TY - JOUR
T1 - Clinical improvement of cardiac function in a patient with systemic lupus erythematosus and heart failure with preserved ejection fraction treated with belimumab
AU - Baniaamam, Milad
AU - Voskuyl, Alexandre E.
AU - Nurmohamed, Michael T.
AU - Handoko, M. Louis
N1 - Funding Information: Funding MLH is supported by the Dutch Heart Foundation (Senior Clinical Scientist grant: 2020T058) Competing interests MB has no potential conflict of interests to report. MTN received speaker/consulting fees from AbbVie, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Janssen, GlaxoSmithKline, Roche and Sanofi, and research funding from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Mundipharma, Novartis, Pfizer, Roche and Sanofi. MLH received speaker/consultancy fees from Novartis, Boehringer Ingelheim, Daiichi Sankyo, AstraZekeca, Vifor Pharma, Quin, Bayer, Merck Sharp & Dohme, and research funding of Vifor Pharma. Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1/15
Y1 - 2021/1/15
N2 - We present a 51-year-old Caucasian woman, with a medical history of systemic lupus erythematosus (SLE) who had dyspnoea at exertion. The SLE was clinically quiescent but serologically active. Echocardiography showed preserved left ventricular (LV) systolic function, pseudonormal mitral inflow pattern (diastolic dysfunction grade III), absence of wall motion abnormalities and elevated E/e' at exercise. An exercise right heart catheterisation was performed, confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF). In the absence of other possible causes, we assumed that HFpEF was mediated by systemic inflammation secondary to SLE. Based on the Paulus' paradigm, that systemic inflammation may lead to diastolic dysfunction, we decided to add belimumab (a biological agent against soluble B-lymphocyte stimulator protein). After 16 weeks of treatment, patient reported an improved condition. Also, cardiopulmonary exercise test and echocardiography results improved, confirming resolution of the underlying LV diastolic dysfunction. This case supports the idea that targeting inflammation has therapeutic potential in a subset of HFpEF-patients.
AB - We present a 51-year-old Caucasian woman, with a medical history of systemic lupus erythematosus (SLE) who had dyspnoea at exertion. The SLE was clinically quiescent but serologically active. Echocardiography showed preserved left ventricular (LV) systolic function, pseudonormal mitral inflow pattern (diastolic dysfunction grade III), absence of wall motion abnormalities and elevated E/e' at exercise. An exercise right heart catheterisation was performed, confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF). In the absence of other possible causes, we assumed that HFpEF was mediated by systemic inflammation secondary to SLE. Based on the Paulus' paradigm, that systemic inflammation may lead to diastolic dysfunction, we decided to add belimumab (a biological agent against soluble B-lymphocyte stimulator protein). After 16 weeks of treatment, patient reported an improved condition. Also, cardiopulmonary exercise test and echocardiography results improved, confirming resolution of the underlying LV diastolic dysfunction. This case supports the idea that targeting inflammation has therapeutic potential in a subset of HFpEF-patients.
KW - heart failure
KW - immunology
KW - systemic lupus erythematosus
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85099604855&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33452071
UR - http://www.scopus.com/inward/record.url?scp=85099604855&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bcr-2020-237549
DO - https://doi.org/10.1136/bcr-2020-237549
M3 - Article
C2 - 33452071
SN - 1757-790X
VL - 14
JO - BMJ Case Reports
JF - BMJ Case Reports
IS - 1
M1 - E237549
ER -