Subclinical systolic dysfunction by speckle tracking echocardiography in patients with systemic lupus erythematosus

Abstract

Background We aimed to compare the prevalence of subclinical left ventricular systolic dysfunction in Hispanic systemic lupus erythematosus (SLE) patients versus healthy controls. Material and methods This cross-sectional study included 46 SLE patients who fulfilled the 2019 European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) classification criteria for SLE and with age ≥ 18 years. For comparison, we included a control group with 46 non-SLE subjects matched by age (±5 years) and gender. A transthoracic echocardiogram was performed on every participant. The echocardiographic measurements evaluated were left ventricular ejection fraction (LVEF), relative wall thickness (RWT), and tricuspid annular plane systolic excursion (TAPSE). Left ventricular-Global Longitudinal Strain (GLS) was evaluated, and a value higher than −18% was classified as subclinical left ventricular systolic dysfunction. Comparisons between groups were made using the Chi-square test or Fisher’s exact test for qualitative variables, and Student’s t-test or the Mann–Whitney’s U test for quantitative variables. A p-value <.05 was considered significant. Results We found a significant difference in the presence of subclinical left ventricular systolic dysfunction between SLE-patients and controls (37.0% vs 8.7%, p = .001). We also found that SLE patients had a lower left ventricular GLS (−18.90% vs −20.51%, p = .011), TAPSE (21.63 mm vs 23.60 mm, p = .009), and LVEF (57.17% vs 62.47%, p = <.001) than controls. Systemic lupus erythematosus diagnosis was independently associated with the presence of subclinical left ventricular systolic dysfunction with an OR of 6.068 (CI 95% 1.675−21.987) ( p = .006). Subclinical systolic dysfunction was more common in men (29.4% vs 3.4%, p = .020), patients with obesity (17.6% vs 0%, p = .045), or hypertension (47.1% vs 6.9%, p = .001). Conclusion Systemic lupus erythematosus Hispanic patients had a higher prevalence of subclinical left ventricular systolic dysfunction, and worse left ventricular GLS, LVEF, and TAPSE values than matched healthy controls. Additionally, we found that male gender, obesity, and hypertension are associated with the presence of subclinical left ventricular systolic dysfunction in SLE patients. The inclusion of speckle tracking echocardiography as part of the cardiovascular evaluation of SLE patients may help identify high cardiovascular risk patients.

Echocardiography myocardial work and cardiac biomarkers indicate subclinical systolic myocardial dysfunction in patients with systematic lupus erythematous

“…Regarding the impact of SLE on myocardial function, there is a growing body of evidence indicating that subclinical LV dysfunction among SLE patients is common finding [12,13]. This dysfunction is typically identified through GLS measurements despite preserved LVEF [24,25]. In line with a recent meta-analysis of 9 studies [26], we confirmed lower GLS values in SLE patients compared to age-and sex-matched healthy controls.…”

“…One of the major complications of SLE associated with a poor prognosis is the cardiac systolic dysfunction [9]. That is primarily associated with the duration and the severity of the disease [21].…”

“…It has been demonstrated that the impairment of LV deformation becomes detectable before the development of an overt systolic dysfunction, especially among patients with auto-immune diseases [8]. To date, a limited number of studies has investigated the presence of subtle systolic dysfunction in SLE patients utilizing STE [9], [10]. The latter studies implicate the early development of myocardial dysfunction before becoming apparent clinically or with the classical echocardiographic indices, like LV ejection fraction (LVEF), in comparison to healthy controls.…”

Cardiovascular manifestations of systemic lupus erythematosus: the significance of heart failure

“…J.R. Azpiri-Lopez и соавт. [83] сравнили распространенность субклинической систолической дисфункции ЛЖ у пациентов с СКВ (n=46) и в здоровом контроле (n=46). Субклиническая систолическая дисфункция ЛЖ при СКВ встречалась статистически значимо чаще (в 37,0% и 8,7% случаев), а ГПД ЛЖ была статистически значимо ниже (-18,90% и -20,51% соответственно), чем в контроле.…”