Quantitative assessment of left ventricular systolic function in patients with systemic lupus erythematosus: a non-invasive pressure-strain loop technique

Xia Li; Huijuan Chen; Meng Han; Yanling Luo; Fengzhen Liu; Lili Chen; Xiaolin Wang; Yu Zhao; Ruirui Kang; Chujun Wang; Chunquan Zhang

doi:10.21037/qims-21-951

Quantitative assessment of left ventricular systolic function in patients with systemic lupus erythematosus: a non-invasive pressure-strain loop technique

Quant Imaging Med Surg. 2022 Jun;12(6):3170-3183. doi: 10.21037/qims-21-951.

Authors

Xia Li¹, Huijuan Chen¹, Meng Han², Yanling Luo¹, Fengzhen Liu¹, Lili Chen¹, Xiaolin Wang¹, Yu Zhao¹, Ruirui Kang¹, Chujun Wang¹, Chunquan Zhang¹

Affiliations

¹ Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
² Department of Clinical Medicine, the Queen Mary School of Nanchang University, Nanchang, China.

Abstract

Background: Systemic lupus erythematosus (SLE) is associated with a variety of cardiovascular diseases, even in the early stage of disease development. The purpose of this study was to quantitatively evaluate left ventricular (LV) systolic function in patients with SLE using a novel non-invasive pressure-strain loop (PSL) technique.

Methods: This prospective case-control study included 132 patients with SLE and 99 normal controls, all of whom underwent traditional transthoracic echocardiography. The LV myocardial work was evaluated with the PSL technique based on speckle tracking and brachial artery blood pressure. The differences among groups were compared, and the correlations between myocardial work, laboratory data, and disease activity were analyzed in the SLE group.

Results: Compared with the normal group, SLE patients had significantly higher global wasted work {GWW; SLE: 109 [82-150] mmHg%; controls: 66 [45-109] mmHg%; P<0.001} and impaired global work efficiency [GWE; SLE: 95% (94-97%); controls: 97% (96-98%); P<0.001]. Global work index (GWI) and global constructive work (GCW) did not show significant differences (P>0.05). Further subdivision analysis found that the increase of GWW and the damage of GWE were more obvious in SLE patients with high disease activity or severe diastolic dysfunction. Multivariate analysis revealed that increased erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-phospholipid antibodies, peak strain dispersion, and SLE Disease Activity Index (SLEDAI) were independently associated with increased GWW (β=0.189, 0.230, 0.444, 0.111, and 0.180, respectively; all P<0.05) and damaged GWE (β=-0.184, -0.130, -0.468, -0.149, and -0.191, respectively; all P<0.05).

Conclusions: The non-invasive PSL can quantitatively evaluate the LV systolic function in SLE patients. This technique may provide a new method for monitoring cardiac function in chronic diseases.

Keywords: Systemic lupus erythematosus (SLE); myocardial work; pressure-strain loop (PSL).