Echocardiographic abnormalities in systemic lupus erythematosus patients at Kenyatta National Hospital
Abstract
Background: The cardiovascular system is frequently affected in patients with systemic
lupus erythematosus (SLE). Involvement of various constituents of the heart and pulmonary
vessels has been found in several clinical and autopsy studies in patients with SLE; most of
which can be detected by noninvasive two dimensional and Doppler echocardiography. More
than half of SLE patients experience clinical cardiovascular manifestation during the course
of the disease and cardiovascular complications are among the leading causes of morbidity
and mortality in patients with SLE. The study set out to determine the prevalence and
spectrum of cardiac abnormalities; determined by echocardiography in SLE patients at KNH.
Methodology: This was a cross-sectional descriptive study of SLE patients attending clinic at
KNH. A total of 63 SLE patients were sampled consecutively over a period of 3 months.
Clinical examination and transthoracic echocardiography were done for all participants. The
echocardiogram outcome variables included; pericardial effusion, thickening and
calcification, systolic and diastolic dysfunction, mitral valve thickening, stenosis and
regurgitation, aortic valve thickening, stenosis and regurgitation, and pulmonary
hypertension.
Results: Sixty three SLE patients participated in the study, the mean age of participants was
36.7 years, with a female to male ration of 20:1. The mean duration of disease was 36.0 (IQR
14.0 – 65.0) months and over 70% of participants were on at least 2 disease modifying
medication. The over all prevalence of echocardiographic abnormalities was found to be
88.9%, the major drivers of this high prevalence being pericardial and valvular thickening.
The single most common cardiac lesion in the study was pericardial thickening at 77.8%. The
mitral valve was the most commonly affected valve with 69.8% and 30.2% having mitral
thickening and regurgitation respectively. Diastolic dysfunction was found in 50.8% of
participants and was found to be associated with older age at diagnosis. Pulmonary
hypertension was found in 22.2% of participants.
Conclusion: The study demonstrates a high prevalence of cardiac abnormalities among SLE
patient despite being on disease modifying medications. Even though the majority of these
abnormalities comprised of clinically insignificant pericardial and valvular thickening, the
prevalence of valvular insufficiency and pulmonary hypertension are substantially high
Publisher
University of Nairobi