儿童期起病的系统性红斑狼疮患者的亚临床左心室功能障碍：一项二维斑点追踪超声心动图研究
Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study.
作者信息
Leal G N, Silva K F, Lianza A C, Giacomin M F, Andrade J L, Kozu K, Bonfá E, Silva C A
机构信息
a Department of Radiology, Children's Institute, Hospital das Clínicas , São Paulo University Medical School.
b Rheumatology Unit, Children's Institute, Hospital das Clínicas, Faculty of Medicine , University of São Paulo.
出版信息
Scand J Rheumatol. 2016;45(3):202-9. doi: 10.3109/03009742.2015.1063686. Epub 2015 Aug 31.
OBJECTIVES
The main purpose of the study was to investigate left ventricular (LV) subclinical systolic and diastolic dysfunction in childhood-onset systemic lupus erythematosus (c-SLE) patients using two-dimensional speckle-tracking (2DST) echocardiography. We also interrogated possible correlations between impairment of myocardial deformation and the SLE Disease Activity Index 2000 (SLEDAI-2K), as well as the presence of traditional and disease-related cardiovascular risk factors (CRFs).
METHOD
A total of 50 asymptomatic patients and 50 controls (age 14.74 vs. 14.82 years, p = 0.83) were evaluated by standard and 2DST echocardiography.
RESULTS
Despite a normal ejection fraction (EF), there was reduction in all parameters of LV longitudinal and radial deformation in patients compared to controls: peak longitudinal systolic strain (PLSS) [-20.3 (-11 to -26) vs. -22 (-17.8 to -30.4)%, p < 0.0001], PLSS rate [-1.19 ± 0.21 vs. -1.3 ± 0.25 s(-1), p = 0.0005], longitudinal strain rate in early diastole [1.7 (0.99-2.95) vs. 2 (1.08-3.00) s(-1), p = 0.0034], peak radial systolic strain [33.09 ± 8.6 vs. 44.36 ± 8.72%, p < 0.0001], peak radial systolic strain rate [1.98 ± 0.53 vs. 2.49 ± 0.68 s(-1), p < 0.0001], and radial strain rate in early diastole [-2.31 ± 0.88 vs. -2.75 ± 0.97 s(-1), p = 0.02]. Peak circumferential systolic strain [-23.67 ± 3.46 vs. -24.6 ± 2.86%, p = 0.43] and circumferential strain in early diastole [0.37 ± 0.17 vs. 0.41 ± 0.15, p = 0.27] were similar between patients and controls, although peak circumferential systolic strain rate [-1.5 ± 0.3 vs. -1.6 ± 0.3 s(-1), p = 0.036] was reduced in c-SLE. Further analysis of patients revealed a negative correlation between LV PLSS and SLEDAI-2K (r = -0.52, p < 0.0001), and also between LV PLSS and the number of CRFs per patient (r = -0.32, p = 0.024).
CONCLUSIONS
2DST echocardiography has identified subclinical LV deformation impairment in c-SLE patients. Disease activity and cumulative exposure to CRFs contribute to myocardial compromise.
目的
本研究的主要目的是使用二维斑点追踪（2DST）超声心动图研究儿童期起病的系统性红斑狼疮（c-SLE）患者的左心室（LV）亚临床收缩和舒张功能障碍。我们还探究了心肌变形受损与系统性红斑狼疮疾病活动指数2000（SLEDAI-2K）之间可能存在的相关性，以及传统和疾病相关心血管危险因素（CRF）的存在情况。
方法
通过标准超声心动图和2DST超声心动图对总共50例无症状患者和50例对照者（年龄分别为14.74岁和14.82岁，p = 0.83）进行评估。
结果
尽管射血分数（EF）正常，但与对照组相比，患者左心室纵向和径向变形的所有参数均降低：纵向收缩期峰值应变（PLSS）[-20.3（-11至-26）对-22（-17.8至-30.4）%，p < 0.0001]，PLSS率[-1.19 ± 0.21对-1.3 ± 0.25 s⁻¹，p = 0.0005]，舒张早期纵向应变率[1.7（0.99 - 2.95）对2（1.08 - 3.00）s⁻¹，p = 0.0034]，径向收缩期峰值应变[33.09 ± 8.6对44.36 ± 8.72%，p < 0.0001]，径向收缩期峰值应变率[1.98 ± 0.53对2.49 ± 0.68 s⁻¹，p < 0.0001]，以及舒张早期径向应变率[-2.31 ± 0.88对-2.75 ± 0.97 s⁻¹，p = 0.02]。患者和对照组之间的圆周收缩期峰值应变[-23.67 ± 3.46对-24.6 ± 2.86%，p = 0.43]和舒张早期圆周应变[0.37 ± 0.17对0.41 ± 0.15，p = 0.27]相似，尽管c-SLE患者的圆周收缩期峰值应变率[-1.5 ± 0.3对-1.6 ± 0.3 s⁻¹，p = 0.036]降低。对患者的进一步分析显示，左心室PLSS与SLEDAI-2K之间呈负相关（r = -0.52，p < 0.0001），左心室PLSS与每位患者的CRF数量之间也呈负相关（r = -0.32，p = 0.024）。
结论
2DST超声心动图已确定c-SLE患者存在亚临床左心室变形受损。疾病活动和CRF的累积暴露导致心肌损害。
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