Subclinical deterioration of left ventricular function in patients with juvenile-onset systemic lupus erythematosus

Objectives: Patients with systemic lupus erythematosus (SLE) have a higher risk of myocardial involvement, which can result in ventricular dysfunction. Little is known about the chronic influence of SLE on heart function in children and adolescents. This is the first study to demonstrate long-term changes in left ventricular function in patients with juvenile-onset SLE. Methods: This was a longitudinal study of 92 patients with juvenile-onset SLE. Two-dimensional echocardiography was performed by a single pediatric cardiologist at baseline, with follow-up at six-month intervals. Clinical and laboratory parameters, disease activity, treatment, nailfold capillaroscopy, and the traditional risk factors for atherosclerosis were evaluated. The baseline comparison of ventricular function was performed against 50 age-matched controls, and the follow-up results were analyzed using generalized estimating equations. Results: The patients' mean age at baseline was 15.9 +/- 4.3 years, the mean disease duration was 3.6 +/- 3.2 years, and the mean follow-up duration was 4.5 +/- 1.6 years. At baseline, the mean left ventricular ejection fraction (LVEF) was 74.7 +/- 5.6% and the mean E/A ratio of left ventricular diastolic filling was 1.7 +/- 0.3 (E: the peak velocity at rapid left ventricular filling; A: the peak velocity during left atrial contraction). The LVEF of the SLE patients was similar to the healthy controls and it did not change during the follow-up period. In contrast, the E/A ratio was lower in the SLE patients than in the healthy controls (1.7 +/- 0.3 versus 1.88 +/- 0.37; p=0.002), and it decreased significantly with time (B +/- SE, -0.013 +/- 0.006, p=0.023). In multiple analyses, abnormal microvasculature in nailfold capillaroscopy had a negative effect on LVEF progression (p=0.039). Disease duration of SLE and proteinuria were risk factors associated with the descent of E/A ratio (p=0.014 and p=0.015, respectively). Conclusion: In patients with juvenile-onset SLE who were free of cardiac symptoms, there was evidence of declining ventricular diastolic function with time. Abnormal nailfold microvasculature, proteinuria and longer disease duration were the main risk factors for worsening of ventricular function.