Background: Systemic lupus erythematosus (SLE) is associated with a variety of cardiovascular diseases, even in the early stage of disease development. The purpose of this study was to quantitatively evaluate left ventricular (LV) systolic function in patients with SLE using a novel non-invasive pressure-strain loop (PSL) technique.Methods: This prospective case-control study included 132 patients with SLE and 99 normal controls, all of whom underwent traditional transthoracic echocardiography. The LV myocardial work was evaluated with the PSL technique based on speckle tracking and brachial artery blood pressure. The differences among groups were compared, and the correlations between myocardial work, laboratory data, and disease activity were analyzed in the SLE group. Results: Compared with the normal group, SLE patients had significantly higher global wasted work {GWW; SLE: 109 [82-150] mmHg%; controls: 66 [45-109] mmHg%; P<0.001} and impaired global work efficiency [GWE; SLE: 95% (94-97%); controls: 97% (96-98%); P<0.001]. Global work index (GWI) and global constructive work (GCW) did not show significant differences (P>0.05). Further subdivision analysis found that the increase of GWW and the damage of GWE were more obvious in SLE patients with high disease activity or severe diastolic dysfunction. Multivariate analysis revealed that increased erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-phospholipid antibodies, peak strain dispersion, and SLE Disease Activity Index (SLEDAI) were independently associated with increased GWW (β=0.189, 0.230, 0.444, 0.111, and 0.180, respectively; all P<0.05) and damaged GWE (β=−0.184, −0.130, −0.468, −0.149, and −0.191, respectively; all P<0.05). Conclusions: The non-invasive PSL can quantitatively evaluate the LV systolic function in SLE patients.This technique may provide a new method for monitoring cardiac function in chronic diseases.

Background The treatment of advanced lung cancer has been revolutionized by immune checkpoint inhibitors (ICIs) in recent years, largely driven by programmed cell death-1 (PD-1) inhibitors. However, patients with lung cancer who are treated with PD-1 inhibitors are prone to immune-related adverse events (irAEs), especially cardiac adverse events. Noninvasive myocardial work is a novel technique used to assess left ventricular (LV) function, which can effectively predict myocardial damage. Here, noninvasive myocardial work was used to evaluate changes in LV systolic function during PD-1 inhibitor therapy and to assess ICIs-related cardiotoxicity. Methods From September 2020 to June 2021, 52 patients with advanced lung cancer in the Second Affiliated Hospital of Nanchang University were prospectively enrolled. In total, 52 patients underwent PD-1 inhibitor therapy. The cardiac markers, noninvasive LV myocardial work, and conventional echocardiographic parameters were measured at pretherapy (T0) and posttreatment after the first (T1), second (T2), third (T3), and fourth (T4) cycles. Following this, the trends of the above parameters were analyzed using analysis of variance with repeated measures and the Friedman nonparametric test. Furthermore, the relationships between disease characteristics (tumor type, treatment regimen, cardiovascular risk factors, cardiovascular drugs, and irAEs) and noninvasive LV myocardial work parameters were assessed. Results Throughout the follow-up, the cardiac markers and conventional echocardiographic parameters showed no significant changes. Based on the normal reference ranges, patients with PD-1 inhibitor therapy had increased values of LV global waste work (GWW) and decreased global work efficiency (GWE) that began at T2. Compared with T0, GWW increased from T1 to T4 (42%, 76%, 87%, and 87%, respectively), while global longitudinal strain (GLS), global work index (GWI), and global constructive work (GCW) decreased in varying degrees (P<0.001). Most of the disease characteristics had no effect on the LV myocardial work parameters; however, the numbers of irAEs were closely associated with GLS (P=0.034), GWW (P<0.001), and GWE (P<0.001). Patients with 2 or more irAEs had higher values of GWW and lower GLS and GWE. Conclusions Noninvasive myocardial work can accurately reflect myocardial function and energy utilization in patients with lung cancer who are undergoing PD-1 inhibitor treatment and may thus benefit the management of patients with ICIs-related cardiotoxicity.