Luo Tingting, Wang Zhenhua, Chen Zhen, Yu Ermei, Fang Chenglong
Department of Echocardiography, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Cardiology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Quant Imaging Med Surg. 2021 Apr;11(4):1271-1283. doi: 10.21037/qims-20-859.
Layer-specific speckle-tracking echocardiography (STE) is a noninvasive approach that assesses subclinical left ventricular dysfunction. We aimed to investigate the (I) alteration of layer-specific STE parameters and the dyssynchrony index; and (II) the disease parameters associated with layer-specific STE change in drug-naïve patients with new-onset systemic lupus erythematosus (SLE) without cardiac symptoms.
Thirty-five drug-naïve patients with new-onset SLE and twenty-five healthy controls were enrolled. All individuals received both conventional echocardiographic and two-dimensional STE assessment. The data of layer-specific global longitudinal strain (GLS), global circumferential strain (GCS), and peak systolic dispersion (PSD) were acquired in layer-specific STE.
All patients had a normal left ventricular ejection fraction (LVEF)(mean LVEF: 58%) and conventional echocardiographic parameters were comparable between patients and controls. Decreased layer-specific GLS and elevated PSD were observed in SLE patients (whole layer GLS: -17.6%±3.0% versus -19.3%±2.6%, P=0.02; endocardial GLS: -20.0%±3.2% versus -22.1%±3.0%, P=0.01; epicardial GLS: -15.6%±2.7% versus -16.8%±2.4%, P=0.04; PSD: 41.0±18.9 versus 28.8±10.1 msec, P=0.007). In contrast, there was no difference in layer-specific GCS at three different levels between patients and controls (P>0.05). More severely impaired GLS was observed in patients with higher disease activity, high-risk antiphospholipid antibody (aPL) profile, or renal involvement. The PSD was increased in patients with higher disease activity or a high-risk aPL profile. Correlational analysis showed that GLS at three layers and PSD correlated with high-sensitivity C-reactive protein (hsCRP) levels (whole GLS: r=0.662, P<0.001; endocardial GLS: r=0.637, P<0.001; epicardial GLS: r=0.658, P<0.001; PSD: r=0.390, P=0.021). PSD correlated with epicardial GLS (r=0.360, P=0.047), when treating the hsCRP level, renal involvement, aPL profile, and disease activity as control variables. Multivariate regression showed the hsCRP level and epicardial GLS were predictors of layer-specific GLS impairment and elevated PSD, respectively.
Drug-naive patients with new-onset SLE are likely to have subclinical GLS impairment and left ventricular dyssynchrony, even in the presence of normal LVEF. SLE-related risk factors are associated with these dysfunctions.
层特异性斑点追踪超声心动图（STE）是一种评估亚临床左心室功能障碍的非侵入性方法。我们旨在研究（I）层特异性STE参数和不同步指数的变化；以及（II）在无心脏症状的初发系统性红斑狼疮（SLE）未用药患者中与层特异性STE变化相关的疾病参数。
纳入35例初发SLE未用药患者和25例健康对照。所有个体均接受常规超声心动图和二维STE评估。在层特异性STE中获取层特异性整体纵向应变（GLS）、整体圆周应变（GCS）和收缩期峰值离散度（PSD）数据。
所有患者左心室射血分数（LVEF）均正常（平均LVEF：58%），患者与对照之间的常规超声心动图参数具有可比性。SLE患者中观察到层特异性GLS降低和PSD升高（全层GLS：-17.6%±3.0%对-19.3%±2.6%，P = 0.02；心内膜GLS：-20.0%±3.2%对-22.1%±3.0%，P = 0.01；心外膜GLS：-15.6%±2.7%对-16.8%±2.4%，P = 0.04；PSD：41.0±18.9对28.8±10.1毫秒，P = 0.007）。相比之下，患者与对照在三个不同层面的层特异性GCS无差异（P>0.05）。在疾病活动度较高、抗磷脂抗体（aPL）高危谱或有肾脏受累的患者中观察到更严重的GLS受损。疾病活动度较高或aPL高危谱的患者PSD升高。相关性分析显示三层的GLS和PSD与高敏C反应蛋白（hsCRP）水平相关（全层GLS：r = 0.662，P<0.001；心内膜GLS：r = 0.637，P<0.001；心外膜GLS：r = 0.658，P<0.001；PSD：r = 0.390，P = 0.021）。当将hsCRP水平、肾脏受累、aPL谱和疾病活动度作为对照变量时，PSD与心外膜GLS相关（r = 0.360，P = 0.047）。多变量回归显示hsCRP水平和心外膜GLS分别是层特异性GLS受损和PSD升高的预测因素。
初发SLE未用药患者即使LVEF正常也可能存在亚临床GLS受损和左心室不同步。SLE相关危险因素与这些功能障碍有关。
