Assessment Of Left Ventricular Early Systolic Function And Synchronicity In Patients With Systemic Lupus Erythematosus By Layer-specific Strain

ObjectiveThe longitudinal and circumferential strains of the global and segmental inner,middle and outer layers of the left ventricle in patients with systemic lupus erythematosus(SLE)were measured by ultrasonic layer-specific strain to evaluate the value of the changes of left ventricular systolic function and synchronicity in SLE patients without evidence of cardiac involvement.To assist clinical judgment and improve the prognosis of patients.To evaluate the degree of mechanical function changes of left ventricular myocardium according to whether SLE patients are inactive phase or not.MethodsForty-two SLE patients(SLE group)and thirty healthy subjects(control group)were collected.After the subject's heart rate is stable and the displayed image is clear,the routine echocardiographic parameters are measured and the two-dimensional gray-scale dynamic images of three long axis sections(standard two chamber section,three chamber section,and four chamber section)and three short axis view(mitral valve,papillary muscle,Apical level)of the left ventricular are stored.The off-line analysis is performed at the Echo PAC workstation.After endocardiography,the parameters of systolic longitudinal strain(LS)and circumferential strain(CS)in the global and segmental left ventricle and the peak strain dispersion(PSD)were obtained after accurately tracing endocardial boundary,and the differences of mechanical parameters between the two groups were compared.According to the SLEDAI-2000 scoring system,SLE patients were divided into two subgroups:the inactive SLE group(SLEDAI score 0-4,SLE-group),a total of 22 people,including 1 man;the active SLE group(SLEDAI score?5,SLE+group),a total of 20 people,including 3 men.And to analyze the differences of relevant parameters in these groups.To draw the ROC curve to analyze the diagnostic value of middle and outer myocardium of apex of left ventricular in active SLE patients.Results1.Compared with the control group,the resting heart rate(RHR),systolic blood pressure(SBP),and proportion of dyslipidemia in SLE group increased(P<0.OS).LVEF in SLE group decreased(P<0.01),but the values were within the normal range.There was no significant difference in the remaining basic information and conventional ultrasound parameters between the two groups(P>0.05).2.In SLE group,the absolute values of LS and CS of the global and segmental left ventricular myocardium still preserved certain gradient characteristics,which is subendocardial myocardium>intermediate myocardium>epicardial myocardium(P<0.05),apical segment>middle segment>basal segment(P<0.05).Compared with the control group,the LS of left ventricle in each layer except the apical segment,the transmural difference of the GLS(?LS),the CS in each layer of the global myocardium and the middle and outer layers of the apical segment decreased in SLE group(P<0.05).The PSD of SLE group was higher than that of the control group(P<0.01).3.Compared with the control group,the LS of the global left ventricular inner layer and each layer of basal segment decreased(P<0.05)and the PSD increased(P<0.01)in the SLE group;In the SLE+group,LS in the global,basal and middle segments of the left ventricle and CS in the middle and outer layers of the global and apical segment decreased(P<0.05),and the PSD increased(P<0.01).Compared with SLE subgroups,CS in the middle and outer layers of the apical segment of the heart was decreased(P<0.05)in SLE+group.There was no significant difference in PSD between the two subgroups(P>0.05).4.ROC curve analysis:the cutoff value,sensitivity,specificity,accuracy index,and area under the curve(AUC)of CSmid in the apical segment of the left ventricle were-25.64%,85.51%,80.02%,0.656 and 0.819,respectively.The cutoff value,sensitivity,specificity,accuracy index and AUC of CSepi were-18.92%,92.51%,70.52%,0.622,and 0.881,respectively.Conclusions1.In this study,the gradient of LS and CS in the left ventricular myocardium of SLE patients was consistent with that of healthy people,that is,decreasing from inside to outside,increasing from base to apex.2.Before the changes of conventional echocardiographic indexes and strain gradient,the longitudinal and circumferential systole peak strain parameters of the global and segmental inner,middle and outer layers of the left ventricle in SLE patients have declined to some extent.In addition to the decrease of left ventricular deformation function,the parameters of myocardial synchronization,PSD,were also decreased in different degrees compared with the control group.Compared with SLE-patients,the injury degree and range of left ventricular longitudinal and circular motion in SLE+patients are relatively large.3.The cutoff values of CSmid and CSepi in the apical segment of the left ventricle were-25.64%and-18.92%,respectively.The active SLE patients can be identified effectively,and the sensitivity and specificity are relatively good.4.It is easy to operate and intuitive to detect the changes of left ventricular mechanical function in subclinical patients with SLE by ultrasonic layer-specific strain.To evaluate the degree of left ventricular systolic function and synchronicity decline according to whether the patients are inactive phase or not.It may provide some reference for the early diagnosis of SLE heart disease.