Lupus Anticoagulant Linked With Cardiac Dysfunction in SLE

Lupus anticoagulant (LAC) may be a predictor of cardiac dysfunction in people with systemic lupus erythematosus (SLE), according to a new study.

SLE is a heterogenous autoimmune disease that can affect multiple organs. However, cardiovascular manifestations are one of the most serious and deadly complications. As many as half of people with SLE will die as a result of cardiovascular disease, noted corresponding author SørenJacobsen, MD, DMSc, of Denmark’s Rigshospitalet, and colleagues. Their study was published in the Journal of Autoimmunity.

Despite the stark prevalence numbers, the investigators said there has not been significant improvement in patient cardiovascular outcomes in the past 2 decades.

“Hence, understanding the underlying pathophysiological mechanisms and identifying risk factors have been subject for increased investigation but are challenged by the highly complex and heterogeneous characteristics of the disease,” they wrote.

The authors said cardiovascular risk in SLE is believed to be tied both to disease-specific factors and individual factors. In the new report, the authors sought to compare disease characteristics with cardiovascular outcomes 5 years later.

Jacobsen and colleagues recruited 108 patients (90% of whom were females) who had an average age of 46.1 and a median disease duration of 14.7 years. Patients underwent blood testing and echocardiography at baseline and at a follow-up of 5 years.

On echocardiography, the investigators found that overall E/A ratio and tricuspid regurgitation peak velocity both regressed, left ventricular end-diastolic volume index increased, and left and right ventricular systolic function was unchanged, on average.

Jacobsen and colleagues said the subjects in their study mostly had normal echocardiographic parameters at baseline, with diastolic dysfunction present in just 9% of patients, most of whom had mild dysfunction related to known heart disease. However, the data show that 5 years later, things had changed.

“These changes were associated with the presence of LAC, suggesting other mechanisms despite simply advancing age and/or coronary artery disease,” they wrote.

The authors found that the presence of LAC was associated with poorer diastolic function and with left ventricular dilatation at follow-up.

About half of the participants underwent clinically significant cardiac remodeling, the authors said, and it is possible that LAC played a mediating role in such changes, they said.

“Hence, we can report of potentially clinically significant changes in diastolic function and cardiac remodeling in this cohort with some association with LAC,” they wrote.

It’s too soon to know whether LAC has real-world prognostic value, but they said clinicians should be aware that the presence of LAC could be a warning sign warranting closer cardiovascular follow-up.

The authors noted limitations including their relatively small sample size and the lack of a healthy control group with which to compare outcomes. They said their main purpose was not to compare people with SLE to people without the disease, but rather to compare clinical findings with biochemical and echocardiographic changes.

“With this prospective study, we wished to identify SLE-related markers that [are] associated with declining cardiac function,” they wrote.

Jacobsen and colleagues said the study provides evidence that LAC is one such marker.

“These results suggest that changes in cardiac size and function in SLE patients are partly attributed to immunological mechanisms,” they wrote.

Reference

Myhr KA, Zinglersen AH, Hermansen MF, et al. Left ventricular size and function in patients with systemic lupus erythematosus associate with lupus anticoagulant: An echocardiographic follow-up study. J Autoimmun. Published online August 24, 2022. doi:10.1016/j.jaut.2022.102884