Left Ventricle Functional Assessment by Three-Dimensional Echocardiography in Patients with Systemic Lupus Erythematosus

Abstract

Background: Systemic lupus erythematosus frequently presents subclinical myocardial involvement; this has an early onset and predicts mortality. The analysis of myocardial deformation (strain) by three-dimensional speckle tracking echocardiography could be useful in the assessment of myocardial function. Objective: The aim of this study was to assess left ventricular structure and systolic function through the analysis of threedimensional deformation. Methods: Thirty seven women with systemic lupus erythematosus (age 35±10 years) and no history of structural heart disease and 20 controls (34±8 years) were included in the study. Two-dimensional and three-dimensional echocardiography was performed according to the recommendations of the American Society of Echocardiography to acquire global longitudinal strain, radial strain, circumferential strain and strain area. Systemic lupus erythematosus activity was estimated with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI), considering a score ≥4 as active disease. Results: There were no differences in age, risk factors, blood pressure, and heart rate between both groups. From a structural point of view, both atria presented larger size in the systemic lupus erythematosus group. This group of patients presented lower global longitudinal strain (-19.7±2.7 vs. -21.1±2.5, p=0.009), global radial strain (50.7±8.7 vs. 56.5±5.6; p=0.02) and global strain area (-32.1±3.9 vs. -34.7±2.1, p=0.004). This decrease was even more marked in women with active systemic lupus erythematosus. Conclusions: All deformation parameters were reduced in patients with systemic lupus erythematosus, which could be due to incipient alterations of left ventricular systolic function.