Morello Matteo, Gholson Bethany, Huang Weiting, Lain William, Malter Maxwell, Abbate Antonio, Weber Brittany N, Lindner Jonathan R
Cardiovascular Division and Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia.
Heart and Vascular Center and Division of Preventive Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
J Am Soc Echocardiogr. 2025 Jun;38(6):486-497. doi: 10.1016/j.echo.2025.03.001. Epub 2025 Mar 8.
In systemic lupus erythematosus (SLE), ventricular dysfunction can occur from primary immune injury or secondarily from SLE-related comorbidities. The aim of this study was to determine clinical predictors of reduced left ventricular (LV) systolic and diastolic function in an effort to understand potentially mitigating strategies.
The authors retrospectively studied 76 patients with SLE who underwent comprehensive transthoracic echocardiography within 3 months of an appointment with a rheumatologist to correlate clinical, laboratory, and echocardiographic features. All key echocardiographic measurements were reviewed and remeasured, when appropriate, by an expert blinded to other study data. Abnormal LV systolic function was defined as a global longitudinal strain threshold of -18.0%. Hierarchical cluster analysis was used to define feature interaction.
The mean age of the population was 49 ± 15 years, and 83% were women. Reduced GLS was found in 24% of the population, of whom 44% had LV ejection fractions <50%. Previously documented heart failure symptoms were more prevalent in the reduced GLS cohort (50% vs 12%, P = .002). Those with reduced GLS had clinical features indicating greater SLE severity over time, including reduced renal function and prior pericardial involvement. GLS was strongly associated with right ventricular free wall strain (r = 0.67, P < .01) and degree of LV diastolic dysfunction. Worsening grades of diastolic dysfunction, like GLS, were associated with renal disease and pericardial involvement. Patients with SLE with reduced GLS and diastolic function also had abnormal left atrial reservoir strain (LASr). Hierarchical cluster analysis segregated populations with reduced GLS, reduced LASr, pericardial and renal involvement, and an additional feature of C-reactive protein known to be associated with chronic disease activity.
Reduced GLS is common in patients with SLE and is associated with heart failure symptoms and markers of increased disease activity over time, particularly pericardial involvement, suggesting common immune mechanisms. The associations of GLS with right ventricular function, diastolic dysfunction, and impairment in LASr suggests a common mechanistic basis involving immune injury.
在系统性红斑狼疮（SLE）中，心室功能障碍可源于原发性免疫损伤或继发于SLE相关的合并症。本研究的目的是确定左心室（LV）收缩和舒张功能降低的临床预测因素，以了解潜在的缓解策略。
作者回顾性研究了76例SLE患者，这些患者在与风湿病学家预约后的3个月内接受了全面的经胸超声心动图检查，以关联临床、实验室和超声心动图特征。所有关键的超声心动图测量值均由一位对其他研究数据不知情的专家进行审查，并在适当情况下重新测量。左心室收缩功能异常定义为整体纵向应变阈值为-18.0%。采用层次聚类分析来定义特征相互作用。
研究人群的平均年龄为49±15岁，83%为女性。24%的人群存在整体纵向应变（GLS）降低，其中44%的左心室射血分数<50%。既往记录的心力衰竭症状在GLS降低的队列中更为普遍（50%对12%，P = 0.002）。GLS降低的患者具有随着时间推移SLE病情更严重的临床特征，包括肾功能降低和既往心包受累。GLS与右心室游离壁应变密切相关（r = 0.67，P < 0.01）以及左心室舒张功能障碍程度。与GLS一样，舒张功能障碍程度的加重与肾脏疾病和心包受累有关。GLS和舒张功能降低的SLE患者左心房储存应变（LASr）也异常。层次聚类分析将GLS降低、LASr降低、心包和肾脏受累以及已知与慢性疾病活动相关的C反应蛋白这一额外特征的人群区分开来。
GLS降低在SLE患者中很常见，并且与心力衰竭症状以及随着时间推移疾病活动增加的标志物相关，特别是心包受累，提示存在共同的免疫机制。GLS与右心室功能、舒张功能障碍和LASr受损之间的关联提示存在涉及免疫损伤的共同机制基础。
