Abstract
BACKGROUND: Although the increased risk of cardiovascular disease in patients with SLE is well-documented, effective tools for risk stratification remain elusive. This study sought to explore the prognostic value of echocardiographic parameters for major adverse cardiovascular and cerebrovascular events (MACCE) in SLE patients. METHODS: This study was designed as a retrospective cohort trial that enrolled 286 patients with SLE and 64 individuals from a health examination cohort as controls between January 2014 and December 2024. Transthoracic echocardiography was performed to measure cardiac structural parameters; clinical and laboratory data were also collected to assess disease activity, and the Left Ventricular Mass Index (LVMI) was calculated. The primary endpoint was MACCE. Propensity score matching was applied to reduce confounding bias. Independent risk factors were identified using Cox proportional hazards regression models, and the optimal cut-off value for LVMI was determined via receiver operating characteristic (ROC) curve analysis. Subsequently, patients were stratified based on this cut-off, and Kaplan-Meier survival curves with Log-rank tests were plotted to compare intergroup differences in survival outcomes. RESULTS: Compared with the control group, patients with SLE were significantly associated with aortic root (p=0.002), right ventricular internal dimension in diastole (RVDd, p=0.038), interventricular septal thickness (IVST, p=0.033), left ventricular posterior wall thickness (LVPWT, p<0.001), LVM (p=0.025), LVMI (p=0.007) left ventricular posterior wall motion amplitude (LVPWMA, p=0.017) and interventricular septal motion amplitude (IVSMA, p=0.004). Multivariate Cox proportional hazards analysis further identified RVDd (p=0.027), LVMI (p=0.017), low-density lipoprotein (p=0.036) as independent predictors for MACCE in the SLE cohort. ROC curve analysis determined an optimal LVMI cut-off of 101.7 g/m² for predicting adverse outcomes, yielding an area under the curve (AUC) of 0.751 (95% CI 0.653 to 0.849), with 76.9% sensitivity and 64.6% specificity. CONCLUSIONS: Compared to the control group, patients with SLE showed significantly higher LVM and LVMI. LVMI was identified as an independent risk factor for MACCE in SLE patients.