Factors associated with long-term cardiac dysfunction in neonatal lupus

Amit Saxena, Peter M. Izmirly, Rebecca P. Bomar, Rachel Shireen Golpanian, Deborah M. Friedman, Ruth Eisenberg, Mimi Y. Kim, Jill P. Buyon

Research output: Contribution to journalArticle

Abstract

Objectives: Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies. Methods: Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age >1-17 years and 64 from age >17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data. Results: Cardiac dysfunction was identified in 22.4% at age 0-1 year, 14.8% at age >1-17 years and 28.1% at age >17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and >1-17 years, 43.8% with dysfunction at age 0-1 year were also affected at age >1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9% developed new dysfunction between ages >1 and 17 years. Among 34 with echocardiograms at ages >1-17 years and >17 years, 6.5% with normal function at age >1-17 years developed dysfunction in adulthood. Conclusions: Risk factors in fetal life can influence cardiac morbidity into adulthood. Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year.

Original languageEnglish (US)
Article number215900
JournalAnnals of the Rheumatic Diseases
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Age Groups
Multiple Birth Offspring
Morbidity
Logistics
Fetal Heart Rate
Counseling
Heart Diseases
Logistic Models
Regression Analysis
Demography
Mortality
Neonatal Systemic lupus erythematosus

Keywords

  • antibodies
  • cardiac dysfunction
  • neonatal lupus
  • outcomes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Saxena, A., Izmirly, P. M., Bomar, R. P., Golpanian, R. S., Friedman, D. M., Eisenberg, R., ... Buyon, J. P. (Accepted/In press). Factors associated with long-term cardiac dysfunction in neonatal lupus. Annals of the Rheumatic Diseases, [215900]. https://doi.org/10.1136/annrheumdis-2019-215900

Factors associated with long-term cardiac dysfunction in neonatal lupus. / Saxena, Amit; Izmirly, Peter M.; Bomar, Rebecca P.; Golpanian, Rachel Shireen; Friedman, Deborah M.; Eisenberg, Ruth; Kim, Mimi Y.; Buyon, Jill P.

In: Annals of the Rheumatic Diseases, 01.01.2019.

Research output: Contribution to journalArticle

Saxena A, Izmirly PM, Bomar RP, Golpanian RS, Friedman DM, Eisenberg R et al. Factors associated with long-term cardiac dysfunction in neonatal lupus. Annals of the Rheumatic Diseases. 2019 Jan 1. 215900. https://doi.org/10.1136/annrheumdis-2019-215900
Saxena, Amit ; Izmirly, Peter M. ; Bomar, Rebecca P. ; Golpanian, Rachel Shireen ; Friedman, Deborah M. ; Eisenberg, Ruth ; Kim, Mimi Y. ; Buyon, Jill P. / Factors associated with long-term cardiac dysfunction in neonatal lupus. In: Annals of the Rheumatic Diseases. 2019.
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abstract = "Objectives: Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies. Methods: Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age >1-17 years and 64 from age >17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data. Results: Cardiac dysfunction was identified in 22.4{\%} at age 0-1 year, 14.8{\%} at age >1-17 years and 28.1{\%} at age >17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and >1-17 years, 43.8{\%} with dysfunction at age 0-1 year were also affected at age >1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9{\%} developed new dysfunction between ages >1 and 17 years. Among 34 with echocardiograms at ages >1-17 years and >17 years, 6.5{\%} with normal function at age >1-17 years developed dysfunction in adulthood. Conclusions: Risk factors in fetal life can influence cardiac morbidity into adulthood. Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year.",
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AU - Saxena, Amit

AU - Izmirly, Peter M.

AU - Bomar, Rebecca P.

AU - Golpanian, Rachel Shireen

AU - Friedman, Deborah M.

AU - Eisenberg, Ruth

AU - Kim, Mimi Y.

AU - Buyon, Jill P.

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N2 - Objectives: Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies. Methods: Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age >1-17 years and 64 from age >17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data. Results: Cardiac dysfunction was identified in 22.4% at age 0-1 year, 14.8% at age >1-17 years and 28.1% at age >17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and >1-17 years, 43.8% with dysfunction at age 0-1 year were also affected at age >1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9% developed new dysfunction between ages >1 and 17 years. Among 34 with echocardiograms at ages >1-17 years and >17 years, 6.5% with normal function at age >1-17 years developed dysfunction in adulthood. Conclusions: Risk factors in fetal life can influence cardiac morbidity into adulthood. Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year.

AB - Objectives: Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies. Methods: Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age >1-17 years and 64 from age >17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data. Results: Cardiac dysfunction was identified in 22.4% at age 0-1 year, 14.8% at age >1-17 years and 28.1% at age >17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and >1-17 years, 43.8% with dysfunction at age 0-1 year were also affected at age >1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9% developed new dysfunction between ages >1 and 17 years. Among 34 with echocardiograms at ages >1-17 years and >17 years, 6.5% with normal function at age >1-17 years developed dysfunction in adulthood. Conclusions: Risk factors in fetal life can influence cardiac morbidity into adulthood. Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year.

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