SPECTRUM OF CARDIAC INVOLVEMENT IN SYSTEMIC LUPUS-ERYTHEMATOSUS - ECHOCARDIOGRAPHIC, ECHO-DOPPLER OBSERVATIONS AND IMMUNOLOGICAL INVESTIGATION

Cardiac involvement was noninvasively evaluated in 75 consecutive pati ents with systemic lupus erythematosus (SLE) by two-dimensional and Do ppler echocardiography. In 50/75 patients anticardiolipin antibodies ( aCL) were also investigated. Major endocardial damage, characterized b y the simultaneous presence of both anatomical and functional valvular involvement (AFVI), was observed in three patients with valvular vege tations and in five patients with combined valvular stenosis and/or re gurgitation. Nine patients showed only an anatomic valvular involvemen t (AVI), expressed by a thickening of one or more valvular leaflets, w ithout echo-Doppler findings of valvular dysfunction. Occurrence of ma jor valvular involvement appears to be correlated with both longer dis ease duration (9.8 +/- 5.6 yrs in AFVI group vs 5.7 +/- 5.6 yrs in the remaining SLE patients; p < 0.001) and IgG aCL (chi-square = 5.546; p < 0.05). Left ventricular systolic function, evaluated by two-dimensi onal echocardiographic ejection fraction, was preserved in all patient s (EF: 60 +/- 5 %). Left ventricular diastolic function, as expressed by echo-Doppler transmitral flow indices of left ventricular filling, was subclinically impaired in 23 patients: only disease duration was s ignificantly longer in these patients (7.7 +/- 5.9 yrs vs 4.9 +/- 4.8 yrs; p < 0.05). Our study demonstrated that cardiac involvement is qui te frequent in SLE patients: the disease duration affects both endocar dial and myocardial involvement; the anticardiolipin antibodies appear to be related to endocardial but not to myocardial damage.