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

Abstract

Introduction: Systemic lupus erythematosus (SLE) myocarditis occurs in between 5% and 10% of patients with lupus. Global longitudinal strain (GLS) via speckle tracking echocardiography can detect cardiac involvement in patients suffering from SLE. We decided to determine the echocardiographic features and subsequent early diagnosis of cardiac involvement in patients with SLE utilizing the GLS index via speckle tracking echocardiography. Methods: In this cross-sectional study, we compared female patients with SLE of at least 2 years’ duration and healthy controls in terms of the left ventricular (LV) GLS via speckle tracking echocardiography. After data collection in both groups, the GLS index and the ejection fraction were evaluated. Results: We analyzed and compared the LV echocardiographic parameters of 33 patients with SLE (mean age=25.45±0.63 years) with those of 35 healthy controls (mean age=27±0.45 years). The apical 2-chamber view indicated a significant decrease in the LV GLS in the case group by comparison with the healthy controls (P=0.005). The LV GLS in the apical 3-chamber view was significantly lower in the case group than in the control group (P=0.006). The LV GLS in the apical 4-chamber view revealed no significant difference between the case and healthy control groups (P=0.2). While there was a significant difference between the case and control groups visà- vis the LV GLS (P=0.02), the LV ejection fraction measured with the Simpson method showed no significant difference between the 2 groups (P=0.96). Conclusion: GLS speckle tracking echocardiography is a noninvasive method with diagnostic and prognostic values; it may, therefore, be a sensitive marker for the diagnosis of myocarditis and other cardiac involvements in patients with SLE.

Deformación miocárdica evaluada por ecocardiografía bidimensional en pacientes lúpicos de un hospital nacional

“…Los avances en el tratamiento del LES han mejorado la sobrevida de los pacientes lúpicos; sin embargo, aún persiste una elevada morbimortalidad por la afección cardíaca (11)(12)(13)(14) . Los estudios reportan entre 40 -50% de afección cardíaca en las autopsias de pacientes lúpicos, pero solo se reporta entre el 7 -10% de casos en vida (15,16) .…”

“…Los avances en el tratamiento del LES han mejorado la sobrevida de los pacientes lúpicos; sin embargo, aún persiste una elevada morbimortalidad por la afección cardíaca (11)(12)(13)(14) . Los estudios reportan entre 40 -50% de afección cardíaca en las autopsias de pacientes lúpicos, pero solo se reporta entre el 7 -10% de casos en vida (15,16) . El análisis de la deformación miocárdica a través del método de speckle tracking es una técnica semiautomática de uso creciente en los últimos años que ha mostrado ser útil en diferentes escenarios clínicos como la enfermedad reumatológica, sobre todo en la afección cardíaca subclínica (17)(18)(19) .…”

Arrhythmogenic Inflammatory Cardiomyopathy in Autoimmune Rheumatic Diseases: A Challenge for Cardio-Rheumatology

“…Newer echocardiographic modalities, like 2D-3D speckle tracking imaging derived by transthoracic echocardiography, should be offered more accurate data for the early diagnosis of the myocardial involvement. Furthermore, several studies [49,50] supported that the early progression of left ventricular systolic dysfunction was demonstrated by global longitudinal strain (GLS) and not by left ventricular ejection fraction. However, even a normal echo cannot rule out the diagnosis.…”

Hidden in Heart Failure

“…[64] An echocardiogram may demonstrate regional or global ventricular dysfunction, with strain techniques offering earlier diagnosis. [65] Cardiac MRI can detect subclinical inflammation in SLE. [66,67] Recommended treatment is corticosteroids and immunosuppressive agents such as cyclophosphamide.…”