Antiphospholipid antibodies are associated with subclinical cardiac impairment in patients with SLE

Background Systemic Lupus Erythematosus (SLE) increases cardiovascular (CV) risk, often through subclinical atherosclerosis. This risk stems from traditional CV factors, chronic inflammation, and autoantibodies, including antiphospholipid (aPL) antibodies, which are linked to thrombosis and cardiac abnormalities. Subclinical changes, such as altered left ventricular mass and diastolic dysfunction, may precede overt CV disease. However, the role of aPL antibodies in these abnormalities remains unclear. Objective To evaluate the association between the presence of aPL antibodies and alterations in the left ventricle's geometry, diastolic, and systolic function in SLE patients. Methods A cross-sectional and comparative study was conducted on women with SLE, aged 18 years or older, who met the 2019 ACR/EULAR criteria. Patients with prior CV disease, pregnancy, and overlap syndrome were excluded. Patients were divided into two groups according to the presence of aPL antibodies, it was considered positive based on elevated levels of either anticardiolipin or anti-β2-glycoprotein antibodies (>12 U/mL and >20 U/mL, respectively). Echocardiographic measurements were made using B-mode, M-mode, Spectral Doppler, Color Doppler, and Tissue Doppler Imaging. Cardiac geometry, diastolic function, and systolic function were classified according to the 2016 ASE/EACVI criteria. The normality was assessed with the Kolmogorov-Smirnov test. Comparisons were performed using the Student's T-test, Chi-square test, and Mann-Whitney U test, accordingly. CV risk factors that were related to ventricular geometry and systolic function were included in a multivariable logistic regression. A p-value of ≤0.05 was considered statistically significant. Results A total of 98 patients were included, 34 with antiphospholipid (aPL) antibodies. Patients with aPL antibodies were younger (33.91 vs. 39.25 years; p = 0.049), had lower weight (63.20 vs. 69.38 kg; p = 0.037), and a lower prevalence of obesity (5.88% vs. 25.00%; p = 0.020), with no significant differences in other CV risk factors or treatments. Patients with aPL antibodies had lower left ventricular mass index (LVMI) (57.20 vs. 63.05 g/m²; p = 0.035) and relative wall thickness (0.314 vs. 0.360; p = 0.014). Multivariable logistic regression showed that higher weight was associated with increased LVMI (OR 1.017, 95% CI: 0.800-0.919, p < 0.001) and eccentric hypertrophy (OR 1.054, 95% CI: 0.008-0.234, p = 0.037). Diastolic dysfunction was more frequent in the aPL group, with fewer patients showing normal diastolic function (14.70% vs. 37.50%; p = 0.019). Systolic function parameters were similar, but S´ wave values were lower in aPL patients (11.00 vs. 13.00; p = 0.050). Conclusion These results suggest that the presence of aPL antibodies may contribute to early alterations in cardiac geometry and diastolic function, underscoring the importance of targeted cardiovascular assessment in this population.