He Wei, Xie Peihan, Li Wei, Yao Fengjuan, Liu Yanqiu, Liang Liuqin, Liu Donghong
Department of Medical Ultrasonics, The First Affiliated Hospital, 71068Sun Yat-sen University, Guangzhou, China.
Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital, 71068Sun Yat-sen University, Guangzhou, China.
Lupus. 2022 Aug;31(9):1084-1093. doi: 10.1177/09612033221102713. Epub 2022 May 15.
We aimed to explore the value of two-dimensional speckle tracking echocardiography measurements of the global longitudinal strain (GLS) and left ventricular mechanical dispersion (LVMD) in the assessment of early stage left ventricular systolic dysfunction and heterogeneity of myocardial contraction in patients with lupus nephritis (LN).
Patients with LN and extra-renal systemic lupus erythematosus (SLE) and healthy participants in the control group underwent echocardiography for the traditional measurement of the left ventricular systolic and diastolic function and speckle tracking measurements of the GLS and LVMD. GLS was defined as the average value of the peak strain during systole of the left ventricular 17 segments, and LVMD was defined as the standard deviation. The demographic characteristics including age, sex, and body mass index (BMI) of all the participants were collected. The clinical and laboratory characteristics of the patients with LN were collected.
We included 41 healthy control, 37 patients with extra-renal SLE, and 73 patients with LN. There were statistically significant differences in the GLS and LVMD between the extra-renal SLE and LN groups (GLS -19.36% vs. -17.61%, < 0.001; LVMD 35.62 ms vs 42.96 ms, <0.001). There was a statistically significant difference in the LVMD between the extral-renal SLE and control groups (35.62ms vs 25.51ms, <0.001), but not in GLS (-19.36% vs -19.52%, > 0.05). Multiple regression analyses were conducted in a subset of patients, and 24-hour proteinuria was independently associated with LVMD (β [SE], 0.793 [0.302], < .05).
Patients with LN have more severe myocardial involvement than patients with extra-renal SLE. The asynchrony in myocardial contraction represented by the LVMD can be recognized earlier than that of the overall contractile functional impairment represented by GLS. In patients with LN, the 24-hour proteinuria was associated with LVMD. This indicates that the heterogeneity in the contractile function may be associated with the severity of renal damage.
我们旨在探讨二维斑点追踪超声心动图测量整体纵向应变（GLS）和左心室机械离散度（LVMD）在评估狼疮性肾炎（LN）患者早期左心室收缩功能障碍及心肌收缩异质性中的价值。
LN患者、肾外系统性红斑狼疮（SLE）患者及对照组健康参与者均接受超声心动图检查，以传统方式测量左心室收缩和舒张功能，并采用斑点追踪技术测量GLS和LVMD。GLS定义为左心室17节段收缩期峰值应变的平均值，LVMD定义为标准差。收集所有参与者的人口统计学特征，包括年龄、性别和体重指数（BMI）。收集LN患者的临床和实验室特征。
我们纳入了41名健康对照者、37名肾外SLE患者和73名LN患者。肾外SLE组和LN组之间的GLS和LVMD存在统计学显著差异（GLS -19.36%对-17.61%，<0.001；LVMD 35.62毫秒对42.96毫秒，<0.001）。肾外SLE组和对照组之间的LVMD存在统计学显著差异（35.62毫秒对25.51毫秒，<0.001），但GLS无差异（-19.36%对-19.52%，>0.05）。对部分患者进行了多元回归分析，24小时蛋白尿与LVMD独立相关（β[标准误]，0.793[0.302]，<0.05）。
LN患者比肾外SLE患者有更严重的心肌受累。由LVMD代表的心肌收缩不同步比由GLS代表的整体收缩功能损害更早被识别。在LN患者中，24小时蛋白尿与LVMD相关。这表明收缩功能的异质性可能与肾损害的严重程度相关。
