Premature aortic stiffness in systemic lupus erythematosus by transesophageal echocardiography

Abstract

To assess aortic stiffness by transesophageal echocardiography (TEE) and to determine its clinical predictors and relation to age, blood pressure, renal function, and atherosclerosis, 50 patients with systemic lupus erythematosus (SLE), 94% women, with a mean age of 38 ± 12 years, and 22 age and gender-matched healthy controls underwent clinical and laboratory evaluations and multiplane TEE to assess stiffness, intima-media thickness (IMT), and plaques of the proximal, mid, and distal descending thoracic aorta. Stiffness at each level and overall aortic stiffness by the pressure-strain elastic modulus was higher in patients than in controls after adjusting for age (overall, 8.25 ± 4.13 versus 6.1 ± 2.5 Pascal units, p = 0.01). Patients had higher aortic stiffness than controls after adjusting both groups to the same mean age, blood pressure, creatinine, and aortic IMT (p = 0.005). Neither IMT nor plaques were predictors of aortic stiffness. Moreover, normotensive patients, those without aortic plaques, and non-smokers had higher stiffness than controls (all p < 0.05). Age at SLE diagnosis and non-neurologic damage score were the only SLE-specific independent predictors of aortic stiffness (both p ≤ 0.01). Thus, increased aortic stiffness is an early manifestation of lupus vasculopathy that seems to precede the development of hypertension and atherosclerosis.

Trial registration: ClinicalTrials.gov NCT00858884.

Figures

Figure 1. Measurement of Aortic Diameters and Intima-media Thickness

This TEE short axis two-dimensional guided M-mode image of the proximal descending thoracic aorta in a patient with SLE demonstrates the measurements of the aortic systolic diameter (sD) at the peak of the T wave on the electrocardiogram and measurement of the diastolic diameter (dD) and aortic intima-media thickness (IMT) during end-diastole (after the P wave on the electrocardiogram). The systolic and diastolic diameters and IMT measured 1.8 cm, 1.6 cm, and 0.6 mm, respectively.

Figure 2. Pressure-Strain Elastic Modulus at the Proximal, Middle, and Distal Descending Thoracic Aorta in Patients with SLE and Controls

Note that the pressure strain elastic modulus (PSEM, mean ± SE) is higher in patients (blue line) than in controls (pink line) at every aortic location. Also note that PSEM progressively increases from the proximal to distal aorta. Unadjusted, p = 0.002 for group and p = 0.05 for location. Adjusted for age, p = 0.02 for group and p = 0.04 for location.

Figure 3. Pressure-Strain Elastic Modulus in Patients and Controls after Adjusting Both Groups to the Same Age, Blood Pressure, Renal Function, and Aortic Intima-media Thickness

SLE patients (blue line) had significantly higher PSEM (mean ± SE) than controls (pink line) at every aortic location (p = 0.005) and a linear trend up of PSEM from proximal to distal aorta was noted (p = 0.04).