Chang Joyce C, Wang Yan, Xiao Rui, Fedec Anysia, Meyers Kevin E, Tinker Craig, Natarajan Shobha S, Knight Andrea M, Weiss Pamela F, Mercer-Rosa Laura
Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA.
Echocardiography. 2020 Dec;37(12):2082-2090. doi: 10.1111/echo.14872. Epub 2020 Oct 3.
Strain analysis with speckle-tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric-onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with pSLE to controls, and assessed the relationship between strain, disease activity, and other noninvasive measures of cardiovascular health.
Twenty pSLE subjects ages 9-21 underwent comprehensive cardiovascular testing, including 2D speckle-tracking echocardiography, ambulatory blood pressure monitoring (ABPM), peripheral endothelial function testing, pulse wave velocity and analysis, and carotid ultrasound. Longitudinal apical-4 chamber (LS ) and midpoint circumferential strain (CS ) were compared to that of 70 healthy controls using multivariable linear regression. Among pSLE subjects, Pearson correlation coefficients were calculated to evaluate relationships between global longitudinal or circumferential strain and other measures of cardiovascular health.
Average SLE disease duration was 3.2 years (standard deviation [SD] 2.1). 2/20 pSLE subjects had persistent disease activity, and only one met criteria for hypertension by ABPM. LS was significantly reduced in pSLE subjects compared to controls (mean -18.3 [SD 3.2] vs -21.8% [SD 2.2], P-value <.001). There was no significant difference in CS (-24.8 [SD 3.7] vs -25.7% [SD 3.4], P = .29). Among pSLE subjects, decreased nocturnal blood pressure dipping on ABPM was associated with reduced global circumferential strain (r -0.59, P = .01).
Longitudinal myocardial deformation is impaired in pSLE patients despite clinical remission and may represent early myocardial damage. Strain analysis should be considered in addition to standard echocardiographic assessment during follow-up of patients with pSLE.
斑点追踪超声心动图应变分析有望成为儿童期系统性红斑狼疮（pSLE）无症状心肌功能障碍的筛查工具。我们比较了pSLE儿童和青少年与对照组的左心室（LV）收缩期变形（通过应变测量），并评估了应变、疾病活动度以及心血管健康的其他非侵入性测量指标之间的关系。
20名年龄在9至21岁的pSLE受试者接受了全面的心血管检查，包括二维斑点追踪超声心动图、动态血压监测（ABPM）、外周内皮功能测试、脉搏波速度及分析以及颈动脉超声检查。使用多变量线性回归将纵向心尖四腔心（LS）和中点圆周应变（CS）与70名健康对照者进行比较。在pSLE受试者中，计算Pearson相关系数以评估整体纵向或圆周应变与心血管健康其他测量指标之间的关系。
SLE平均病程为3.2年（标准差[SD]2.1）。20名pSLE受试者中有2名患有持续性疾病活动，只有1名通过ABPM符合高血压标准。与对照组相比，pSLE受试者的LS显著降低（平均值-18.3[SD 3.2]对-21.8%[SD 2.2]，P值<.001）。CS无显著差异（-24.8[SD 3.7]对-25.7%[SD 3.4]，P = 0.29）。在pSLE受试者中，ABPM时夜间血压下降幅度减小与整体圆周应变降低相关（r -0.59，P = 0.01）。
尽管临床缓解，pSLE患者的纵向心肌变形仍受损，可能代表早期心肌损伤。在pSLE患者随访期间，除了标准超声心动图评估外，还应考虑应变分析。
