Three-dimensional echocardiographic evaluation of the right ventricle in patients with uncomplicated systemic lupus erythematosus

Abstract

Our aim was to identify subclinical right ventricular (RV) alterations in systemic lupus erythematosus (SLE) by combining standard and three-dimensional echocardiography (3DE). Fifty SLE patients without concomitant cardiac disease and 50 healthy controls, matched for age and gender, were enrolled. Disease damage was evaluated by inflammatory markers and SLE damage index. All patients underwent an echo-Doppler examination with 3DE assessment of RV function, RV septal and lateral longitudinal strain. The two groups had comparable body mass index and blood pressure. RV transversal middle diameter and pulmonary arterial pressure were significantly higher in SLE compared to controls. By 3DE, RV end-systolic volume ( p = 0.037) was greater, whereas stroke volume ( p = 0.023), ejection fraction ( p < 0.0001) and septal and lateral longitudinal strain (both p < 0.0001) were lower in SLE. SLE damage index ≥ 1 was negatively associated with tricuspid annular plane systolic excursion (TAPSE) ( p < 0.002), tricuspid E/A ratio ( p = 0.003), RV ejection fraction ( p < 0.05), lateral longitudinal strain ( p < 0.0001) and septal longitudinal strain ( p = 0.04). By separate multivariate models, after adjusting for age, C reactive protein and proBNP, SLE damage index was independently associated with TAPSE ( p = 0.009) and RV lateral longitudinal strain ( p = 0.007). In conclusion, a subclinical RV systolic dysfunction is detectable in SLE by 3DE, RV lateral wall strain being a key parameter. RV dysfunction is associated with cumulative disease damage.

Reference Values of Right Ventricular Volumes and Ejection Fraction by Three-Dimensional Echocardiography in Adults: A Systematic Review and Meta-Analysis

“…Studies reported that 3DE-derived RV volumes and RVEF could strongly correlate with CMR imaging findings, even if RV volumes may be underestimated by 3DE vs. CMR (42)(43)(44)(45). RV volumes and RVEF by 3DE have been considered parameters for the diagnosis and outcomes of cardiopulmonary diseases or RV possible subclinical changes in patient workups (12,15,18,46,47). The RVEF <45% can reflect RV systolic dysfunction universally, but reference values for RV volumes and RVEF by 3DE are insufficiently investigated (4).…”

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

“…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) .…”

Right ventricular-pulmonary arterial coupling ratio derived from 3-dimensional echocardiography predicts outcomes in systemic lupus erythematosus-associated pulmonary arterial hypertension patients

“…The cohort of 46 patients with SLE-PAH was followed for a median of 24 months (IQR [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The time of baseline echocardiography to the development of clinical outcome constituted a median of ∼18 months (IQR 3-25) for 16 patients (34.7%) who experienced the clinical outcome; specifically, 6 (13.0%) patients died; 6 (8.3%) patients had PAH-related hospitalization with increased RV failure; and 4 (6.7%) patients had upgraded PAH drug therapy with intravenous prostacyclin.…”