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 the pericardium, endocardium, myocardium, coronary 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. Objective: To determine the prevalence and spectrum of cardiac abnormalities; determined by echocardiography in SLE patients at Kenyatta National Hospital (KNH). Methods: This was a cross-sectional descriptive study of SLE patients attending clinic at KNH. A targeted history and physical examination and a detailed trans-thoracic echocardiography were performed for all patients. The independent variables included; age, sex, duration of disease and medications. 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 was 36.7 years, with a female to male ration of 20:1 and a meadian duration of disease of 36 months. Over 70% of participants were on at least 2 disease modifying medication. The overall prevalence of echocardiographic abnormalities was 88.9%, the major drivers of this high prevalence being pericardial and valvular thickening. The single moast common cardiac lesion 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. Aortic valve thickening and regurgitation was found in 25.4% and 6.3% of participants 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 patients 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 and relatively higher than the prevalence seen in other studies in the case of pulmonary hypertension.