Journal Article

904 Left ventricular dysfunction and inflammatory markers in systemic lupus erythematosus (SLE) patients with and without coronary microvascular dysfunction

Nelson, Michael D, Bairey Merz, C Noel, Bernardo, Marianne, Jefferies, Caroline, Bose, Moumita, Berman, Daniel S, Ishimori, Mariko, Hagiwara, Audrey M, Wei, Janet, Wallace, Daniel

2024

Overview

BackgroundWomen with SLE have an elevated risk of cardiovascular disease. Many women with SLE frequently report chest pain in the absence of obstructive coronary artery disease (CAD) due to coronary microvascular dysfunction (CMD), a form of ischemia with no obstructive CAD (Manchanda et al, 2022). Echocardiographic studies have shown that SLE patients have reduced left ventricular (LV) function, which may also correlate with higher SLE disease activity scores (Gegenava et al, 2020). As such, we used cardiac magnetic resonance imaging (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers, and cardiac function in female SLE patients.MethodsWe performed stress cMRI in women with SLE and chest pain with no obstructive CAD (n=13, all met ACR 1997 criteria, table 1) and reference controls (n=22) using our published protocol (Aldiwani et al, 2022). We evaluated LV function, tissue characterization (T1 mapping, ECV), and delayed enhancement, using CV142 software (Circle Cardiovascular Imaging Inc, Calgary, AB, Canada). Myocardial perfusion reserve index (MPRI) was calculated using our published protocol (Thomson et al, 2015). SLEDAI and SLICC Damage Index (DI) were calculated per validated criteria (Bombardier et al, 1992, Gladman et al, 1997). Serum samples were analyzed for inflammatory markers and autoantibodies (table 1). Independent two-tailed t test was performed on clinical values with CMD and no CMD SLE subjects, and on cMRI values with all SLE subjects and controls. Correlation analysis was done on clinical values, and cMRI values on all SLE subjects.ResultsOverall, 40% of SLE subjects had MPRI values < 1.84, consistent with CMD. Compared to controls, SLE subjects had significantly lower LVEF, and higher LVESVi and LVMi (table 2). Corresponding to this, radial, longitudinal, and circumferential strain were significantly lower in the SLE subjects. In correlation analysis of serum inflammatory biomarkers to cMRI values in the SLE subjects, SLICC DI was related to worse cardiac function (lower radial, circumferential and longitudinal strain) and higher T1 time (table 3).Additionally, fasting insulin and ESR were negatively correlated with LVMi. Fasting insulin also negatively correlated with ECV. CRP had a positive association with LVESV index and CI and a negative association with longitudinal strain.ConclusionsAmong women with SLE with chest pain and no obstructive CAD, 40% have CMD. While evaluations of known inflammatory markers (such as CRP and ESR) predictably correlated with decreased cardiac function (Jha et al, 2022), our study found that decreased fasting insulin levels as a novel marker of diminished LV function. In addition, although studies have used SLEDAI as a marker of disease activity in cardiac dysfunction, we are the first to demonstrate that SLICC DI, an assessment of SLE damage, is also correlated with cardiac dysfunction in SLE. This indicates that SLE patients with higher SLICC DI and increased SLE-related damage could potentially have silent involvement in their cardiac tissue, and as such using SLICC DI is another tool that should be used to evaluate the association between SLE and LV dysfunction. [694]Abstract 904 Table 1Baseline characteristics of female SLE participants. There were no group difference in clinical and laboratory values in the SLE participants with and without CMD. Complement 3 (C3); Complement 4 (C4); Erythrocyte Sedimentation Rate (ESR); C-Reactive Protein (CRP); Antinuclear antibody (ANA); Ribonucleoprotein (RNP); Smith (Sm); Anti- topoisomerase I antibody (Scl-70). Mean ±SD [ range ] SLE patients (n=13) CMD (n=5) No CMD (n=8) P values Age 46 ± 6 years 43 [37–51] years 48 [43–57] years NS SLICC 1.9 ± 2.5 2.8 ± 3 [0–6] 1.4 ± 2 [0–6] NS SLEDAI 0.5 ± 1 0.8 ± 0.8 [0–2] 0.4 ± 1 [0–3] NS Clinical Labs Fasting Blood Sugar(mg/dl) 77.6 ± 8.6 80.2 ± 6.5 [72–90] 75.5 ± 10.1 [65–91] NS Fasting Insulin (mIU/ml) 9.2 ± 11.3 14.8 ± 15.4 [2–42] 4.5 ± 2.5 [1.4–7.6] NS Serum Creatinine (mg/dL) 0.70 ± 0.08 0.67 ± 0.12 [0.55–0.84] 0.72 ± 0.03 [0.66–0.76] NS Serum Protein (g/dL) 7.29 ± 0.96 7.58 ± 1.47 [6.4–10.1] 7.09 ± 0.40 [6.8–7.9] NS C3 (mg/dL) 114 ± 30 124 ± 34 [81–153] 108 ± 26 [77–156] NS C4 (mg/dL) 26 ± 12 20 ± 11 [10–32] 29 ± 12 [22–51] NS ESR (mm/hr) 20.5 ± 20.5 32 ± 24 [16–73] 14 ± 16 [1–47] NS CRP (mg/dL) 3.2 ± 4.8 2.6 ± 2.2 [0.4–5.4] 3.6 ± 6.0 [0.2–17.9] NS Anti-ANA 434 ± 273 424 ± 299 [50–640] 440 ± 277 [80–640] NS Anti-DNA <10 <10 <10 — RNP Antibody 42.3 ± 58 68 ± 70.4 [2–156] 26.3 ± 46.8 [2–133] NS Anti-Sm 13.9 ± 18.7 17.2 ± 20.6 [2–52] 11.9 ± 18.6 [1–51] NS SSA (Ro) 22.8 ± 38.6 42.8 ± 55 [2–104] 10.4 ± 19.2 [1–56] NS SSB (La) 12.2 ± 28.4 22.8 ± 45.5 [2–104] 5.5 ± 8.3 [1–25] NS Anti-Scl 6 ± 7 4.2 ± 3.3 [2–10] 1 ± 25 [1–25] NS Abstract 904 Table 2Comparison of cardiac MRI analysis between SLE participants and reference controls (RC). Left Ventricular (LV) End Diastolic Volume (LVEDV); LV End Systolic Volume (LVESV); LV Systolic Volume (LVSV); Ejection Fraction (EF); LV Mass (LVM); LV End Systolic Diameter (LVESD); Body Surface Area (BSA); LVEDV/BSA (LVEDV index); LVESV/BSA (LVESV index); LVSV/BSA (LVSV index); LVM/BSA (LVM index); CO/BSA (cardiac index), Extracellular Volume Fraction (ECV). Variable SLE (n=13) RC (n=22) p-value LVEDV (ml) 127 ± 34 114 ± 18 NS LVESV (ml) 53 ± 20 42 ± 10 0.0339 LVSV (ml) 75 ± 18 73 ± 10 NS EF (%) 59 ± 7 64 ± 5 0.0242 LVM/LVESD (g/dL) 0.66 ± 0.08 0.62 ± 0.07 NS LVEDV/BSA (LVEDVi, mL/m2) 72.02 ± 15.4 67.40 ± 9.3 NS LVESV/BSA (LVESVi, mL/m2) 29.9 ± 10.2 24.5 ± 5.6 0.0481 LVSV/BSA (LVSVi, mL/m2) 42.56 ± 8.2 42.92 ± 5.4 NS LVM/BSA (LVMi, g/m2) 47.31 ± 9.3 41.34 ± 4.3 0.0141 CO/BSA (CI, L/min/m2) 3 ± 1 2.6 ± 0.3 NS LVM (g) 83 ± 20 70 ± 9 0.0119 Radial Strain 29.70 ± 6.2 34.37 ± 5.8 0.0306 Circumferential Strain -17.94 ± 2.5 -19.73 ± 2 0.0251 Longitudinal Strain -18.40 ± 2.2 -20.10 ± 1.9 0.0202 T1 1263 ± 35 1259 ± 56 (n=11) NS ECV 29 ± 3 29.3 ± 2.3 (n=11) NS Abstract 904 Table 3Correlation analysis of cardiac function versus clinical values from SLE participants in the study. The Spearman r coefficient and p value (p) is shown. LVESV: left ventricular end-systolic volume; LVEDV: left ventricular end-diastolic volume; LVSV: left ventricular systolic volume; EF: ejection fraction; LVM: left ventricular mass; BSA: body surface area; ECV: extracellular volume.

• Publisher: Lupus Foundation of America,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Antibodies / Biomarkers / Cardiac function / Cardiovascular disease / Correlation analysis / Ejection fraction / Insulin / Lupus / Lupus & Cardiovascular Disease