To Evaluate Vascular Endothelial Change In Patients With Systemic Lupus Erythematosus With The Different Left Ventricular Function By High Frequency Sonography

Objective1.To evaluate the correlation between the different left ventricular function and the change of vascular endothelial in patients with systemic lupus erythematosus（SLE）.2.To evaluate the correlation between the fluid shear stress of brachial artery with different left ventricular function and the change of vascular endothelial in patients with systemic lupus erythematosus（SLE）.Methods30 cases of healthy volunteers were chosen as the control group（group A）,and 60 cases of SLE patients were divided into group B（35 cases,LVEF≥50%）and group C（25 cases,LVEF<50%）according to the different left ventricular ejection fractions（LVEF）.Measurement of LVEF: the apical four-chamber view and two-chamber view were obtained,the endocardial interfaces of left ventricular were demonstrated completely and they were traced.Then,the LVEF were measured by the biplane modified Simpson’s rule.Measurement of the tissue doppller imaging（TDI）parameters: the parameters include the movement velocity of the mitral annular of left ventricular.The systolic peak velocity（Vs）,early diastolic peak velocity（Ve）and end diastolic peak velocity（Va）were also obtained,then the average Ve/Va values could be calculated and compared.Measurement of the vascular endothelial function: the parameters include brachial artery end-diastolic diameter on basic condition（D0）,brachial artery end-diastolic diameter after reaction hyperemia（D₁）and brachial artery end-diastolic diameter after taking nitroglycerin drops（D₂）,and then using the formulas EDD=（D₁-D₀）/D₀×100% and NEDD=（D₂-D₀）/D₀×100%,the brachial artery endothelial dependent dilation（EDD）and non-endothelial dependent dilation（NEDD）could be calculated for the control group and the patients with SLE.Measurement of the shear stress（τm）: The peak velocity,mean velocity and blood viscosity of brachial artery were measured fristly.Then,using the following formulas: τm=η×4×V/D,the brachial artery shear stress（τm）was calculated.Results1.The change of brachial artery endothelial functionEDD was significantly lower in group C than that of group A（P<0.05）and group B（P<0.05）,while there was no significant difference between group A and group B（P>0.05）.NEDD was significantly lower in group C than that of group A（P<0.01）,while there was no significant difference between group A and group B as well as group B and group C（P>0.05）.2.The change of left ventricular functionAverage Vs was significantly lower in group C than that of group A and group B（P<0.05）,while there was no significant difference between group A and group B（P>0.05）.Average Va was significantly higher in group C than that of group A and group B（P<0.01）,while there was no significant difference between group A and group B（P>0.05）.Average Ve of the each wall of mitral annular of left ventricular was significantly lower in group C than that of group A（P<0.05）and group B（P<0.05）,while there was no significant difference between group A and group B（P>0.05）.Average Ve/Va of the each wall of mitral annular of left ventricular was significantly lower in group C than that of group A（P<0.01）and group B（P<0.01）,while there was no significant difference between group A and group B（P>0.05）.3.The change of the brachial arteryPeak velocity,mean velocity and average shear stress were significantly lower in group C than that of group A,in group C than that of group B and in group B than that of group A（P<0.05）,respectively.Blood viscosities of group A,group B and group C were no significant difference（P>0.05）.4.The correlation analysis showed thatFor the SLE group,EDD had significantly positive relation with average Ve（r=0.278,P=0.031）and average Ve/Va（r=0.271,P=0.036）,NEDD had significantly positive relation with average Ve（r=0.260,P=0.026）and average Ve/Va（r=0.278,P=0.031）.Moreover,for the SLE group,EDD had significantly positive relation with the τm（r=0.584,P=0.000）,while NEDD also had significantly positive relation with the τm（r=0.266,P=0.040）.ConclusionHigh frequency ultrasonography and tissue doppler imaging technology could be used to accurately assess the change of vascular endothelial and the shear stress change of brachial artery with different left ventricular function in patients with systemic lupus erythematosus（SLE）,and there were positive relationship between the change of vascular endothelial and the change of left ventricular function and the shear stress change of brachial artery,respectively.