Association between body mass index and myocardial involvements in patients with systemic lupus erythematosus

doi:10.3969/j.issn.1674-8115.2021.02.009

Abstract

Abstract: Objective

·To explore the association between body mass index (BMI) and myocardial involvement in patients with systemic lupus erythematosus (SLE).

Methods

·Fifty-four healthy participants and sixty-one patients with SLE who were admitted to the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine were prospectively recruited from July 2014 to November 2016 and then underwent cardiac magnetic resonance (CMR) and echocardiography examination. SLE patients were grouped according to the quartile of the BMI index, and then CMR morphology, function and histology indicators of each group were compared. The relationship between BMI and extracellular volume fraction (ECV) was explored by using multivariate linear analysis.

Results

·Compared with normal BMI group (18.73?23.00 kg/m²) and high BMI group (>23.00 kg/m²), low BMI group (≤18.72 kg/m²) had higher median ECV (34.33% vs 30.52% vs 31.44%,P=0.007) after being adjusted for age and disease duration. The incidences of right ventricular hypertrophy (33.3%), pulmonary hypertension (26.7%) and edema (6.7%) were lower in low normal BMI group (18.73?20.20 kg/m²) than those in the low BMI group, high normal BMI group (20.21?23.00 kg/m²) and high BMI group. There was a strong correlation between BMI and ECV in long standing SLE patients. When BMI was less than 23.00 kg/m², it showed a negative correlation (r=-0.597, P=0.009), and a positive correlation (r=0.739, P=0.023) when over 23.00 kg/m². However, there was no significant correlation between ECV, left ventricular (LV) ejection fraction, LV end-systolic volume and BMI in control group. In the multivariable linear regression, BMI in patients with SLE was associated with elevated ECV independently after being adjusted for age, usage of immunosuppressor and pulmonary artery pressure (BMI>23.00 kg/m²: β=-0.457, P=0.006. BMI≤23.00 kg/m²: β=0.766, P=0.001).

Conclusion

·Cardiac involvement in SLE is closely related to BMI. Low BMI patients should be careful with the cardiac injury. Maintaining BMI at normal low level (18.73?20.20 kg/m²) and avoiding overweight (≤23.00 kg/m²) may be necessary to myocardial protection.

Key words: systemic lupus erythematosus (SLE), body mass index (BMI), cardiac magnetic resonance (CMR), extracellular volume fraction (ECV)

CLC Number:

R593.2

Ze-hao FENG, Ye-zi CHAI, Xuan SU, Bao-hang-xing SUN, Qi-ming LIU, Meng JIANG, Jun PU. Association between body mass index and myocardial involvements in patients with systemic lupus erythematosus[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(2): 180-186.

Figures/Tables 7

TrendMD

References 17

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Indicator	Control group (n=54)	SLE group (n=61)	P value
Age/year	30 (24, 49)	37 (28, 45)	0.324
Female/n (%)	43 (79.6)	56 (91.8)	0.842
BMI/ (kg·m^-2)	22.76 (21.04, 25.16)	20.20 (18.72, 23.00)	0.000
Clinical feature
Smoking/n (%)	2 (3.7)	1 (1.6)	0.915
Hypertension/n (%)	2 (3.7)	1 (1.6)	0.915
Disease duration/month	?	60 (24, 114)	?
New onset/n (%)	?	27 (44.3)	?
PAPm/mmHg	?	30 (21, 67)	?
Laboratory examination
Hematocrit/%	0.39 (0.36, 0.41)	0.34 (0.28, 0.40)	0.001
TnI/ (ng·mL^-1)	0 (0, 0.01)	0.01 (0.01, 0.03)	0.000
BNP/ (pg·mL^-1)	52 (26, 167)	280 (51, 809)	0.018
Cardiac function classification
NYHA Ⅲ?Ⅳ/n (%)	0 (0)	2 (3.3)	0.918
CCS Ⅲ?Ⅳ/n (%)	0 (0)	1 (1.6)	1.000
Other autoimmune disease
Sjogren's syndrome/n (%)	?	3 (5.9)	?
PH/n (%)	?	32 (52.5)	?
Hashimoto's thyroiditis/n (%)	?	1 (1.6)	?
Concurrent medicine in long-standing SLE
Prednisone/n (%)	?	31/34 (91.2)	?
Mycophenolate/n (%)	?	3/34 (8.8)	?
Cyclosporine/n (%)	?	2/34 (5.9)	?
Azathioprine/n (%)	?	1/34 (2.9)	?

Indicator	Control group (n=54)	SLE group (n=61)	P value
Age/year	30 (24, 49)	37 (28, 45)	0.324
Female/n (%)	43 (79.6)	56 (91.8)	0.842
BMI/ (kg·m^-2)	22.76 (21.04, 25.16)	20.20 (18.72, 23.00)	0.000
Clinical feature
Smoking/n (%)	2 (3.7)	1 (1.6)	0.915
Hypertension/n (%)	2 (3.7)	1 (1.6)	0.915
Disease duration/month	?	60 (24, 114)	?
New onset/n (%)	?	27 (44.3)	?
PAPm/mmHg	?	30 (21, 67)	?
Laboratory examination
Hematocrit/%	0.39 (0.36, 0.41)	0.34 (0.28, 0.40)	0.001
TnI/ (ng·mL^-1)	0 (0, 0.01)	0.01 (0.01, 0.03)	0.000
BNP/ (pg·mL^-1)	52 (26, 167)	280 (51, 809)	0.018
Cardiac function classification
NYHA Ⅲ?Ⅳ/n (%)	0 (0)	2 (3.3)	0.918
CCS Ⅲ?Ⅳ/n (%)	0 (0)	1 (1.6)	1.000
Other autoimmune disease
Sjogren's syndrome/n (%)	?	3 (5.9)	?
PH/n (%)	?	32 (52.5)	?
Hashimoto's thyroiditis/n (%)	?	1 (1.6)	?
Concurrent medicine in long-standing SLE
Prednisone/n (%)	?	31/34 (91.2)	?
Mycophenolate/n (%)	?	3/34 (8.8)	?
Cyclosporine/n (%)	?	2/34 (5.9)	?
Azathioprine/n (%)	?	1/34 (2.9)	?

Indicator	Control group （n=54）	SLE group （n=61）	P value
LVEF/%	67.60±6.62	63.02±10.48	0.006
LVEDV/mL	110.95 (98.58, 129.42)	109.20 (86.45, 131.18)	0.295
LVEDV/BSA/(mL·m^-2)	65.08 (61.01, 75.56)	69.71 (55.46, 80.33)	0.444
LVESV/mL	36.06 (27.57, 44.53)	35.50 (25.55, 49.65)	0.894
LVESV/BSA/(mL·m^-2)	20.51 (17.61, 25.94)	22.83 (17.42, 29.57)	0.214
LV mass/g	87.66 (73.98, 104.67)	110.45 (87.78, 123.23)	0.000
LV mass/BSA/(g·m^-2)	53.12 (46.26, 60.77)	67.14 (58.05, 81.82)	0.000
RVEF/%	61.72±8.45	50.13±11.33	0.000
RVEDV/mL	102.05 (84.08, 126.23)	114.80 (97.38, 135.93)	0.098
RVEDV/BSA/(mL·m^-2)	59.68 (50.98, 75.20)	71.44 (61.74, 91.83)	0.002
RVESV/mL	40.00 (29.23, 52.35)	55.25 (42.70, 73.60)	0.000
RVESV/BSA/(mL·m^-2)	23.00 (19.20, 30.86)	34.40 (27.12, 47.84)	0.000
LV native myocardial T1/ms	1 284.36±44.02	1 360.48±70.33	0.000
LV ECV/%	26.22±2.40	30.94±3.74	0.000

Indicator	Control group （n=54）	SLE group （n=61）	P value
LVEF/%	67.60±6.62	63.02±10.48	0.006
LVEDV/mL	110.95 (98.58, 129.42)	109.20 (86.45, 131.18)	0.295
LVEDV/BSA/(mL·m^-2)	65.08 (61.01, 75.56)	69.71 (55.46, 80.33)	0.444
LVESV/mL	36.06 (27.57, 44.53)	35.50 (25.55, 49.65)	0.894
LVESV/BSA/(mL·m^-2)	20.51 (17.61, 25.94)	22.83 (17.42, 29.57)	0.214
LV mass/g	87.66 (73.98, 104.67)	110.45 (87.78, 123.23)	0.000
LV mass/BSA/(g·m^-2)	53.12 (46.26, 60.77)	67.14 (58.05, 81.82)	0.000
RVEF/%	61.72±8.45	50.13±11.33	0.000
RVEDV/mL	102.05 (84.08, 126.23)	114.80 (97.38, 135.93)	0.098
RVEDV/BSA/(mL·m^-2)	59.68 (50.98, 75.20)	71.44 (61.74, 91.83)	0.002
RVESV/mL	40.00 (29.23, 52.35)	55.25 (42.70, 73.60)	0.000
RVESV/BSA/(mL·m^-2)	23.00 (19.20, 30.86)	34.40 (27.12, 47.84)	0.000
LV native myocardial T1/ms	1 284.36±44.02	1 360.48±70.33	0.000
LV ECV/%	26.22±2.40	30.94±3.74	0.000

Indicator	New onset SLE		P value	Long standing SLE		P value
Indicator	Active SLE (n=14)	Inactive SLE (n=13)	P value	Active SLE (n=17)	Inactive SLE (n=17)	P value
Age/year	22 (18, 31)	29 (21, 51)	0.089	32 (28, 47)	35 (24, 45)	0.704
Disease duration/month	0 (0, 1)	0 (0, 0)	0.505	60 (30, 66)	60 (30, 138)	0.327
BMI/(kg·m^-2)	19.45 (18.07, 20.75)	20.03 (18.28, 21.93)	0.627	21.37 (18.52, 24.40)	21.26 (19.24, 24.24)	0.890
CK-MB/(ng·mL^-1)	7.8 (1.0, 18.8)	0.7 (0.4, 1.1)	0.023	10.8 (5.8, 22.3)	2.2 (1.0, 12.0)	0.057
BNP/(pg·mL^-1)	127 (47, 692)	36 (13, 214)	0.043	300 (57, 958)	259 (34, 790)	0.538
TNI/(ng·mL^-1)	0.03 (0, 0.14)	0.01 (0, 0.01)	0.181	0.01 (0.01, 0.03)	0.01 (0.01, 0.05)	0.915
CMR
LVEF/%	66.70 (54.55, 70.35)	66.7 (60.8, 71.50)	0.608	67.90 (57.20, 74.75)	60.3 (53.7, 63.95)	0.121
LV ECV/%	29.46 (25.92, 36.16)	31.40 (28.89, 34.59)	0.594	30.67 (29.29, 34.44)	31.92 (30.57, 32.92)	0.306
LV native myocardial T1/ms	1 347 (1 280, 1 391)	1 325 (1 305, 1 448)	0.412	1 366 (1 347, 1 452)	1 370 (1 323, 1 408)	0.519
RVEF/%	56.20 (41.30, 64.90)	52.30 (43.20, 62.50)	0.700	50.40 (46.10, 57.70)	46.40 (34.75, 56.65)	0.256
Global radial strain
LV/%	42 (36, 50)	43 (34, 56)	0.568	36 (32, 50)	46 (37, 49)	0.484
RV/%	12 (9, 17)	24 (16, 31)	0.027	18 (16, 24)	16 (10, 33)	0.337