| Objectives:This study aims to evaluate left ventricular systolic function in patients with systemic lupus erythematosus(SLE)using conventional echocardiographic and layer-specific strain(LSS).Furthermore,the association between echocardiographic parameters and the occurrence of cardiovascular events was assessed.Methods:A total of 179 patients with SLE fulfilled the 1997 American College of Rheumatology and 2012 Systemic Lupus Erythematosus International Collaborating Clinics classification criteria for SLE from January 2010 to October 2022 in the Department of Rheumatology and Immunology of the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine and the Affiliated Hospital of Hangzhou Normal University;who underwent a dedicated multidisciplinary assessment,including echocardiography,were analyzed at the time of their first visits.Patients with SLE were divided into a mildly active group,a moderately active group,and a severely active group,according to the SLE disease activity index 2000(SLEDAI-200)scoring standard.The control group consistid of 68 ageand sex-matched healthy subjects.Interventricular septal width in diastole(IVSd),LV postirior wall width in diastole(LVPWd),LV internal dimension in diastole(LVIDd),LV end-diastolic volume(LVEDV),LV end-systolic volume(LVESV),stroke volume(SV),LV ejection fraction(LVEF),global longitudinal peak strain(GLPS)and(global circumferential peak strain,GCPS)on endocardial,mid-myocardial and epicardial layers at 17cardiac segments were measured.The transmural strain gradient was calculated as the differences in systolic strain among the endocardial,mid-myocardial,and epicardial layers.Cox proportional hazard ratio(HR),receiver operating characteristic curve,and Kaplan-Meier survival curves analyses were performed for the prediction of cardiovascular events.Results:Compared with control subjects,patients with SLE showed significant higher in systolic and diastolic blood pressures(P<0.05).The IVSd,LVPWd,LVIDd,LVEDV,LVESV,SV,LVEF showed statistically significant differences among the four groups(all P<0.01).In addition,GLPS and GCPL on endocardial,mid-myocardial and epicardial layers,the GLPS and GCPL transmural strain gradient of endocardial and mid-myocardial showed significant differences among the four groups(all P<0.01).The GLPS and GCPL on endocardial,mid-myocardial and epicardial layers in severely active SLE group were significante lower in control group,mildly active group,and moderately active group(all P<0.05).During a median follow-up period of 80 months(range:11-116 months),67 patients(36.8%)developed cardiovascular events.In the multivariate Cox regression models,endocardial GLPS(HR,1.022;P<0.05)and ndocardial GCPS(HR,1.058;P<0.01)were independent cardiovascular events.In addition,the results of the ROC analyses the prediction of cardiovascular events,the cutoff values of endocardial GLPS and endocardial GCPS had higher sensitivity and specificity.The Kaplan-Meier log-rank test revealed signifcant diferences in the overall cumulative rates of cardiovascular events in both separations.Patients with SLE with more impaired LV endocardial GLPS had higher cumulative rates of cardiovascular events compared to patients with less impaired LV endocardial LS≤-21.7%(χ2=8.916,P=0.003);meanwhile,patients with lower LV endocardial GCPS had higher cumulative rates of cardiovascular events compared to patients with an absolute higher value of endocardial CS≥29.1%(χ2=13.851,P<0.001).Conclusions:Conventional echocardiography and LSS technology can find that the left ventricular systolic function of the patients with severe active SLE is significantly lower than that of the healthy controls.In patients with SLE,LV endocardial GLPS and GCLS were associated with cardiovascular events,potentially representing a new technology to improve risk stratification in these patients. |
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