







































_____________________________________________________________________________________________________ 
 
*Corresponding author: E-mail: esmat.shaker@stu.edu.iq; 
 
Cite as: Shaker, Esmat Esam. 2025. “Frequency and Patterns of Cardiac Involvement in Systemic Lupus Erythematosus”. 
Asian Journal of Immunology 8 (1):60-69. https://doi.org/10.9734/aji/2025/v8i1160. 
 
 

 
 

Asian Journal of Immunology 
 
Volume 8, Issue 1, Page 60-69, 2025; Article no.AJI.134457 
 

 
 

 

 

Frequency and Patterns of Cardiac 
Involvement in Systemic Lupus 

Erythematosus 
 

Esmat Esam Shaker a* 
 

a Department of Medical Laboratories at the Technical Medical Institute in the Southern 
Technical University, Basra, Iraq. 

 
Author’s contribution  

 
The sole author designed, analysed, interpreted and prepared the manuscript. 

 
Article Information 

 
DOI: https://doi.org/10.9734/aji/2025/v8i1160 

 
Open Peer Review History: 

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,  
peer review comments, different versions of the manuscript, comments of the editors, etc are available here: 

https://pr.sdiarticle5.com/review-history/134457 

 
 

Received: 13/02/2025 
Published: 23/04/2025 

 
 
ABSTRACT 
 

The aim of the study was to determine the prevalence of myocardial and circulatory complications 
among lupus patients, such as pericarditis, heart failure, endocarditis, ventricular dysfunction, and 
Myocarditis. It was also to assess the association of lupus with increased myocardial injury and to 
evaluate therapeutic (choriokinin, corticosteroids, and glucocorticoids) interventions to reduce the 
complication of cardiovascular disease. 
This study focused on the immunological aspect of the effect of immunosuppressive therapy in 
systemic lupus erythematous (SLE), specifically choriokinin, corticosteroids, and glucocorticoids 
(GCs), on the exposure of cardiovascular disease. The study period extended from 2022 to early 
2024 and relied on the results of screening of 88 SLE patients and a control group of 85 patients. 
The causes of heart damage in SLE patients were identified to assess the relationship with disease 
activity, duration, and rheumatic treatment. Previously, we first determined N_terminal prohormone 
of brain natriuretic peptide (NT_proBNP) levels in SLE patients not receiving specific rheumatic 

Original Research Article 

https://doi.org/10.9734/aji/2025/v8i1160
https://pr.sdiarticle5.com/review-history/134457


 
 
 
 

Shaker; Asian J. Immunol., vol. 8, no. 1, pp. 60-69, 2025; Article no.AJI.134457 
 
 

 
61 

 

treatment and identified a relationship between biomarker and immunological marker 
concentrations of SLE activity (increased serum levels of anticardiolipin IgG, anti_dsDNA, 
antinuclear antibodies, and decreased complement C4) and markers reflecting impaired kidney 
function (Nasonov, 2010, Kim, et al., 2017). Corticosteroids are effective in preventing the 
progression of SLE and increasing patient survival, while reducing the exposure of atherosclerosis 
and thrombosis (Nasonov, 2010, Tan, et al., 1982, Hochberg, 1997) and hypercholesterolemia 
(Kim, et al., 2017, Petri, et al., 2012), ultimately reducing a exposure of cardiovascular disease at 
SLE patients, despite isolated reports of cardiac toxicity (Hochberg, 1997). 
Noticed a statistical difference between the two groups in NT_proBNP, as it was shown that the 
second group had a lower NT_proBNP result 0.05 than the first group, and the same applies to 
Anti_JO1, which gives us evidence beyond doubt that immunosuppressive treatments work 
positively in treating heart muscle diseases resulting from lupus. 
 

 
Keywords: Immunosuppressant; SLE; immunosuppressive; myocarditis; BNP; ACA; Anti_JO1. 
 

1. INTRODUCTION 
 
Systemic lupus erythematous (SLE) is a chronic, 
multisystem immunological disorder of unknown 
causality and genetic predisposition it presents 
with diverse clinical features and follows an 
unpredictable progression (Nasonov, 2010). 
Myocarditis affects more than 55% of SLE 
patients and is a leading cause of fatal condition. 
All cardiac anatomical structures can be            
affected by SLE, such as the pericardium, 
endocardium, coronary vessels, and 
myocardium, with heart failure (HF) being the 
final stage of cardiac and circulatory disease 
(Kim, et al., 2017). 
 
Recent studies indicate that systemic lupus 
erythematosus (SLE) is a major risk factor for 
Myocarditis and has a significant impact on 
causing actual damage to the myocardic, 
pulmonary valve, and ventricular, endocardial, 
and pericardial dysfunction, which requires 
continuous monitoring in the intensive care unit 
(ICU) (Tan, et al., 1982, Cieślik & Holecki, 2022). 
alarming results have been recorded for deaths 
due to heart failure in several countries around 
the world. In the Middle East, Saudi Arabia 
occupied an advanced position in deaths, with 
36% of deaths due to heart muscle failure due to 
pericarditis, followed by Egypt with a rate of 
21.5% of deaths due to myocardial infarction, 
and Jordan with a rate of 12% due to myocardial 
infarction (Mazurek, et al., 2022). while the death 
rate due to heart failure in Latin America was 
recorded in 2023 alone, more than 470 deaths 
due to Myocardial infarction resulting from lupus, 
in Mexico there are no official statistics on these 
cases, but medical investigative reports suggest 
that the percentage is increasing due to 
myocardial infarction (Adawi & Blum, 2020, 
Mazurek, et al., 2022). the American Heart 

Association reported that approximately 2 million 
patients suffer from fatal Myocardial infarctions, 
most of whom are women of childbearing age. 
There are Myocardial infarctions that have 
become chronic and life-threatening, and 
diseases resulting from hypertension and 
repeated Myocardial infarction (Foret, et al., 
2022, Mazurek, et al., 2022). 
 
The pathogenesis of cardiac damage in SLE is 
thought to depend on the combined or 
independent effects of chronic immunological 
disorder inflammation, accelerated progression 
of atherosclerosis, and the use of certain ant 
rheumatic drugs (Tan, et al., 1982). According to 
an epidemiological study (n = 500 people), in 
patients with systemic lupus erythematous M 
cardiac damage was more frequently recorded 
(Gladman & Ibanez, 2002): arrhythmia and 
electrical disturbances in 22% and 6%, coronary 
Myocarditis - in 13% and 4%, major valve 
insufficiency in 11% and 2%, myocardial 
infarction (MI) - in 6% and 2%, cor pulmonale in 
2.2% and 0.2%, heart failure (HF) in 1.0%. 
 
In Iraq, there are no statistics that show us the 
death rate resulting from systemic lupus 
erythematosus. The last statistics for Iraq 
reached 11% in 1989, and Baghdad, the         
capital, topped the list. All deaths were             
among fertile women between the ages of 25 - 
45, and the statistics indicated myocardial 
infarction. 
 
After years of war, annual statistics were absent. 
In this research, I focused on studying the effect 
of lupus on the heart muscle for the year 2022 to 
the beginning of 2024, in terms of the effect of 
lupus on heart function within the available 
medical data and for the same age group in 
1989. 



 
 
 
 

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62 

 

2. METHODOLOGY 
 
The study included 88 patients, 80 (92%) females 
and 8 (9.5%) males, with a mean age of 35 
years, making it an ideal sample for the study. A 
control group of 85 patients was selected. We did 
not care about gender matching, although the 
majority of participants in the control group were 
female and had similar symptoms and conditions 
to the study group. The patients were monitored 
at Al- Mawaddah Private Hospital and private 
laboratories specializing in immunodiagnostics 
from 2022 to 2024. 
 

1. The medical history of each participating 
patient was analyzed, including 
confirmation of lupus and cardiac 
symptoms such as impaired carbohydrate 
metabolism and cardiac and circulatory 
complications in patients with rheumatoid 

arthritis and systemic lupus 
erythematosus. 

2. Identifying the immune damage caused by 
lupus other than cardiac muscle, to help us 
understand the context of cardiac damage, 
whether direct or indirect (Table 1). 

3. All participants underwent an ECG and 
Echo-cardiography to confirm cardiac 
involvement or detect signs of myocardial 
ischemia (Table 2). 

4. Laboratory and immunological 
examinations of the participants were 
performed to provide a clear statistical 
picture. 

 
Note / This study paid special attention to the 
immunological aspect of the effect of systemic 
lupus erythematosus on the cardical seeking to 
understand the role of autoimmune diseases 
(lupus) on the cardic muscle. 

 
Table 1. key immune related manifestation of condition. 

 

Main immunological manifestations of diseases 

SLEDAI_2K 4- 15 coordinates 
SLICC_DI (damage index) 0- 1 coordinates 
hematological disorders 22% 
nephritis 31% 
arthritis 25% 
skin lesions 22% 
sororities 22% 
antinuclear factor (ANF) 94%, antibodies to double-stranded DNA (anti_dsDNA) 
ant phospholipid syndrome 76% of patients (positive) 
Sjogren's syndrome 7% (positive) 

 

 
 

Fig. 1. Volumetric Effect of Immunological disorder Manifestations of the Disease 
 

Sororities, 18%

Skin lesions, 
18%

Arthritis, 21%

Hematological 
Disorders, 

18.00%

Nephritis, 25%Sororities
Skin lesions
Arthritis
Hematological Disorders
Nephritis



 
 
 
 

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63 

 

Table 2. Immunodiagnostic with systemic lupus erythematous cautilizing myocardial infection 
 

N. Sle Immunological disorder cardiomyopathy by systemic lupus 
erythematous 

Rate values 

16 pericardium 26% 
18 Adhesive pericarditis 30% 
15 Exudative pericarditis 10% 
4 acute myocarditis 5% 
5 Ischemic Myocarditis (IHD) 3% 
10 Heart Failure (HF) 15% 
2 myocardial infarction (MI) 1% 
16 cardiac arrhythmias 9% 
2 patients with SLE respectively 1% 

 

 
 

Fig. 2. values cardiomyopathy by systemic lupus erythematous 
 
Exclusion Criteria: This study specifically 
targeted patients aged 30 ± 15 years,               
based on the statistical system issued                          
by the Iraqi Ministry of Health before                          
1989 regarding the rate of infections and               
deaths from heart diseases resulting from           
lupus. 
 
The following categories were excluded: 
 

1. The following categories of people under 
the legal age of 18 were excluded for legal 
considerations, which require the research 
body to obtain judicial approval and be 
under judicial supervision 

2. Those over 45 years of age were excluded, 
as most of the study participants were 
women and must be fertile. As is the 
practice in current research regarding 
lupus, participants must be no older than 
45.  

3. Those with comorbidities such as tumors, 
malignancies, or infectious diseases 

 
The medical reports provided by cardiologists 
were reviewed for all patients, and they had 
conventional hazard factors for cardiac and 
circulatory disease. 
 
Transthoracic echocardiography was performed. 
Patients were evaluated for left ventricular 
diastolic and systolic function, ejection fraction 
(EF), left ventricular myocardial thickness, 
chamber sizes, systolic pulmonary artery and 
diastolic pressure, pericardial status, and valves. 
 
Laboratory and Statistical Diagnosis: 
Concentration of the N-amino terminal fragment 
of (probrain- natriuretic – peptide) (NT_proBNP) 
in serum was determined by electrochemical 
analysis (ECL) on a Cobas analyzer utilizing the 
Elecsys proBNP II test system. Typically, 

myocardial 
infarction (MI), 

1.00%

Heart Failure (HF), 
20.00%

Ischemic Heart 
Disease (IHD), 

4.00%

acute myocarditis, 
7.00%

Exudative 
pericarditis, 14%

Adhesive 
pericarditis, 41%

cardiac 
arrhythmias, 12%

patients with SLE 
respectively, 1%

myocardial infarction (MI)

Heart Failure (HF)

Ischemic Heart Disease
(IHD)
acute myocarditis

Exudative pericarditis

Adhesive pericarditis

cardiac arrhythmias

patients with SLE
respectively



 
 
 
 

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64 

 

NT_proBNP levels are ≤125 pg/ml, according to 
procedural guidelines (McMurray, et al., 2012). 
Statistical analysis was performed utilizing 
parametric and nonparametric statistical methods 
of Applied Statistics NT_proBNP in the two 
groups is equal to 12. Variables were presented 
as medians (ME), with the upper and lower 
quartiles indicated in parentheses (25th 
percentile; 75th percentile). The reliability of 
variations between the two groups was assessed 
utilizing the (SPSS software) criterion. Qualitative 
indicators were compared in two unrelated 
groups in association table utilizing the χ2 test. 
The significance level was p < 0.05 (Rebrova, 
2002). 
 
Procedures: Median duration of SLE was two 
years, with moderate disease activity 
(SLEDAI_2K) 9 coordinates (Hochberg, 1997), 
and the SLICC_DI damage index was 2 
coordinates (Kim, et al., 2017). The main clinical 
manifestations of the disease embraced 
hematological disorders (49%), nephritis (45%), 
arthritis (37%), skin lesions (34%), and synovitis 
(33%). Eighty-six patients (98%) had immune 
disorders: elevated levels of antinuclear factor 
(ANF) were recognition in 95%, and anti_dsDNA 
antibodies were recognition at 78% of SLE 
patients. Associated antiphospholipid syndrome 
(allergic fungal sinusitis (AFS) and Sjögren's 
syndrome were identified in 9 (9%) and 10 (11%) 
patients, respectively (Miyakis, et al., 2006). 
 
Valvular regurgitation with varying degrees of 
regurgitation (not requiring surgical treatment) 
was the most frequently observed cardiac 
abnormality in systemic lupus erythematous 
(SLE), identified in 79 patients (90%): 78 patients 
(89%) with tricuspid regurgitation, 72 patients 
(82%) with mitral regurgitation, 57 patients (7%) 
with pulmonary artery regurgitation, and 15 
patients (14%) with aortic regurgitation. 
Endocarditis was identified in 26 patients (30%), 
and mitral or tricuspid valve prolapse in 30 
patients (34%). The rarest was mitral, tricuspid, 
and aortic stenosis, identified in one patient (1%). 
The median concentration of NT_proBNP was 92 
(27–332) pictograms per milliliter, an elevated 
level of NT_proBNP (> 125 pictograms per 
milliliter) was identified in 29 patients (32%). 
 
The possible association of cardiac disorders 
with therapy used in SLE, patients had divided 
into two groups. 
 

• Group 1: embraced 43 patients (40 
women - 3 men) with a median age of 30 ± 

15 years who, at time of examination, had 
not received glucocorticoids (GC), 
immunosuppressant 

• Group 2: embraced 45 patients (40 
women - 5 men), the median age was 30 ± 
15 years patients took a variety of 
combinations of these drugs. choroquine, 
corticosteroids at a dose of 150 mg/day. 
Among them were both newly ill and long-
term patients with SLE, but who canceled 
previously prescribed therapy. HA was 
received by 44 (98%) of them, the median 
dose was 20 mg /day when calculated for 
prednisone. During the entire period of the 
disease, cyclophosphamide was used in 
23 (48%) patients, azathioprine in 17 
(38%), mycophenolate mofetil in 16 (36%), 
methotrexate in 9 (19%), choroquine, 
corticosteroids in 43 (96%). 

 

3. RESULTS IMMUNOLOGICAL 
 
Immunology and laboratory characteristics            
of patients of both groups are presented in            
Table 2. The groups were comparable in          
age and gender, women predominated (93% - 
90%). 
 
Patients of the 2nd group had a longer duration of 
illness than participants of the 1st group p < 
0.00001), less activity (SLEDAI_2K and 12 
coordinates, p < 0.001), a higher damage index 
(SLICC_DI 1 - 0 coordinates, p < 0.001), they 
exhibited a lower incidence of skin lesions (11% 
and 57%, p < 0.0001), joints (22% - 52%, p < 
0.05) and hematological disorders (24% and 
73.8%, p < 0.0001) . 
 
The main immunology examination 
manifestations of SLE in group 1 patients have 
hematological disorders (74%), skin lesions 
(57%), kidneys (55%) and joints (52%), all also 
revealed immunological disorders an increase 
the level of antinuclear factor (ANF) in 100%, 
anti dsDNA in 80% patients. 
 

• Group 1: Nephritis (36%), sororities (29%), 
hematological disorders (24%) and arthritis 
(22.2%). 

• Group 2: Immunological disorders have 
identified in 96% of patients. no relevant 
variations were identified in the 
concomitant Sjogren's syndrome and 
Allergic Fungal Sinusitis (AFS). 

 
This, division of patients with SLE into groups 
upon taking ant rheumatic therapy 



 
 
 
 

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65 

 

(immunosuppressant, GIBP) allowed us to 
assess its relationship with the activity and 
duration of SLE, since the groups differed 
relevantly in these indicators. 
 
Value level of NT_proBNP in untreated patients 
was elevated than in group 2nt (151 - 33 

pictograms per milliliter, respectively, p < 0.01), 
while exceeding normal values. 
 
Note / that the mean value of and the mean 
value of the control group is equal to 4, noting 
that P. value NT_proBNP equal 0.05 mean value 
lupus value is equal 19.37. 

 

Table 3. Comparison immunological and laboratory characteristics of patients of both groups 
are presented 

 

Characters SLE (n = 88) Control (n=85) P. value Notes 

NT_proBNP (mean) 19.37 4 0.05 Based on the assumption 
that the overall mean for 
both groups is equal to 12, 
the probability value 
indicates the difference in 
statistical significance 

Age (mean ± SD) 30 ± 15 30 ± 14 <0.001 There is a difference in the 
statistical results regarding 
the distribution of ages 

Gender (male) 3 (10%) 5 (4%) <0.0001 The statistical difference in 
results is very high between 
the two genders 

Gender (female) 40 (90%) 40 (96%) <0.0001 The statistical difference in 
results is very high between 
the two genders 

Total sample size 88 85   
N. of individuals with 
determined gender 

43 45   

 

Anti_ENA (Extractable Nuclear Antibodies): antibody ranges intermediate to SLE sufferers and 
manipulate organization is supplied in Table 5. The evaluation outcomes reveal there haven’t 
extensive variations (P > 0.015) within the detection results of Anti_JO1 and anti_Scl70 antibody 
<0.001 intermediate to SLE patients and manage institution. but, the SLE patient institution exhibited 
relevantly raised of antiRNP levels <0.001, anti_Sm <0.001, anti SSA, and anti SSB compared with 
group of control, with all variations being statistically relevant (P < 0.01). These results in the bottom. 

 

Table 4. Comparison Levels Anti_ENA 
 

Antibody SLE (n = 88) Control (n = 85) P. values 

Anti_JO1   
Negative 6(7%) 78(92%) <0.001 
Positive 82(93%) 7(8%) 
Anti-RNP  <0.001 
Negative 13(15%) 72(85%) 
Positive 75(85%) 13(15%) 
Anti_Scl70  0.15 
Negative 77(88%) 81(95%) 
Positive 11(12%) 4(5%) 
Anti_Sm  <0.001 
Negative 66(75%) 83(98%) 
Positive 22(25%) 2(2%) 
Anti_SSA  <0.001 
Negative 35(40%) 68(80%) 
Positive 53(60%) 17(20%) 
Anti_SSB   0.005 
Negative 72(82%) 77(90%) 
Positive 16(18%) 8(10%) 



 
 
 
 

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Analysis of Associate Chartered Accountant 
(ACA) levels: Results comparing ACA levels in 
patients with SLE to those in the control group 
are outlined in Table 6. The analysis revealed 
that positive rate of ACA antibodies had 
increased over time, ACA (IgA, IgG, IgM), are 
elevated in SLE group compared to the control 
group, with these variations achieving statistically 
relevant (P < 0.05) as shown in Table 6. 

• P25 represents the first quartile of the 
25% percentile. 

• P75 represents the middle quartile of 
the 75% percentile. 

• Interquartile range (IQR) measure of 
spread and dispersion shows the             
least effect of infection and the            
result is the first quartile - the middle 
quartile. 

 
Table 5. Comparison of ACA detection results between SLE group and the control group 

 

ACA (n (%) SLE (n = 88) Control (n = 85) P. values 

Negative 59(67%) 53(62%) <0.001 
Positive 29 (33%) 32(38%) 
Antibody Median IQR = P75- P25 P. values 
ACA IgA (P75-P25) 5 (7.67-2.32) 5.35 0.017 
ACA IgG (P75-P25) 6 (8.75-2.63) 6.12 0.001 
ACA IgM (P75-P25) 9 (13.51-4.82) 8.69 0.004 

 
Table 6. Comparison of B2_GPI Autoantibodies detection results between SLE group and 

control group 
 

Antibody SLE (n = 88) Control (n = 85) P. value 

B2_GPI Autoantibodies 25(28%) 14(17%) <0.001 
IgA (median) 8(12.94-4.08) 6(8.36-2.77) <0.001 
IgG (median) 6(8.36-2.8) 5(7.84-2.53) <0.001 
IgM (median) 6(8.35-3) 5(7.84-2.53) <0.001 

 
Table 7. Operational definition 

 

Immunological 
test 

Examination 
(Manufacturer) 

Aim 

SLLICC_DI N/N The aim of the examination is to assess the amount of 
accumulated damage to the organs resulting from lupus 

Anti_dsDNA ELISA test (thermo 
fisher scientific) 

It aims to detect autoantibodies, which are responsible 
for attacking the body's tissues. 

NT_proBNP Cobas (Beckman 
Coulter) 

The purpose of screening is to diagnose a heart 
condition by detecting the level of peripheral brain 
peptide 

ACA ELISA test 
(Euroimmun) 

The aim is to detect anti- centromere antibodies 
responsible for attacking healthy tissues in an 
immunological disorder disease. 

Anti_ENA ELISA test (Inova) It aims to detect antibodies to nuclear antigens and is 
used to 

  detect Sjögren's syndrome and polymyositis. 
SLEDAI_2K N/N The index is used to evaluate lupus disease and helps 

doctors assess the patient's response to treatment. 
Anti_JO_1 Antibody ELISA test (Inova) Type of Anti _ENA test 
Anti_RNP Antibody ELISA test (Inova) Type of Anti _ENA test 
Anti_SCI70 
Antibody 

Topoisomerase 
test 

The aim of detecting SCI70 antibodies in the blood is to 
diagnose systemic scleroderma. 

Anti_Sm _Antibody ELISA test (Inova) Type of Anti _ENA test 
Anti_SSA Antibody ELISA test (Inova) Type of Anti _ENA test 
Anti_SSB Antibody ELISA test (Inova) Type of Anti _ENA test 
B2_GPI 
Autoantibodies 

ELISA test 
(Euroimmun) 

The aim of detecting antiphospholipid syndrome is to 
detect antibodies to beta-2 protein. 



 
 
 
 

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B2_GPI Autoantibodies levels: When detecting 
antibodies B2_GPI Autoantibodies and 
comparing the results with the lupus disease and 
control group, it was identified that positive 
results for antibodies B2_GPI Autoantibodies 
were higher in lupus patients compared to the 
control group as shown in Table 7. 
 

4. RESULTS AND DISCUSSION 
 
The influence of immunological disorder 
inflammation in the endocardium, valves, aortic 
dissection and hypertension and HA therapy            
are discussed as possible causes of these 
changes. The use of HA can lead to                  
rapid "healing" of inflammation of a valve 
especially of the heart (valvulitis) (Gladman & 
Ibanez, 2002). 
 
Despite the fact that bacterial or nonbacterial 
thrombotic endocarditis is a characteristic classic 
valve lesion in SLE (Adawi & Blum, 2020), most 
researchers agree that the most common change 
in heart valves is insufficiency with varying 
degrees of regurgitation (Mazurek, et al., 2022). 
Some indicate a high incidence of aortic valve 
insufficiency, others indicate mitral valve 
insufficiency (Kim, et al., 2017). 
 
In my study, tricuspid and mitral valve 
insufficiency was more common, and aortic valve 
insufficiency was less common; the changes 
were not clinically relevant and did not require 
surgical correction. 
 
An increase in the level of natriuretic peptide 
(BNP) is not specific for myocarditis, Based on 
the dynamics of the NT_proBNP level, the 
effectiveness of treatment is evaluated and a 
prognosis is made. While maintaining its high 
concentration, it can be assumed that there is 
active inflammation, its carbonization. Therefore, 
according to the recommendations immunologic 
and cardiologists, all patients with clinical 
suspicion of myocarditis should conduct a study 
of the initial level of NT_proBNP and its 
dynamics (Hochberg, 1997). 
 
They do not have any special features, and 
associations with SLE-specific autoantibodies 
and therapy have also not been identified. In the 
present study, rhythm disturbances were 
recognition in 18% of patients. 
 
The number of atherosclerotic plaques in the 
coronary and femoral arteries is twice as high in 
patients with disease as in people suffering from 

rheumatoid arthritis and DM diseases with high 
cardiovascular hazard (Petri, et al., 2012). 
 
In my study, I did not observe a statistical 
difference in the incidence of various 
Myocarditiss and heart failure between those 
who received immunosuppressant and high 
blood pressure treatments and those who did not 
receive them, but the difference was clear in 
those who developed lupus. 
 
98% of cases, HA was used, hypertension, an 
increase in total cholesterol and BMI values were 
more often observed, which confirms the opinion 
about the effect of HA on the frequency of TFR. 
 
Currently, the determination of the concentration 
of NT_proBNP is used for the screening of 
HEART FAILURE (HF), assessment of its 
severity and prognosis, as well as monitoring the 
effectiveness of therapy. In addition, a high level 
of NT_proBNP is an independent hazard factor 
not only for Heart Failure (HF). 
 
There are isolated studies on the concentration 
of BNP NT_proBNP in immunological disorder 
inflammatory diseases. In SLE, the level of this 
biomarker was determined only in patients 
receiving pathogenesis therapy (Tan, et al., 
1982, Gladman & Ibanez, 2002). The 
concentration of BNP NT_proBNP in patients 
with SLE was higher than in the control group, 
this increase was primarily associated with 
myocardial dysfunction, but was not associated 
with vascular damage, including atherosclerotic, 
inflammatory markers, and SLE activity. 
 

5. CONCLUSION 
 
Despite the young age of patients, therapy 
(primarily with glucocorticoids, HA) and a long 
duration of certain SLE are linked to a higher 
prevalence hazard factors (hypertension, 
hypercholesterolemia, overweight), and 
myocarditis A practicing rheumatologist should 
pay attention to the need for joint management of 
patients with SLE with a cardiologist and 
immunological , assessment of markers of Heart 
Failure (HF) as a potentially fatal complication, 
especially in patients with high disease activity 
under medical control of TFR utilizing a minimum 
dose of HA during remission and low activity. 
 

6. LIMITATIONS 
 

1. Despite the extreme importance of the 
study, we were unable to include larger 



 
 
 
 

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68 

 

areas, at least in southern Iraq, due to legal 
restrictions on allowing data collection and 
involving a larger study sample. 

2. Medical records were used to collect 
information for patients, especially the 
control group. 

3. There is no similarity between patients in 
the severity and duration of the injury 

4. Limited laboratory materials and CT scan 
results for patients prompted us to 
communicate directly with patients for re-
evaluation. 

 

7. RECOMMENDATIONS 
 

1. Raising awareness among doctors about 
the risks of lupus and its direct impact on 
heart function, especially in its early 
stages. 

2. It is necessary to deepen the studies and 
establish a longitudinal study to increase 
understanding of the effect of lupus on the 
heart. 

3. Encourage teamwork among cardiologists, 
rheumatologists, and immunologists to 
develop an early picture of lupus disease 
progression and the potential for cardiac 
damage. 

4. Requiring lupus patients to undergo heart 
function tests even if they do not show 
heart symptoms and making it a 
mandatory work routine 

 

CONSENT  
 

As per international standards or university 
standards, patient(s) written consent has been 
collected and preserved by the author(s). 
 

ETHICAL APPROVAL 
 

As per international standards or university 
standards written ethical approval has been 
collected and preserved by the author(s). 
 

DISCLAIMER (ARTIFICIAL INTELLIGENCE) 
 

Author(s) hereby declare that NO generative AI 
technologies such as Large Language Models 
(ChatGPT, COPILOT, etc) and text-to-image 
generators have been used during writing or 
editing of this manuscript.  
 

ACKNOWLEDGEMENT 
 

I would like to extend my sincere gratitude and 
appreciation to Professor Dr. Fateh Shaker Abdul 
Hussein, a specialist in cardiology and vascular 

diseases, for his valuable insightful guidance to 
completion of this research. 
 

COMPETING INTERESTS 
 
Author has declared that no competing interests 
exist. 
 

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