Assessment Of Right Atrial Function In Patients With Systemic Lupus Erythematosus By Two-dimensional Speckle Tracking Echocardiography

Objective To assess right atrial function in patients with systemic lupus erythematosus(SLE)by two-dimensional speckle tracking echocardiography(2D-STE).Methods According to the patient's pulmonary systolic pressure(PASP),patients with SLE clinically diagnosed in our hospital,102 patients were enrolled in our hospital from September 2015 to October 2018,aged between 20 and 52 years old,with an average of43.2±9.3 years old,11 males and 91 females,male to female ratio 1:8.3,excluding congenital pulmonary stenosis,right ventricular outflow tract stenosis,coronary heart disease,hyperthyroidism,hypertension,iron deficiency cardiomyopathy and other cardiac organic lesions,etc.They were divided into three groups: group B 37 cases without PAH,PASP ? 30 mm Hg,age 21 to 51 years,mean(45.3±8.4)years old,4males and 33 females,male to female ratio 4:33,group C 34 cases,30 mm Hg < PASP <50 mm Hg,age 20 to 51 years old,average(41.3±9.6)years old,4 males and 30 females,male to female ratio 4:30,group D 31 cases,PASP ? 50 mm Hg,age 23 to 51 years old,average(43.3±7.5)years old,3 males and 28 females,male to female ratio 3:28.Group A(control group)was selected as 30 healthy volunteers,aged 23 to 52 years old,average:(42.1±10.5)years,3 males and 27 females,male to female ratio of 1:9,all control group subjects had no family history,chronic medical history,no cardiovascular disease,and all tests were normal.All patients were recorded age,gender,heart rate,body mass index,blood pressure,body surface area,etc.The patient maintained a steady breathing,took the left lateral position,the GE Vivid 7 Doppler ultrasound system is equipped with an M3 S probewith a frequency of 1.7 to 3.4 MHz.Ultrasound parameters are acquired.The main parameters of the ultrasound measurement include: using conventional two-dimensional ultrasound: the inferior vena cava inner diameter(IVCD)was measured in the long axis of the inferior vena cava view,tricuspid annulus plane systolic excursion(TAPSE)was measured by M-mode echocardiography,right ventricular end-systolic area(RVESA)and right ventricular end-diastolic area(RVEDA)was measured in the apical four-chamber view,tricuspid annulus systolic velocity(S')was measured by tissue Doppler imaging,the left ventricular ejection fraction(LVEF)was measured by the two-plane Simpson's method,and calculated the inferior vena cava inhalation rate,and the right ventricular ejection fraction(RVEF)was calculated from right ventricular fractional area change(RVFAC).The maximum volume of the atrioventricular diastolic right atrium(RAVmax),the right atrial minimum volume(RAVmin),and the pre-systolic volume of the right atrium(RAVpre)were measured at the apical four-chamber view.The passive emptying fraction of the right atrium was calculated(RAPEF).)and right atrial active emptying score(RAAEF).The images were analyzed offline by Echo PAC software: the overall peak strain rate(SRs)of the right atrium during systole,the overall peak strain rate(SRe)of the right atrium in the right atrial diastolic,and the overall peak strain rate of the right atrium in the late diastolic period(SRa).Results1.Patient characteristicsThere were no significant differences in male and female ratio,age,body mass index,diastolic blood pressure,and systolic blood pressure between each group(all P >0.05).There was a statistically significant difference in heart rate between group D and the other three groups(both P > 0.05).There was no statistically significant difference in LVEF between the four groups(both P > 0.05).2.Right ventricular function parametersThe TAPSE,RVFAC,and pulsed Doppler S waves were significantly lower than those of the group D compared with groups A,B and C(all P < 0.05).However,there isno significant difference between groups A,B and C with TAPSE,RVFAC and pulsed Doppler S waves(both P > 0.05).3.Right atrial function parametersThe corresponding values of RAVmax,RAVmin,RAVpre,RAAEF and SRa in group C were significantly increased compared with groups A and B(both P < 0.05).The corresponding values of RAPEF,SRe and SRs in group C were significantly reduced compared with groups A and B.(all P < 0.05).The RAVmax,RAVmin,RAVpre,RAAEF and SRa in group D were significantly increased compared with A,B and C groups(both P < 0.05).In group D,RAPEF,SRe and SRs were significantly reduced compared with groups A,B and C.(all P < 0.05).The results of all measurements in group B were not statistically significant compared with group A(both P > 0.05).Conclusion 2D-STE could evaluate the function of right atrium in patients with different degrees of PAH in SLE.