Early onset left ventricular remodeling in juvenile systemic lupus erythematosus; Insight from 3-dimensional speckle tracking echocardiography

Abstract

Background Early diagnosis and treatment of myocardial affection in patients with systemic lupus erythematosus (SLE) are crucial. Objectives To evaluate the ventricular systolic function in juvenile-onset systemic lupus erythematosus (j-SLE) patients by 3-D speckle tracking echocardiography (3D-STE) and to determine the predictors of left ventricular (LV) dysfunction if present. Methods Twenty-six SLE patients without heart failure and 21 healthy controls were studied by standard echocardiogram and 3D-STE. Conventional parameters included LV ejection fraction (EF), fractional shortening (FS), and mitral annular plane systolic excursion (MAPSE). Global LV strain (GLS) and global area strain (GAS) were obtained by 3D-STE. Medical records, including diagnosis criteria, duration of disease, and SLE disease activity index (SLEDAI) were evaluated. Results The mean age was similar in patients and controls 11.42 vs 11.48 years p = 0.93. The mean duration of the disease was 1.87 ± 1.02 years and SLEDAI ranged from 0 to 9. By conventional and tissue Doppler imaging echocardiography, only MAPSE was significantly lower in SLE patients compared to controls (14.56 vs 18.46 mm, p < 0.001). By 3D speckle tracking echocardiography, GLS and GAS were significantly reduced in SLE patients compared to controls (−15.07 vs −19.9.4%, −34.6% vs −39.7%, respectively, p < 0.001). Multiple linear regression and ROC analyses indicated that the SLEDAI score was the only predictive factor for the left ventricular remodeling. Conclusions These results indicate that early subclinical LV dysfunction occur in jSLE patients even with normal EF and SLE disease activity might be a potential driver for LV deformation.

Left ventricular systolic function assessed by standard and advanced echocardiographic techniques in patients with systemic lupus erythematosus: A systemic review and meta-analysis

“…LVEF was significantly lower in almost every reported study in our meta-analysis, with very few exceptions. 20,21,[40][41][42][43][44][45][46][47][48][49][50][51][52] Left ventricular systolic function assessment with STE derived LVGLS showed consistently lower levels in every reported study without exceptions. 40,41,53,54 Interestingly, these findings are confirmed and extended by the subgroup analyses, showing similar results both in studies using 2D STE and in those using 3D STE modalities.…”

“…LVEF was significantly lower in almost every reported study in our meta-analysis, with very few exceptions. [ 20 , 21 , 40 - 52 ]…”

A deeper look into the functions of right ventricle using three-dimensional echocardiography: the forgotten ventricle in children with systemic lupus erythematosus

“…Hence, the need for monitoring irretrievable organ damage to help provide the best care. Furthermore, most of the research in c-SLE has focused on LV functions, even on using 3DE [ 29 , 30 ]. Therefore, the current work shed light on the subclinical myocardial functional alterations of the forgotten ventricle “the RV” in asymptomatic pediatric patients with c-SLE in relation to controls using conventional ECHO, tissue Doppler, and specific emphasis on 3DE-derived parameters.…”

Higher body mass index and disease duration are associated with increased risk of left ventricular diastolic dysfunction in women with systemic lupus erythematosus

“…Studies have also shown that global longitudinal strain (GLS) is a good predictor of mortality in patients with HF, and in patients with SLE it has been shown to find significant impairment of diastolic and systolic function 5,6 and even before these changes the alterations can be detected by two-dimensional ultrasound 7 and are related to a longer duration and high SLE activity index 8 regardless of age. 9…”

“…Studies have also shown that global longitudinal strain (GLS) is a good predictor of mortality in patients with HF, and in patients with SLE it has been shown to find significant impairment of diastolic and systolic function 5,6 and even before these changes the alterations can be detected by two-dimensional ultrasound 7 and are related to a longer duration and high SLE activity index 8 regardless of age. 9 Diabetes mellitus (DM) is an increasingly important contributor to HF. 10 In this context, insulin resistance (IR) may play a role in the initiation and progression of metabolic cardiomyopathy affecting LV contractility and stiffness through the shift in substrate utilization toward fatty acid metabolism.…”