Clinical Markers of the Heart and Blood Vessels Syntropic Lesions in Patients with Systemic Lupus Erythematosus, Their Diagnostic Value (First Notice)

Abstract

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with numerous clinical manifestations that affects any organs or systems and requires a comprehensive study. The aim of the study. To find out the clinical markers of the heart and blood vessels syntropic lesions in patients with SLE and evaluate their diagnostic value. Materials and methods. The study included 118 patients with SLE with the presence of syntropic (having common etiological and/or pathogenetic mechanisms with the main disease) lesions of the heart and blood vessels (107 women (90.68%) and 11 men (9.32%) aged 18 to 74 years (average age 42.48 ±1.12 years)). The study included the identification of clinical markers of syntropic lesions of the heart and blood vessels, determination of the diagnostic value of individual clinical markers and their constellations in terms of sensitivity, specificity and accuracy in patients with SLE, and the identification of one of them with the most reliable diagnostic value. Results. Clinical markers for detecting mitral valve insufficiency in patients with SLE are morning stiffness, new rash, dyspnea, memory problems, presence of weakened cardiac sounds, systolic murmur on the apex of the heart, accent of the second sound on the pulmonary artery; mitral valve consolidation - new rash, the presence of legs edema, dyspnea, a feeling of interruptions in the work of the heart, pain in the heart area, the presence of weakened cardiac tones, systolic murmur on the top of the heart; myocarditis - muscle ache, alopecia, legs edema, shortness of breath , palpitation, systolic murmur on the top of the heart; pericardial effusion – legs edema, dyspnea, palpitations, the presence of weakened cardiac tones; endocarditis - the presence of the accent of the second tone on the pulmonary artery. The optimal value for the diagnosis of mitral valve insufficiency in patients with SLE is the constellation of clinical markers "pain in the joints + new rash + accent of the second tone on the aorta"; of mitral valve consolidation - "dyspnea + a feeling of interruptions in the work of the heart"; of myocarditis - "heart palpitations + systolic murmur on the apex of the heart"; of pericardial effusion - "pain in the joints + weakening of heart tones"; of endocarditis - "fever + systolic murmur over the top of the heart + emphasis of the second tone on the pulmonary artery". Conclusions. In patients with SLE the optimal value among clinical monomarkers and their constellations for the diagnosis of mitral valve insufficiency is dyspnea and the constellation "pain in the joints + new rash + accent of the second tone on aorta"; for MV consolidation - a complaint of a feeling of interruptions in the work of the heart and the constellation "shortness of breath + feeling of interruptions in the work of the heart"; for myocarditis - palpitations and the constellation "heartbeat + systolic murmur on the apex of the heart", pericardial effusion - the presence of weakened cardiac tones and the constellation "pain in the joints + weakened cardiac tones"; for endocarditis - accent of the second tone on the pulmonary artery and the constellation "fever + systolic murmur on the apex of the heart + accent of the second tone on the pulmonary artery". Constellations of clinical markers, but not individual clinical markers, have optimal value for the diagnosis of the syntropic heart lesions in patients with SLE.