Active lupus nephritis is associated with structural cardiac lesions with good response to induction therapy

Background SLE, and especially lupus nephritis (LN), significantly increases cardiovascular (CV) risk. Despite the magnitude of the problem, clear and homogeneous guidelines specifically focused on CV disease prevention and management are still lacking. This study assessed the degree of affection of cardiac structures in patients with active LN and its outcomes with induction therapy. Methods A Prospective study included 64 active LN patients. Screening of cardiac affection was done by the Echo for all patients at the beginning of the study. The patients who had evident cardiac lesions were assessed by echo after 3 months with termination of induction immunosuppressive therapy to assess cardiac outcomes. Results The prevalence of cardiac lesions was 23.4% (15 patients) in active LN. It was the following; mean ejection fraction (EF) (54 ± 10%), global hypokinesia 33.3% (5 patients), mild to moderate pericardial effusion (PE) 73.3. % (11 patients) Moderate to severe mitral valve regurgitation (MVR) 66.7% (10 patients), mild aortic regurgitation (AVR) 13.3% (2 patients) moderate to severe tricuspid valve regurgitation (TVR) 33.3% (5 patients) & elevated right ventricular systolic pressure (RVSP) 33.3% (5 patients). Baseline EF was negatively correlated with serum creatinine (r-value = -0.301) p-value 0.016. After 3 months of active LN management, there were significant improvements in EF, PE, and severe MVR p-values < 0.001, 0.027, and 0.015 respectively. EF was improved with either Mycophenolate mofetil or Cyclophosphamide p-values 0.011, and 0.012 respectively while PE was improved by Mycophenolate mofetil p-value 0.026. MVR was significantly improved by Cyclophosphamide p-value 0.029. Management of active LN carries recovery of EF 1.9 times (odds ratio:1.9), PE 15 times (odds ratio:15), and MVR 64 times (odds ratio:64). TVR, AVR, and RVSP were independent cardiac lesions with active LN. Conclusion Structural cardiac lesions are highly prevalent in active LN, and effective induction therapy of active LN for 3 months is positively linked to cardiac improvement.