title: 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.
authors.affiliation: Department of Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA. croldan@salud.unm.edu
authors.forename: C A
authors.initials: CA
authors.lastname: Roldan
authors.forename: J
authors.initials: J
authors.lastname: Joson
authors.forename: C R
authors.initials: CR
authors.lastname: Qualls
authors.forename: J
authors.initials: J
authors.lastname: Sharrar
authors.forename: W L
authors.initials: WL
authors.lastname: Sibbitt
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001013:Aorta, Thoracic / Q000473:pathology*; D050197:Atherosclerosis / Q000209:etiology; D016022:Case-Control Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D055815:Young Adult
references.citation: Rheumatology (Oxford). 2007 Oct;46(10):1560-5
references.pmid: 17693444
references.citation: N Engl J Med. 2003 Dec 18;349(25):2399-406
references.pmid: 14681505
references.citation: J Am Coll Cardiol. 2009 Feb 3;53(5):445-51
references.pmid: 19179203
references.citation: Lupus. 2007;16(5):309-17
references.pmid: 17576731
references.citation: Circulation. 2004 Jul 27;110(4):399-404
references.pmid: 15262847
references.citation: Hypertension. 2001 May;37(5):1236-41
references.pmid: 11358934
references.citation: Clin Immunol Immunopathol. 1992 Jun;63(3):214-20
references.pmid: 1623641
references.citation: Arthritis Rheum. 2004 Jan;50(1):151-9
references.pmid: 14730611
references.citation: Hypertension. 2008 Nov;52(5):818-27
references.pmid: 18852389
references.citation: Clin Exp Rheumatol. 2008 Sep-Oct;26(5 Suppl 51):S72-9
references.pmid: 19026147
references.citation: Hypertension. 2001 Apr;37(4):1075-82
references.pmid: 11304506
references.citation: Am J Physiol Regul Integr Comp Physiol. 2009 Apr;296(4):R1258-67
references.pmid: 19158408
references.citation: J Ultrasound Med. 2007 Sep;26(9):1157-65
references.pmid: 17715309
references.citation: Lupus. 2007;16(12):981-6
references.pmid: 18042592
references.citation: J Clin Rheumatol. 2009 Apr;15(3):111-6
references.pmid: 19300290
references.citation: Arthritis Rheum. 1999 Jan;42(1):51-60
references.pmid: 9920014
references.citation: Kardiol Pol. 2008 Nov;66(11):1194-9; discussion 1200-1
references.pmid: 19105096
references.citation: Lupus. 2009 Mar;18(3):249-56
references.pmid: 19213864
references.citation: Lupus. 2007;16(9):731-5
references.pmid: 17728367
references.citation: N Engl J Med. 2003 Dec 18;349(25):2407-15
references.pmid: 14681506
references.citation: Lupus. 2006;15(10):644-50
references.pmid: 17120590
references.citation: Arthritis Rheum. 2004 Feb;50(2):581-8
references.pmid: 14872502
references.citation: Lupus. 2009 May;18(6):508-15
references.pmid: 19395452