16.7%. Myocardial perfusion defects were present in 36.7% of patients, despite normal ECG recordings and a lack of clinical symptoms of myocardial ischaemia. There was a significant association between thickening of valvular leaflets and/or pericardium and high CRP and low C3c and C4 concentrations. On the other hand, increased RVSP and the presence of myocardial perfusion defects were associated with the presence of anticardiolipin and antiβ2GPI antibodies of the IgG class. Increased anticardiolipin IgG levels predicted perfusion defects in SPECT study with 100% sensitivity and 68% specificity, whereas elevated antiβ2GPI IgG levels predicted RVSP elevation (>30 mmHg) with 100% sensitivity and 78% specificity. In stable SLE patients pericardial and valve abnormalities may be associated with markers of an ongoing inflammation. Also, pulmonary systolic pressure elevation and myocardial perfusion defects are combined with elevated levels of anticardiolipin and antiβ2GPI antibodies of the IgG class. These results indicate that even clinically silent pulmonary hypertension and myocardial perfusion defects in SLE patients could be causally related to the presence of antiphospholipid antibodies.
传统的冠心病危险因素不能解释系统性红斑狼疮（SLE）患者心血管发病率的增加。本研究旨在确定心脏结构和功能异常与通过非侵入性成像技术和标记物评估的既定预后价值之间的可能关联，这些标记物反映了 SLE 患者的自身免疫和炎症现象。在病情稳定的情况下，对 60 例 SLE 患者进行了超声心动图和单光子发射计算机断层扫描（SPECT；Tc-99m-MIBI）检查。实验室评估包括血清 C 反应蛋白（CRP）、补体 C3c 和 C4 成分以及抗磷脂抗体（aPL）的水平。后者包括血清抗心磷脂（aCL）和抗-β2-糖蛋白 I（抗β2GPI）抗体的 IgG 和 IgM 类，以及血浆中的狼疮抗凝剂（LA）。超声心动图显示超过 60%的患者出现瓣叶和/或心包病理性增厚。16.7%的患者右心室收缩压（RVSP）升高（>30mmHg）。尽管心电图记录正常且无心肌缺血的临床症状，但 36.7%的患者存在心肌灌注缺损。瓣叶和/或心包增厚与 CRP 升高和 C3c 和 C4 浓度降低显著相关。另一方面，增加的 RVSP 和存在心肌灌注缺损与 IgG 类抗心磷脂和抗β2GPI 抗体有关。升高的 IgG 类抗心磷脂水平可预测 SPECT 研究中的灌注缺损，敏感性为 100%，特异性为 68%，而升高的抗β2GPI IgG 水平可预测 RVSP 升高（>30mmHg），敏感性为 100%，特异性为 78%。在稳定的 SLE 患者中，心包和瓣膜异常可能与持续炎症的标志物相关。此外，肺动脉收缩压升高和心肌灌注缺损与 IgG 类抗心磷脂和抗β2GPI 抗体水平升高有关。这些结果表明，即使在 SLE 患者中存在临床无症状的肺动脉高压和心肌灌注缺损，也可能与抗磷脂抗体的存在有关。
