Left Ventricular Systolic Function in Patients with Systemic Lupus Erythematosus and Its Association with Cardiovascular Events

Abstract

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with potential cardiovascular involvement. The aim of this study was to assess left ventricular (LV) systolic function in a large cohort of patients with SLE using standard echocardiographic measurements and global longitudinal strain (GLS) by two-dimensional speckle-tracking analysis. Furthermore, the association between echocardiographic parameters and the occurrence of cardiovascular events was assessed. Methods: A total of 102 patients with SLE (88% women; mean age, 43 6 14 years) undergoing a dedicated multidisciplinary assessment were analyzed, including echocardiography, at the time of their first visit. A control group consisted of 50 age-and sex-matched healthy subjects. Results: Compared with control subjects, patients with SLE showed impaired LV systolic function on the basis of LV ejection fraction (51 6 6% vs 62 6 6%, P < .001) and by LV GLS (À15 6 3% vs À19 6 2%, P < .001). During a median follow-up period of 2 years (interquartile range, 1-6 years), 38 patients (37%) developed cardiovascular events. Kaplan-Meier survival curves showed that patients with SLE with more impaired LV GLS (on the basis of the median value of À15%) experienced higher cumulative rates of cardiovascular events compared with those with less impaired LV GLS (c 2 = 8.292, log-rank P = .004). On multivariate Cox regression analysis, LV GLS demonstrated an independent association with cardiovascular events (hazard ratio, 2.171; 95% CI, 1.015-4.642; P = .046), whereas LV ejection fraction was not significantly associated with the outcome. Conclusions: In patients with SLE, LV systolic function as measured by LV GLS is significantly impaired and associated with cardiovascular events, potentially representing a new tool to improve risk stratification in these patients.

Speckle tracking imaging combined with myocardial comprehensive index to evaluate left ventricular function changes in patients with systemic lupus erythematosus

“…There was no statistically significant difference in terms of LVESV in the three studied groups. Moreover, although SPI reflected left ventricular geometry, there was no significant difference in the three studied groups, indicating that the early left ventricular systolic function may be locally impaired in SLE; however, the decline in function is not obvious, and the overall function is still within the normal range 8 . At the same time, there was a statistically significantly decrease in GLS, GCS and LVtw in the mild‐to‐moderate and severe groups compared to the control group, indicating that the left ventricular systolic function is damaged in the early stage.…”

“…Moreover, although SPI reflected left ventricular geometry, there was no significant difference in the three studied groups, indicating that the early left ventricular systolic function may be locally impaired in SLE; however, the decline in function is not obvious, and the overall function is still within the normal range. 8 At the same time, there was a statistically significantly decrease in GLS, GCS and LVtw in the mild-to-moderate and severe groups compared to the control group, indicating that the left ventricular systolic function is damaged in the early stage. This may be due to fact that SLE can lead to the deposition of immune complexes in the cardiovascular system or inflammatory changes after complement activation that result in the degeneration of collagen fibers in the myocardial interstitium.…”

Speckle Tracking Imaging Combined With Myocardial Comprehensive Index to Evaluate Left Ventricular Function Changes in Patients With Systemic Lupus Erythematosus

“…This study showed that LVEF in the SLE group decreased significantly, LVEDV, LV EDmass, and LV ESmass increased significantly, and LVESV had no significant change compared with the control group. Moreover, although SPI reflected left ventricular geometry, there was no significant difference, indicating that the early left ventricular systolic function may be locally impaired in SLE; however, the decline in function is not obvious, and the overall function is still within the normal range [8] . At the same time, the results showed that the three-dimensional strain parameters of the left ventricle (GLS, GCS, and LVtw) decreased in the SLE group, indicating that the left ventricular systolic function is damaged in the early stage.…”

Early assessment of subclinical myocardial injury in systemic lupus erythematosus by two-dimensional longitudinal layer speckle tracking imaging

“…A previous study showed (12) that LV whole strain can evaluate LV systolic function of patients with SLE and found that GLSglobal was reduced in patients with SLE. We obtained the same result.…”