Table 1.
Findings on Cardiovascular and Brain Imaging and Neurocognitive Testing
| Abnormality | Acute NPSLE (n=30) |
SLE (n=46) |
Controls (n=26) |
P value |
|---|---|---|---|---|
|
Transesophageal Echocardiography mean ± SD or n (%) |
||||
| Valve vegetations | 26 (87%)*† | 13 (28%) | 2 (8%) | <0.001 |
| Mitral valve | 20 (67%)*† | 6 (13%) | 1 (4%) | <0.001 |
| Aortic valve | 14 (47%)*† | 11 (24%) | 2 (8%) | 0.004 |
| Valve thickening | 26 (87%)*† | 16 (35%)* | 2 (8%) | <0.001 |
| Mitral valve | 20 (67%)*† | 8 (17%)* | 0 | <0.001 |
| Aortic valve | 18 (60%)*† | 12 (26%) | 2 (8%) | 0.002 |
| Valve regurgitation | 15 (50%)*† | 5 (11%) | 0 | <0.001 |
| Mitral valve | 13 (43%)*† | 4 (9%) | 0/25 | <0.001 |
| Aortic valve | 2 (7%) | 3 (7%) | 0 | 0.60 |
| Any valve abnormality | 28 (93%)*† | 18 (39%)* | 3 (12%) | <0.001 |
| PFO or interatrial septal aneurysm |
1 (3%)† | 11 (24%) | 2 (8%) | 0.03 |
| LV ejection fraction <50% | 2 (7%) | 0 | 0 | 0.15 |
| Ao intima-media thickness | 0.88 ± 0.37* | 0.80 ± 0.23* | 0.66 ± 0.15 | 0.01 |
| Ao intima-media thickening | 7/29 (24%) | 10/45 (22%) | 1 (4%) | 0.07 |
| Ao plaque (any portion) | 9 (30%)* | 8 (17%)* | 0 | 0.007 |
| Ao intima-media thickening or plaque |
11 (37%)* | 14 (30%)* | 1 (4%) | 0.006 |
| Carotid Artery Duplex, mean ± SD or n (%) | ||||
| Intima-media thickness | 0.55 ± 0.11*† | 0.50 ± 0.07 | 0.48 ± 0.08 | 0.01 |
| Intima-media thickening | 4 (13%) | 1 (2.2%) | 1 (4%) | 0.11 |
| Plaque | 5 (17%) | 1 (2.2%) | 2 (8%) | 0.06 |
| Intima-media thickening or plaque |
8 (27%)† | 2 (4%) | 3 (12%) | 0.02 |
| Transcranial Doppler, n (%) | ||||
| Right or left MCA microemboli | 8 (27%)*† 17 events/43.1 hours*† |
9 (20%) 11 events/68.5 hours* |
0 | 0.009 HR 2.5 (p=0.02) |
| Clinical Domain | Neurocognitive Z-Scores, mean ± SD (range) | |||
| Pre-morbid intelligence | −0.67 ± 1.17 (27) | −0.46 ± 0.93 (45) | −0.06 ± 1.03 | 0.10 |
| Attention | −3.14 ± 3.60*† | −0.91 ± 0.92 (45) | −0.06 ± 0.82 | <0.001‡ |
| Memory | −1.54 ± 1.43(29)* | −1.03 ± 0.90 (45)* | −0.056 ± 0.81 | <0.001‡ |
| Language | −1.02 ± 1.04 (27)* | −0.99 ± 1.16 (45)* | −0.05 ± 0.89 | <0.001‡ |
| Processing speed | −2.19 ± 1.95 (28)*† | −0.87 ± 1.15 (45)* | −0.06 ± 0.93 | <0.001‡ |
| Executive function | −3.58 ± 3.58 (29)*† | −1.63 ± 2.20 (45)*† | −0.10 ± 0.79 | <0.001‡ |
| Motor function | −5.17 ± 8.67 (26)*† | −1.70 ± 1.66 (37) | −0.056 ± 0.63 | <0.00‡ |
| Global | −2.76 ± 2.54*† | −1.19 ± 0.91 (45)*† | −0.07 ± 0.52 | <0.001‡ |
| Global abnormal§ | 12 (60%)*† | 15 (33%)* | 1 (4%) | <0.001‡ |
| Brain Lesions on MRI, median (IQR) or n (%) | ||||
| Any focal brain lesion | 22 (73%)*† | 19/45 (42%)*∥ | 4 (15%)∥ | <0.001 |
| Focal brain lesions (n) | 12 (3, 47) * | 2 (0, 9) | 0 (0, 2) | <0.001¶ |
| Old or recent cerebral infarcts | 14 (47%)*† | 0 | 0 | <0.001 |
| Cerebral infarcts (n) | 0 (0, 2)*† | 0 | 0 | <0.001¶ |
| White matter abnormalities | 20 (67%)*† | 18/45 (40%)* | 4 (15%) | <0.001 |
| White matter abnormalities (n) | 9 (1, 46) *† | 2 (0, 9) | 0 (0, 2) | <0.001¶ |
|
White Matter Brain Lesion Load (cm3) Median (IQR) |
||||
| Left hemisphere | 0.96 (0.16, 2.21)*† | 0.13 (0.05, 0.23) | 0.04 (0.03, 0.15) | 0.003¶ |
| Right hemisphere | 1.23 (0.18, 2.84)* | 0.11 (0.05, 0.24) | 0.05 (0.03, 0.10) | 0.01¶ |
| Whole brain | 2.92 (3.18, 5.55)*† | 0.26 (0.13, 0.38) | 0.13 (0.07, 0.23) | 0.002¶ |
*
p<0.05 compared to controls by Fisher’s post hoc least significant difference method.
†
p<0.05 for acute NPSLE compared to SLE by Fisher’s post hoc least significant difference method.
‡
all p≤0.009 after simultaneously adjusting for education, premorbid intelligence, and depression index.
§
Global abnormal defined as ≥1.5 SD below the mean total of controls.
∥
One SLE patient did not complete MRI studies due to claustrophobia; includes 2 controls with history of sports related head trauma.
¶
by Kruskal-Wallis test.
NPSLE = neuropsychiatric systemic lupus erythmatosus, PFO = patent foramen ovale, Ao = aorta, LV = left ventricle, MCA = middle cerebral artery, HR = hazard ratio.