Left ventricular diastolic dysfunction and diseases severity contribute to impaired exercise capacity in systemic lupus erythematosus

Abstract

Objectives Patients with systemic lupus erythematosus (SLE) have a higher risk of myocardial involvement, which can result in ventricular dysfunction. The aim of our study was to estimate potential relationship between exercise capacity assessed by six minute walk test (6MWT) and echocardiographic parameters of left and right ventricular function in SLE patients. Methods We prospectively studied 66 SLE patients (57 F, age 44 (20–75) years) and 27 age matched healthy subjects. In addition to routine evaluation, 6MWT and transthoracic echocardiography including LV diastolic dysfunction parameters (E/A, E/É) were performed. Results While E/A was similar in both groups, E/E’ was higher in patients with SLE than in controls, 7.5 (4–22) vs 6.8 (1.6–9.4), p = 0.018. The mean 6MWT distance was significantly shorter in SLE (561.6 ± 150.7 vs 682.6 ± 98.1 m, p < 0.002). Among SLE patients only 53 (80.3%) were capable to walk at least 450 m, while in controls 27 (100%) (p = 0.013). We observed significant correlations between 6MWT distance and SLICC/ACR-DI (rho=−0.44, p < 0.001), E/A (rho = 0.30, p = 0.004), E/E’ (rho=−0.36, p < 0.001) in SLE patients. Univariable logistic regression models revealed that SLICC/ACR-DI, E/E’, tricuspid regurgitant peak gradient (TRPG), and right ventricular systolic pressure (RVSP) were associated with 6MWT distance lower than < 450 m. ROC curves shown high predictive value of E/E’ ratio, TRPG, RVSP in the prediction for 6MWT distance < 450 m. Conclusion Impaired exercise tolerance seems to result mainly from the severity of SLE and LV diastolic dysfunction.

Early Detection of Subclinical Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus: A Case-Control Study

“…Moreover, in our study, lower values of E velocity were observed without difference in A velocity and the E/A ratio in the SLE patients compared to healthy controls. Since diastolic dysfunction had not yet occurred, the characteristics of diastolic dysfunction, including low velocity E, high velocity A, and the inverse E/A ratio, were not observed in the SLE patients, which is contrary to previous studies (18,25,26). In the investigation by Chung et al (27), the LVEFs of SLE patients and healthy individuals were simi-lar, while the E/A ratio in the SLE patients was much lower than the control group.…”

Ventricular-arterial coupling in systemic lupus erythematosus women without cardiovascular risk factors

“…We recently found a strong association among endothelial dysfunction, nailfold videocapillaroscopy and circulating CD3 + CD31+CXCR4+ lymphocytes (angiogenic T cells) in patients with systemic lupus erythematosus (SLE), short disease duration, low disease activity, and without cardiovascular (CV) risk factors, demonstrating a clear microvascular perturbation since the early stage of the disease. 1 On the other hand, in parallel with other rheumatologic diseases, SLE itself is characterized by subclinical myocardial impairment, particularly regarding diastolic dysfunction 2 and altered myocardial contractility. 3 However, understanding the left ventricular (LV) performance requires not only examining the properties of the left ventricle itself, but also investigating the modulating effects of the arterial system on LV function.…”