The early cardiovascular changes in pediatric patients with systemic lupus erythematosus
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ORIGINAL ARTICLE
The early cardiovascular changes in pediatric patients with systemic lupus erythematosus Betul Sozeri & Murat Deveci & Nida Dincel & Sevgi Mir
Received: 24 June 2012 / Revised: 22 September 2012 / Accepted: 26 September 2012 / Published online: 8 November 2012 # IPNA 2012
Abstract Background In patients with systemic lupus erythematous (SLE) late-onset deaths are due to morbid cardiovascular changes (CVCs). Inflammatory and immune-mediated mechanisms are involved in promoting atherosclerosis development in SLE that is reflected in both functional and morphological changes in the cardiovascular system. The aim of our study was to determine the presence of these changes in pediatric SLE patients. Methods Fifty-one consecutive patients (13 male, 38 female) with SLE and 25 healthy controls were included in the study. Arterial stiffness was assessed by carotid–femoral pulse wave velocity (PWVcf) and augmentation index (AIx), as measured by the Vicorder. Carotid intima-media thickness (cIMT) and the left ventricular mass index (LVMi) were also determined. Results Patients with SLE, despite equivalent exposure to “traditional” cardiovascular risk factors, presented a higher mean PWVcf and AIx than controls (6.56±1.45 vs. 5.29± 0.67 m/s, P 00.01 and 14.7±8.1 vs. 9.36±3.59 %, P 0 0.02, respectively). SLE patients had greater values of cIMT and LVMi than controls (0.54±0.06 vs. 0.35±0.12 mm, P00.00 B. Sozeri (*) Department of Pediatric Rheumatology, Faculty of Medicine, Ege University, Bornova, Izmir, Izmir, Turkey e-mail: [email protected] M. Deveci Department of Pediatric Cardiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey N. Dincel : S. Mir Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
and 32.4±10.8 vs 28.8±1.5, P00.01, respectively). Nine patients had left ventricular hypertrophy (LVMi >38 g/m2.7). There was no significant difference in PWV, AIx, cIMT and LVMi values between presence of hypertension or nephritis within SLE patients. We found significant correlations between all parameters and activity scores. Conclusions Our results demonstrate that functional and morphological CVCs are independent of traditional risk factors in pediatric SLE patients and correlate with SLE disease activity scores in the early disease stages. Keywords Cardiovascular disease . Systemic lupus erythematosus . Nephritis . Pediatric . Atherosclerosis
Introduction Systemic lupus erythematous (SLE) has a bimodal pattern of mortality. Early deaths are due to lupus activation or infective complications, and late-onset deaths are due to morbid cardiovascular changes (CVCs), with a standardized mortality ratio of 3.78 [1, 2]. The excess risk of CVC in SLE patients compared with that of the general population cannot be completely explained by the excess presence of “traditional” risk factors, such as hypertension, hypertriglyceridemia, diabetes and chronic kidney disease. Apart from such traditional risk factors, several disease-related mechanisms, such as
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