Biventricular tissue tracking demonstrating associations between left ventricular myocardial extracellular volume, pulmonary artery pressure, and reduced right ventricular ejection fraction in patients with systemic lupus erythematosus using cardiovascular MRI

Characterization and clinical significance of biventricular mechanics in patients with systemic lupus erythematosus by 3T cardiovascular magnetic resonance tissue tracking

“…In patients with PAH, RV longitudinal strain obtained by CMR tagging and CMR-based heart deformation analysis was also positively correlated with mean pulmonary artery pressure and pulmonary vascular resistance (38,40). These findings were consistent with the results of Wu et al (35) and further confirmed that the RV contraction function in the longitudinal direction was gradually impaired due to PAH before that in the circumferential direction, as RV PDGLSR was significantly lower in our SLE participants (43), elevated anti-RNP levels have been associated with lupus myocarditis in SLE. In addition, anti-RNP antibody has also been associated with interstitial lung disease, which may affect the RV afterload (44,45).…”

“…The interdependence between the left and right ventricles can be explained appropriately by 3D echocardiography investigation (34): circumferentiallyoriented myofibers located on the RV epicardial surface encompass the sub-pulmonary infundibulum and advance more or less parallelly to the atrioventricular groove; a primary mechanism of RV pump function is bulging of the interventricular septum into the RV during LV contraction and stretching of the free wall over the septum, causing RV shortening in the anteroposterior direction. Additionally, LGE in the interventricular septum and RV insertion points might facilitate biventricular interaction, which is consistent with the research findings of Wu et al (35) and Puntmann et al (36). Studies of pulmonary hypertension have also reported that the extent of LGE in the RV insertion points was correlated with RV functional parameters (RV volumes, mass, EF, and longitudinal strain) (37,38).…”

“…We hypothesized that the impairment of LV endocardial longitudinal fibers might be the most susceptible and significant in SLE-related cardiac involvement. In addition to RV involvement caused by microvasculitis, myocarditis, and pulmonary hypertension in patients with SLE (14,35,39), biventricular interaction may lead to RV dysfunction when LV dysfunction is present (34). Furthermore, LV GLS was correlated with LVEF and LGE in this study.…”

“…Guo et al (14) also found that the RV was affected first in cardiac impairment after exclusion of SLE patients with CAD. Several studies have proposed that the cause of RV dysfunction might be related to PAH, the involvement of smaller-sized and medium-sized arteries, or microvascular injury related to endothelial dysfunction induced by antiphospholipid antibodies (APL) (14,35,39). Furthermore, we found that RV GLS was positively correlated with the PAH.…”

The Prognostic Importance of Right Ventricular Longitudinal Strain in Patients with Cardiomyopathies, Connective Tissue Diseases, Coronary Artery Disease, and Congenital Heart Diseases

“…CMR study investigated 47 women with SLE and found that only RV circumferential strain and not RVLS could discriminate SLE patients with normal RVEF (>50%) from those patients with reduced RVEF (<50%) [64]. However, both circumferential and longitudinal RV strain could differentiate between SLE patients with positive and negative LV LGE or between SLE patients with and without pulmonary hypertension [64]. RV circumferential strain was independently associated with extracellular volume and RVEF, whereas RVLS was independently related to pulmonary pressure [65].…”