2263 - Damage Accrual in Patients with Systemic Lupus Erythematosus Is Associated with Endothelial Function Detriment: A Prospective Cohort Study

Tuesday, November 8, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Chiara Tani1, R. Bruno1, Anna d'Ascanio2, Lorenzo Ghiadoni1, Y. Plantinga1, Rossella Neri1, Antonio Tavoni3, Linda Carli1, Stefano Taddei1, Stefano Bombardieri2 and Marta Mosca1, 1University of Pisa, Pisa, Italy, 2Rheumatology Unit, Pisa, Italy, 3AOUP, Pisa, Italy
Presentation Number: 2263

Background/Purpose: Endothelial dysfunction is considered an initial step in the pathogenesis of atherosclerosis and an important predictor of future cardiovascular events. Flow-mediated dilation (FMD) is a reliable and non invasive technique to assess endothelial function (EF) Our aim was to study EF in a cohort of systemic lupus erythematosus (SLE) patients prospectively followed at our unit and to investigate its relation with disease activity and damage over time.

Method: 38 female SLE patients without overt cardiovascular involvement were enrolled (mean age 35.8±8; 21- 55 years) and clinically followed-up for a mean of 4.45±1.5 years. Clinical history, traditional cardiovascular risk factors, laboratory parameters as well as a complete serological profile were recorded. Disease activity was evaluated with the ECLAM global score (a score >2 were arbitrarily used to defined “active disease”) while SLICC/ACR-DI was used for scoring disease damage. An increase in SLICC/ACR DI or death were defined as poor outcome. FMD was assessed in the brachial artery by high-resolution ultrasound and computerized edge detection system (Quipu s.r.l., Pisa, Italy); FMD was defined as maximal % change in brachial artery diameter after reactive hyperemia induced by 5-min forearm ischemia. In addition, endothelium-independent dilation after administration of glyceryl trinitrate (25 μg s.l.) was also assessed. FMD assessment was performed at study entry and was repeated in a subgroup of 21 patients after a follow-up of 4.45±1.5 years.

Result: At enrolment, 18 patients (47%) presented an active disease and 7 (15%) an active renal involvement; 20 (53%) were inactive; mean FMD was 7.9±3.1% with no statistically significant differences between active (8.7±1) and inactive group (7.9±0.8; p=0.53), even after correction for age and disease duration. During the follow-up, 3 patients died and 12 accrued organ damage with cardiovascular complications in eight patients (21%) and progression to renal failure in 6 (15%) . Interestingly, while basal EF did not predict the poor final outcome (death or damage accrual), its decline over time did. In fact, in the follow-up FMD showed a significant decline over time (from 8.0±3.2 to 5.9±3.3, P=0.04) while endothelial-independent dilation did not (from 9.2 ±3.5 to 8.6±4.9; p= 0.63). The decline was not different between active and inactive group; however, patients with poor outcome (n=7) showed a greater worsening in FMD over time (-4.1% vs -2.0%).

Conclusion: This study shows that in SLE patients damage accrual is associated with progressive loss of FMD, with preserved response to glyceryl trinitrate, suggesting a progressive detriment in EF. On the other hand, disease activity does not appear to influence EF. Rapid progressive worsening of EF over time could represent an early marker of poor outcome and its assessment by repeated measurement of FMD could allow its early and non invasive identification. In this perspective, EF preservation may be important in preventing damage accrual and life-threatening consequences and therefore could be viewed as a therapeutic goal.

Keywords: damage, endothelial function and systemic lupus erythematosus

Disclosure: C. Tani, None; R. Bruno, None; A. d'Ascanio, None; L. Ghiadoni, None; Y. Plantinga, None; R. Neri, None; A. Tavoni, None; L. Carli, None; S. Taddei, None; S. Bombardieri, None; M. Mosca, None.