Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography

Abstract

AimsLupus myocarditis occurs in 5–10% of patients with systemic lupus erythematosus (SLE). No single feature is diagnostic of lupus myocarditis. Speckle tracking echocardiography (STE) can detect subclinical left ventricular dysfunction in SLE patients, with limited research on its utility in clinical lupus myocarditis. We report on STE in comparison to conventional echocardiography in patients with clinical lupus myocarditis.Methods and resultsA retrospective study was done at a tertiary referral hospital in South Africa. SLE patients with lupus myocarditis were included and compared to healthy controls. Echocardiographic images were reanalyzed, including global longitudinal strain through STE. A poor echocardiographic outcome was defined as final left ventricular ejection fraction (LVEF) <40%. 28 SLE patients fulfilled the criteria. Global longitudinal strain correlated with global (LVEF: r = −0.808; P = 0.001) and regional (wall motion score: r = 0.715; P < 0.001) function. In patients presenting with a LVEF ≥50%, global longitudinal strain (P = 0.023), wall motion score (P = 0.005) and diastolic function (P = 0.004) were significantly impaired vs controls. Following treatment, LVEF (35–47% (P = 0.023)) and wall motion score (1.88–1.5 (P = 0.017)) improved but not global longitudinal strain. Initial LVEF (34%; P = 0.046) and global longitudinal strain (−9.5%; P = 0.095) were lower in patients with a final LVEF <40%.ConclusionsThis is the first known report on STE in a series of patients with clinical lupus myocarditis. Global longitudinal strain correlated with regional and global left ventricular function. Global longitudinal strain, wall motion score and diastolic parameters may be more sensitive markers of lupus myocarditis in patients presenting with a preserved LVEF ≥50%. A poor initial LVEF and global longitudinal strain were associated with a persistent LVEF <40%. Echocardiography is a non-invasive tool with diagnostic and prognostic value in lupus myocarditis.

Early diagnosis of cardiac involvement in systemic lupus erythematosus via global longitudinal strain (GLS) by speckle tracking echocardiography

“…In fact, GLS impairment has an early diagnostic and prognostic value. 16 This finding is in line with the results of a study by Huang et al, 27 who reported a reduction in the LV GLS in 2D echocardiography in their patients with lupus by comparison with their healthy subjects. A similar study, conducted in 2016 with the aid of speckle-tracking echocardiography to evaluate strain indices in patients suffering from lupus, indicated that the strain indices were decreased in the treatment-resistant lupus group compared with the non-resistant lupus group.…”

“…1-10 Lupus myocarditis is a serious manifestation of SLE which occurs in 5% to 10% of patients with SLE. 11-16…”

Transesophageal Versus Transthoracic Echocardiography for Assessment of Left Ventricular Diastolic Function

“…The second most common cause of LV diastolic dysfunction in SLE patients is probably arterial hypertension, which is a highly prevalent condition (25% to 35%) in these patients [34,35]. Premature peripheral arterial stiffness independent of arterial hypertension causing increased LV afterload and LV mass may be another pathogenetic factor [36]. Finally, primary myocarditis is a rare cause of LV diastolic dysfunction in these patients.…”

Echocardiographic strain analysis reflects impaired ventricular function in youth with pediatric‐onset systemic lupus erythematosus

“…14 In SLE patients with clinical lupus myocarditis, reduced strain is also prognostic of persistent systolic dysfunction following treatment. 20 There are two pediatric studies suggesting that impaired LV systolic strain is present in children with pSLE. 21,22 However, the majority of these patients were still using glucocorticoids, which can influence afterload.…”

“…20) of pSLE subjects had a history of lupus nephritis, one subject had a history of serositis, and one had a history of neuropsychiatric SLE. Average disease activity at the initial onset of SLE was high (mean baseline SLEDAI of 12.4 [SD 7.3]).…”