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Clinical improvement of cardiac function in a patient with systemic lupus erythematosus and heart failure with preserved ejection fraction treated with belimumab
  1. Milad Baniaamam1,2,
  2. Alexandre E Voskuyl1,
  3. Michael T Nurmohamed1,2 and
  4. M Louis Handoko3
  1. 1Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Rheumatology, Reade, Amsterdam, The Netherlands
  3. 3Cardiology, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr M Louis Handoko; ml.handoko{at}amsterdamumc.nl

Abstract

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.

  • heart failure
  • immunology
  • systemic lupus erythematosus

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Footnotes

  • Contributors MB, MLH and AV contributed to data acquisition, manuscript preparation, manuscript draft and manuscript editing and revision. MTN contributed to manuscript draft and manuscript editing and revision.

  • 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.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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