The ischemic areas in conjunctival microvasculation are significantly increased in patients with systemic lupus erythematosus (SLE) and pulmonary arterial hypertension (PAH), according to a new study published in the journal Disease Markers.

Combined with the vessel density and the microvascular flow index, the ischemic areas can improve the accuracy of echocardiography in assessing the risk of death in these patients, Jiangbiao Xiong and the coauthors of the study said.

PAH is a serious complication of SLE. Right heart catheterization is standard for diagnosis but this is a highly invasive and expensive technique that is not suitable to evaluate the effect of treatments on a regular basis. Echocardiography is an alternative method, although results obtained with this technique do not always correlate with those from right heart catheterization. 

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A previous study proposed conjunctival microvasculation as an effective method to assess hypercoagulable or prethrombotic state in patients with SLE.

Read more about PAH diagnosis

Here, a team of researchers assessed the value of conjunctival microvasculation combined with echocardiography in evaluating patients with PAH with SLE.

The researchers prospectively compared the changes in conjunctival microvascular in 17 patients with SLE and PAH and 34 patients with SLE without PAH from The First Affiliated Hospital of Nanchang University in China between January and December 2020.

They found that vessel density and microvascular flow index were significantly correlated with N-terminal prohormone of brain natriuretic peptide as well as the 6-Minute Walking Distance test.

Their findings propose a new method to evaluate the prognosis of SLE and PAH. 

“The ischemic area, [vessel density], and [microvascular flow index] of conjunctival microcirculation combined with echocardiography can improve the accuracy of risk assessment of PAH in SLE,” they wrote.


Xiong J, Yu S, Liu R, Fang X, Wu R. The role of conjunctival microvasculation combined with echocardiography in evaluating pulmonary arterial hypertension in systemic lupus erythematosus. Dis. Markers. Published online Novermber 26, 2021. doi:10.1155/2021/2135942