Cardiac biomarkers in patients with systemic lupus erythematosus: association with valvular heart disease and utility for routine screening

Background

Valvular heart disease (VHD) is more prevalent in patients with systemic lupus erythematosus (SLE) compared to the general population, determined by direct autoimmune involvement as well as early valvular degeneration, and is associated with higher morbidity and mortality.

Purpose

We aimed to assess the utility of cardiac biomarkers in screening SLE patients for the early detection of VHD.

Methods

This observational prospective cohort study included consecutive adult SLE patients evaluated in our Cardiology Department between August 2021 and May 2024. Clinical data, echocardiography and laboratory parameters including NT-proBNP and high-sensitivity cardiac troponin T (hsTnT) were obtained. Patients with left ventricular ejection fraction ≤50% were excluded. Echocardiographic diastolic dysfunction (DD) was defined according to the 2016 ASE/EACVI guidelines.

Results

Our cohort included 86 SLE patients (mean age 53±12 years, 96% female, 30% with moderate VHD, 41% DD). Median disease duration was 13[IQR 4-21] years.

NTproBNP was associated with DD, mitral regurgitation (MR), aortic regurgitation (AR), and mitral stenosis (MS) (Table 1), but not with ischemic heart disease (IHD) (AUC 0.560, p=0.61), arterial hypertension (HTN) (AUC 0.553, p=0.43), or diabetes mellitus (DM) (AUC 0.637, p=0.29).

hsTnT was associated with DD, MR, AR, MS (Table 1), with IHD (AUC 0.749, p=0.004) and pericardial disease (PD)(AUC 0.736, p=0.002), but not with HTN (AUC 0.612, p=0.12), DM (AUC 0.524, p=0.86).

Association of NTproBNP and hsTnT and VHD was documented for patients with and without DD (Table 1).

In multiple linear regression models adjusted for age and DD, MR (p=0.038), MS (p<0.001), AR (p=0.017) were independent predictors of NTproBNP levels.

In multiple linear regression models adjusted for age, DD, PD, and IHD, MS (p<0.001) and AR (p=0.032) were independent predictors of hsTnT levels.

Conclusions

Increased levels of NTproBNP and hsTnT in SLE patients should prompt echocardiographic evaluation and screening for VHD and DD.