Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study

Abstract

Objectives: The main purpose of the study was to investigate left ventricular (LV) subclinical systolic and diastolic dysfunction in childhood-onset systemic lupus erythematosus (c-SLE) patients using two-dimensional speckle-tracking (2DST) echocardiography. We also interrogated possible correlations between impairment of myocardial deformation and the SLE Disease Activity Index 2000 (SLEDAI-2K), as well as the presence of traditional and disease-related cardiovascular risk factors (CRFs).

Method: A total of 50 asymptomatic patients and 50 controls (age 14.74 vs. 14.82 years, p = 0.83) were evaluated by standard and 2DST echocardiography.

Results: Despite a normal ejection fraction (EF), there was reduction in all parameters of LV longitudinal and radial deformation in patients compared to controls: peak longitudinal systolic strain (PLSS) [−20.3 (−11 to −26) vs. −22 (−17.8 to −30.4)%, p < 0.0001], PLSS rate [−1.19 ± 0.21 vs. −1.3 ± 0.25 s⁻¹, p = 0.0005], longitudinal strain rate in early diastole [1.7 (0.99–2.95) vs. 2 (1.08–3.00) s⁻¹, p = 0.0034], peak radial systolic strain [33.09 ± 8.6 vs. 44.36 ± 8.72%, p < 0.0001], peak radial systolic strain rate [1.98 ± 0.53 vs. 2.49 ± 0.68 s⁻¹, p < 0.0001], and radial strain rate in early diastole [−2.31 ± 0.88 vs. −2.75 ± 0.97 s⁻¹, p = 0.02]. Peak circumferential systolic strain [−23.67 ± 3.46 vs. −24.6 ± 2.86%, p = 0.43] and circumferential strain in early diastole [0.37 ± 0.17 vs. 0.41 ± 0.15, p = 0.27] were similar between patients and controls, although peak circumferential systolic strain rate [−1.5 ± 0.3 vs. −1.6 ± 0.3 s⁻¹, p = 0.036] was reduced in c-SLE. Further analysis of patients revealed a negative correlation between LV PLSS and SLEDAI-2K (r = –0.52, p < 0.0001), and also between LV PLSS and the number of CRFs per patient (r = –0.32, p = 0.024).

Conclusions: 2DST echocardiography has identified subclinical LV deformation impairment in c-SLE patients. Disease activity and cumulative exposure to CRFs contribute to myocardial compromise.

Acknowledgements

We thank Ulysses Doria-Filho for the statistical analysis.