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Background and Aims

To study the predictive value of serum PCSK9 on cardiovascular complications in patients with systemic lupus erythematosus (SLE).

Methods

Consecutive patients who fulfilled ≥4 ACR criteria for SLE and consented for a biomarker study in 2009-2012 were included. Stored serum samples were assayed for PCSK9. New ischemic vascular events over time were evaluated. Patients were stratified into high/low PCSK9 groups based on the best cut-off by ROC analysis in predicting vascular events. Cox regression was performed to study the effect of the PCSK9 subgroups on vascular events adjusted for confounders.

Results

539 SLE patients were studied (93% women, age 41.9±14.0 years). A PCSK9 level of 243.25ng/ml best predicted a new vascular event (sensitivity 69%; specificity 61%). The high PCSK9 group (n=220) did not differ from the low PCSK9 group (n=319) in SLE manifestations except for more frequent renal disease. Over 91.3±18.6 months, 29 patients developed 31 vascular events and 40 patients succumbed (25% for vascular events). The cumulative incidence of a first vascular event at 5 years was 7.8% in the high PCSK9 and 1.9% in the low PCSK9 group (p=0.003). Patients with high PCSK9 had a significantly higher risk of all-cause mortality (HR2.68[1.39-5.14]; p=0.003) and vascular mortality (HR12.4[1.56-98.4]; p=0.02). Cox regression showed high PCSK9 was significantly associated with new vascular events (HR2.56[1.10-5.99]; p=0.03) independent of age, sex, SLE duration, traditional risk factors, antiphospholipid antibody and the use of statins, aspirin and immunosuppressive drugs.

Conclusions

Serum PCSK9 is a promising biomarker for ischemic vascular events in patients with SLE.

Background and Aims

As survival of SLE patients has improved significantly in the past decades, there have been an increase in organ damage accrual as a result of lupus flares, co-morbidity and treatments.

The objective was to assess the accumulated damage (AD) and determine the contribution of comorbidities to the damage score

Methods

A retrospective study was conducted on patients with a diagnosis of SLE (ACR 1997) included in the national registry of Systemic Lupus Erythematosus of the Argentine Society of Rheumatology (RELESSAR). Socio-demographic, clinical and therapeutic variables, the damage score at the last control (SLICC / SDI) and comorbidities were evaluated: diabetes, hypertension (HT), dyslipidemia, smoking, alcoholism and chronic obstructive pulmonary disease (COPD)

Results

One thousand five hundred fifteen patients were included, 1390 women (91.7%), 685 (45.2%) mestizos, mean age at diagnosis 28.7 years, and 37.6 years at the last evaluation . The median SLE duration was 73.7 months; 47.5% did not present AD in the follow-up; 28.4% had score of 1. The most frequent damage was gonadal failure (9.43%). Patients with AD had a higher frequency of smoking, alcoholism, hypertension, diabetes, dyslipidemia, COPD (p<0.05)

In the linear regression analysis, the variables that were significantly associated with AD were age (β 0.007), SLE duration (β 0.002), maximum doses of corticosteroids (β 0.519), the number of hospitalizations by SLE activity (β 0.178), COPD (β 0.324) and HT (β 0.275).

Conclusions

The damage score was influenced by the presence of comorbidities such as COPD and HT, in addition to others characteristics of SLE

Background and Aims

The aim of this study was to examine whether speckle tracking echocardiography (STE) and scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) may detect the presence of subclinical myocardial involvement in patients with SLE.

Methods

We consecutively recruited 29 SLE patients (M/F=3/26; age 45±11 years; disease duration 15±10 years; median [IQR] SLEDAI 2 [0-6]) and 32 controls comparable for age, sex, and cardiovascular risk factors. Patients with current cardiac symptoms or prior history of any heart disease were excluded. All participants underwent a complete echocardiography examination including STE and eSCAR.

Results

Global longitudinal strain (GLS) was significantly lower in most myocardial segments in SLE patients than in control subjects, except for the myocardial apical region that was comparable between the two groups. Higher SLEDAI was associated with an impaired GLS-4 chamber (r=0.415, p=0.02). A higher daily dosage of prednisone was also associated with an impaired GLS in the infero-septal myocardial segment (r=0.482, p=0.008). Myocardial scar by eSCAR was observed in 5 (17%) out of 29 SLE patients, mainly in the inferoseptal myocardial segment. A significant association was found between the infero-septal GLS and the presence of scar by eSCAR technique (r=0.662 p<0.001; Figure).

Conclusions

Advanced echocardiography techniques detected the presence of a subclinical myocardial dysfunction in SLE patients with no history of cardiac disease compared to controls. An ‘apical sparing’ GLS pattern was also observed in SLE patients. In about one-fifth of these SLE patients, a myocardial scar by eSCAR technique was also identified, mainly in the infero-septal segments.