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Disease Chronicity and Activity Predicts Subclinical Left Ventricular Systolic Dysfunction in Patients with Systemic Lupus Erythematosus
  1. Gabriel WK Yip (gabrielyip{at}cuhk.edu.hk)
  1. The Chinese University of Hong Kong, China
    1. Qing Shang (b119556{at}mailserv.cuhk.edu.hk)
    1. The Chinese University of Hong Kong, China
      1. Lai-Shan Tam (lstam{at}cuhk.edu.hk)
      1. The Chinese University of Hong Kong, China
        1. Qing Zhang (qingzhang{at}cuhk.edu.hk)
        1. The Chinese University of Hong Kong, China
          1. Edmund K-M Li (edmundli{at}cuhk.edu.hk)
          1. The Chinese University of Hong Kong, China
            1. Jeffrey W-H Fung (jwhfung{at}cuhk.edu.hk)
            1. The Chinese University of Hong Kong, China
              1. Cheuk-Man Yu (cmyu{at}cuhk.edu.hk)
              1. The Chinese University of Hong Kong, China

                Abstract

                Objective: We investigated parameters that could predict subclinical cardiac dysfunction in systemic lupus erythematosus (SLE) in absence of valvular, clinical coronary artery and pericardial disease.

                Design: A case-control trial.

                Setting: Rheumatology clinic, a university teaching hospital.

                Patients: Eighty-two female SLE patients (49±9 years) and 82 female normal subjects (49±13 years) matched for age, body mass index, blood pressure and heart rate.

                Interventions: All underwent standard echocardiography and tissue Doppler imaging.

                Main outcome measures: Twenty-two (27%) patients had evidence of impaired left ventricular (LV) long-axis function with mean myocardial peak systolic velocity (Sm) of basal 6 segments <4.4cm/s and also subnormal stress-corrected midwall fractional shortening. Thirty-four (42%) patients demonstrated impaired right ventricular (RV) long-axis function. These occurred in the presence of comparable normal LV ejection fraction, cardiac index, and RV fractional area change to the control group. Patients with subnormal mean Sm were older (49±8 versus 44±9; p=0.043), had higher prevalence of hypertension (46% versus 22%; p=0.034), longer disease duration >10 years (82% versus 50%, p=0.01), higher disease activity score (73% versus 48% for SLEDAI ≥1, p=0.049), and end-organ damage index (64% versus 47% with SLICC ≥1, p=0.049) than those with normal values. Disease duration >10 years, disease activity index, and increased arterial stiffness provided additional incremental predictive value of LV long-axis function.

                Conclusion: SLE patients have subclinical long and short-axis dysfunctions. Regular monitoring of cardiac function by tissue Doppler echocardiography may be indicated for patients who had SLE for >10 years, frequent flare or when arterial stiffening is demonstrated.

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