Assessment Of Right Atrial Function In Systemic Lupus Erythematosus Patients By Three-Dimensional Echocardiography

Objective: To evaluate the right atrial function in patients with systemic lupus erythematosus(SLE)complicated by estimated pulmonary arterial hypertension(PAH)by three-dimensional echocardiography(3DE).Methods: We elected 102 patients who clinically diagnosed SLE,enrolled in our hospital from October 2015 to May 2017.The age ranged from 20 to 52 years old,with an average of(43.2 ± 9.3)years old,11 males and 91 females,male to female ratio of 1:8.3.The eligibility criteria of SLE diagnosis met the standard of 2012 Systemic Lupus International Collaborating Clinics criteria.Exclusion of congenital pulmonary stenosis,right ventricular outflow tract stenosis,congenital heart disease,heart failure,coronary heart disease,cardiomyopathy and valvular disease,moderate to severe pericardial effusion,obstructive pulmonary disease and infectious myocarditis,echocardiography chart examines poor image quality and people who are unwilling to participate in the study.All patients used transthoracic echocardiography ultrasound estimated pulmonary artery systolic pressure(PASP)method with tricuspid regurgitation.They were divided into 3 groups: group A was SLE without PAH(PASP?30mm Hg,n=37,aged 21~51years,mean age: 45.3±8.4 years,male to female ratio of 4:33),group B was SLE with mild PAH(30mm Hg<PASP<50mm Hg,n=34,aged 20~52 years,mean age: 41.3±9.6 years,male to female ratio of 4:30),group C was SLE with moderate to severe PAH(50mm Hg?PASP,n=31,aged 23~51 years,mean age: 43.3±7.5years,male to female ratio of 3:28).Thirty healthy volunteers were selected into separate group as in contrast(n=30,aged 23~52 years,mean age: 42.1±10.5 years,male to female ratio of 1:9).1.Generall parameters All patients were recorded gender,age,heart rate,height,body mass,blood pressure,body surface area,etc.The patient maintained a steady breathing,took the left lateral position,synchronized the electrocardiogram,and performed a conventional echocardiogram with the M3 S probe,performed in all subjects.Measurement of relevant ultrasound parameters: All subjects to the left lateral position,and the tricuspid regurgitation peak velocity spectrum was measured on a standard apical four-chamber view to estimate pulmonary systolic pressure,PASP=4×V2+ right atrial pressure,of which V tricuspid regurgitation peak velocity.2.Right atrial ultrasound parameters The apical four-chamber view fully displays the right atrial image.By swithing 3V probe,it allows us to acquire and store three cardiac cycle images.Start the "Multiplane" and "Tri-plane" keys when the right endocardium is viewed clearly.The software will automatically display three orthogonal planes,and adjust them to the center,then to obtain the data by recording endocardium of the right atrium.Measure right atrial maximal volume(Vmax),right atrial minimal volume(Vmin),and right atrial precontraction volume(Vpre),in order to calculate emptying fractions(EF).Passive stroke volume(SVpas)= Vmax-Vpre,Passive empty fraction(EFpas)=(Vmax-Vpre)/Vmax,Active stroke volume(SVact)=Vpre-Vmin;Active empty fraction(EFact)=(Vpre-Vmin)/Vpre.All volume parameters are divided by the body surface area to obtain the corresponding volume parameter index: VImax?VImin?VIpre?EFI? SVIpas?EFIpas?SVIact?EFIact.Results: 1.Patient characteristics parameters Among the four groups,there were no significant differences in sex,age and body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP)(all P>0.05).Nevertheless,there were significant differences in heart rate between group C and other groups(all P<0.05).2.Right atrial ultrasound parameters There were no significant differences of all the parameters between group A and control group(P>0.05).The active stroke volume index(SVIact)was increased with the raised PAH,and it was significantly increased in group B and group C when compared with the control group.While with the increasing of PASP,the total empty fraction index(EFI)and passive empty fraction index(EFIpas)were both decreased,and the EFI and EFIpas in group B and group C were significantly decreased in comparison of the control group(all P<0.05).Active empty fraction index(EFIact)in group B and group C significantly increased compared with the control group(all P<0.05).Conclusions: 1.The right atrial function of patients with SLE is gradually impaired with the increasing severity of PAH.2.3DE can objectively evaluate changes in right atrium saving function,pipeline function and auxiliary pump function.