Cardiovascular Autonomic Nervous System Dysfunction in Systemic Lupus Erythematosus: Assessment and Relation to Disease Characteristics

Background: Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disorder with varied clinical manifestations including neurological involvement. The clinical implications of cardiovascular autonomic neuropathy (CAN) in SLE patients remain insufficiently characterized, necessitating comprehensive investigation. Objectives: This study aimed to ascertain the frequency of cardiovascular autonomic dysfunction in SLE patients and explore its associations with clinical features and disease activity and evaluate the diagnostic utility of the head-up tilt table test (TTT) in identifying cardiovascular autonomic neuropathy (CAN). Patients and methods: 100 patients with SLE attending Ain Shams University Hospital were enrolled. All participants underwent detailed clinical evaluation, routine laboratory testing and autonomic function assessment using TTT and measurements of postural blood pressure changes. Disease activity was evaluated with the SLEDAI-2K score. Results: The cohort included 100 patients (74 females & 26 males) with a mean age of 29.51 ± 5.92 years. A high proportion demonstrated abnormal responses on TTT. Positive TTT findings showed significant associations with higher SLEDAI-2K scores (OR=1.116, p<0.001), vasculitis (OR=6.366, p=0.005), proteinuria (OR= 24.733, p< 0.001), leukopenia (OR = 0.694, p = 0.001) and elevated anti-dsDNA levels (OR=3.933, p= 0.007). TTT exhibited high sensitivity (92%) and moderate specificity (56%) for detecting CAN. Conclusion: Cardiovascular autonomic dysfunction is not uncommon in SLE patients. TTT is a useful non-invasive tool for early CAN detection. The significance of routine screening for autonomic involvement to reduce long-term cardiovascular problems is highlighted by identified clinical and laboratory predictors.