Zhong Xiaofang, Chen Lixin, Peng Guijuan, Sheng Yuanyuan, Liu Xiaohua, Zheng Yingqi, Huang Yuxiang, Xu Jinfeng, Liu Yingying
Department of Ultrasound, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.
Quant Imaging Med Surg. 2022 May;12(5):2947-2960. doi: 10.21037/qims-21-805.
To investigate the feasibility of quantitatively assessing left ventricular function and synchronization and diagnose subclinical myocardial injury in patients with systemic lupus erythematosus (SLE) using two-dimensional (2D) longitudinal layer speckle tracking imaging (STI).
This was a single-center prospective study. A total of 69 patients with SLE were included in the case group and further divided into 2 subgroups, a nonactive and an active group, according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring standard. We selected 30 healthy volunteers as the control group. The global longitudinal strain (GLSglobal), global endocardial longitudinal strain (GLSendo), global epicardial longitudinal strain (GLSepi), and peak strain dispersion (PSD) were obtained. The transmural gradient of longitudinal strain (TGLS) was calculated for the difference in strains between the inner and outer membranes.
(I) Compared with the control group, decreased speckle strain parameters and elevated PSD were observed in patients with SLE (GLSglobal: -18.80%±2.41% -21.19%±2.16%, GLSendo: -21.15%±2.47% -24.09±2.49%; GLSepi: -16.58%±2.39% -18.50±1.77%; TGLS: -4.56%±1.24% -5.59%±1.39%; and PSD: 36.61±10.85 30.00±8.54 ms). More severely impaired layer strains were observed in active-stage patients. Compared with the nonactive group, GLSendo, GLSglobal, GLSepi, TGLS, complement C3, and complement C4 were decreased in the active group, while SLEDAI, erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (Hs-CRP) were elevated. (II) Receiver operating characteristic (ROC) analysis demonstrated that subendocardial myocardial longitudinal strain was the most powerful tool for detecting myocardial insufficiency early in patients with SLE [area under the curve (AUC) =0.809], especially in patients in the active stage (AUC =0.734), and the optimal cut-off point was -21.35%, with a sensitivity of 71.9% and a specificity of 62.2%. (III) Correlation analysis revealed that GLSendo was moderately correlated with PSD, SLEDAI, ERS, Hs-CRP, and complement C3 (correlation coefficients: 0.535, 0.428, 0.659, 0.559, and -0.440, respectively).
Subclinical myocardial injury in patients with SLE can be assessed early using 2D longitudinal STI, and the injury is more obvious in active-stage patients. Endocardial longitudinal strain is a more sensitive index than epicardial longitudinal strain for the early detection of subclinical myocardial injury in patients with SLE, which is a potentially valuable clinical tool to assist in the early detection of myocardial damage.
探讨应用二维纵向分层斑点追踪成像（STI）定量评估系统性红斑狼疮（SLE）患者左心室功能及同步性并诊断亚临床心肌损伤的可行性。
这是一项单中心前瞻性研究。病例组纳入69例SLE患者，并根据2000年系统性红斑狼疮疾病活动指数（SLEDAI）评分标准进一步分为非活动组和活动组2个亚组。选取30名健康志愿者作为对照组。获取整体纵向应变（GLSglobal）、心内膜整体纵向应变（GLSendo）、心外膜整体纵向应变（GLSepi）及峰值应变离散度（PSD）。计算纵向应变跨壁梯度（TGLS），即内膜与外膜应变的差值。
（I）与对照组相比，SLE患者斑点应变参数降低，PSD升高（GLSglobal：-18.80%±2.41%对-21.19%±2.16%，GLSendo：-21.15%±2.47%对-24.09±2.49%；GLSepi：-16.58%±2.39%对-18.50±1.77%；TGLS：-4.56%±1.24%对-5.59%±1.39%；PSD：36.61±10.85对30.00±8.54 ms）。活动期患者的分层应变受损更严重。与非活动组相比，活动组的GLSendo、GLSglobal、GLSepi、TGLS、补体C3和补体C4降低，而SLEDAI、红细胞沉降率（ESR）和高敏C反应蛋白（Hs-CRP）升高。（II）受试者工作特征（ROC）分析表明，心内膜下心肌纵向应变是早期检测SLE患者心肌功能不全的最有效工具[曲线下面积（AUC）=0.809]，尤其是活动期患者（AUC =0.734），最佳截断点为-21.35%，敏感性为71.9%，特异性为62.2%。（III）相关性分析显示，GLSendo与PSD、SLEDAI、ERS、Hs-CRP和补体C3中度相关（相关系数分别为0.535、0.428、0.659、0.559和-0.440）。
应用二维纵向STI可早期评估SLE患者的亚临床心肌损伤，且活动期患者损伤更明显。对于早期检测SLE患者的亚临床心肌损伤，心内膜纵向应变比心外膜纵向应变更敏感，是协助早期检测心肌损伤的潜在有价值的临床工具。
