Doppler echocardiographic evaluation of left ventricular diastolic function in patients with systemic lupus erythematosus

doi:10.1016/0002-8703(90)90163-R

American Heart Journal

Volume 120, Issue 1, July 1990, Pages 82-87

https://doi.org/10.1016/0002-8703(90)90163-R Get rights and content

Abstract

Subclinical myocardial involvement frequently occurs in patients with systemic lupus erythematosus (SLE). In this study, left ventricular diastolic function was assessed in 58 patients (54 female and 4 male; mean age 32 ± 11 years) and in 40 sex-matched and age-matched healthy control subjects (37 female and 3 male; mean age 33 ± 9 years) by means of pulsed Doppler echocardiography. All subjects had no clinical evidence of overt myocardial disease or abnormal left ventricular systolic function. Compared with the control group, patients with SLE had significantly prolonged isovolumic relaxation time (62 ± 12 vs 80 ± 14 msec; p < 0.01), reduced peak early diastolic flow velocity (peak E) (82 ± 18 vs 76 ± 16 cm/sec; p < 0.05), increased peak late diastolic flow velocity (peak A) (45 ± 7 vs 53 ± 8 cm/sec; p < 0.01), reduced E/A ratio (1.81 ± 0.32 vs 1.46 ± 0.29; p < 0.001), and lower deceleration rate of early diastolic flow velocity (EF slope) (489 ± 151 vs 361 ± 185 cm/sec²; p < 0.05). Subgroup analysis according to disease activity revealed that when compared to the inactive disease group, the active disease group had significantly longer isovolumic relaxation time (74 ± 21 msec vs 92 ± 18 msec; p < 0.01), lower peak E (78 ± 16 vs 70 ± 16 cm/sec; p < 0.05), higher peak A (51 ± 8 vs 57 ± 7 cm/sec; p < 0.01), lower E/A ratio (1.56 ± 0.25 vs 1.26 ± 0.27; p < 0.001) and lower EF slope (379 ± 169 cm/sec² vs 324 ± 172 cm/sec²; p < 0.05). In conclusion, an abnormal pattern of left ventricular diastolic filling dynamics occurs in patients with SLE. These abnormalities may represent myocardial involvement in SLE and may be related to disease activity.

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Cited by (50)

Multimodality Cardiac Imaging in Patients with Systemic Lupus Erythematosus
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Systemic lupus erythematous (SLE) is an autoimmune disease with a wide range of cardiovascular complications. The main manifestations include diseases of the coronary arteries, valves, pericardium, and myocardium. Multimodality cardiovascular imaging techniques are critical for evaluating the extent of cardiac manifestations in SLE patients, which can provide valuable prognostic information. However, their utility has previously not been well defined. This review provides a state-of-the-art update on the cardiovascular manifestations of lupus, as well as the role of multimodality cardiac imaging in guiding management of patients with SLE.
Left ventricular diastolic abnormalities other than valvular heart disease in antiphospholipid syndrome: An echocardiographic study
2018, International Journal of Cardiology
Citation Excerpt :
In general, primary APS appears to be associated with LV diastolic dysfunction, whereas secondary APS and SLE with an impairment of LV systolic function [9]. Old studies identified impairment of LV diastolic function, again evident in both APS (particularly primary) and SLE [10–13]. These diastolic abnormalities were assessed by standard Doppler echocardiography and included transmitral E/A ratio reduction with increased contribution of atrial systole to global LV filling and prolongation of both E velocity deceleration time and isovolumic relaxation time.
Antiphospholipid syndrome (APS) can be primary or secondary to other autoimmune disorders. Besides valvular heart disease (VHD) and coronary artery disease (CAD), little is known about the impact of APS on left ventricular (LV) function.
After excluding CAD, relevant VHD and heart failure, 69 patients (mean age = 43.9 years, 40 with primary and 29 with secondary APS) were assessed by echo-Doppler. Sixty-nine heathy controls, matched for age and sex, formed the control group. APS was diagnosed in presence of at least one clinical criteria and one confirmed laboratory criteria, including lupus anticoagulant (LA) titre. The adjusted global APS score (aGAPSS), derived from the combination of risk factors for thrombosis and autoimmune-antibody profile was calculated.
Patients had similar blood pressure and heart rate, but higher body mass index (BMI) than controls. LV mass index (p = 0.007) and left atrial volume index (p < 0.01) were greater, while early diastolic velocity (e′) was lower (p = 0.003) and E/e′ higher (p = 0.007) in APS. Primary APS patients had lower E/A and e′ compared to both controls and secondary APS, while E/e′ was higher in secondary APS than in controls. APS patients with diastolic dysfunction were older but did not differ for risk factors prevalence from those with normal/indeterminate diastolic function. In the pooled APS, LA positivity was independently associated with e′ and E/e′ after adjusting for age, BMI and aGAPSS in separate multivariate models.
In APS, LV diastolic abnormalities are detectable. They are more pronounced in primary APS and independently associated with LA positivity.
Heart failure in systemic lupus erythematosus
2018, Trends in Cardiovascular Medicine
Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by a constellation of cardiovascular (CV) and non-CV manifestations. Even though CV complications such as accelerated atherosclerosis and elevated risk of myocardial infarction (MI) have been recognized for many years, there is limited evidence regarding SLE and its association with heart failure (HF). Traditional risk factors of atherosclerotic CV disease, as well as various SLE manifestations and therapies, independently or together, increase the risk of HF in this population. There is a need for sufficiently powered intervention studies focusing on specific risk factors to improve CV outcomes in SLE patients.
Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians
2018, Autoimmunity Reviews
Citation Excerpt :
Myocardial involvement occurs in 8 to 14% of SLE patients. Left ventricular diastolic dysfunction is well-noted in several studies when patients were assessed by echocardiography or other modalities (i.e. cardiac magnetic resonance image (MRI)) [25–29]. Also, significant deterioration of systolic longitudinal strain was observed.
Systemic autoimmune diseases can affect various kinds of organs including the kidney, the skin, soft tissue and the bone. Among others, cardiovascular involvement in rheumatic diseases has been shown to affect myocardium, pericardium, cardiac vessels, conduction system and valves, eventually leading to increased mortality. In general, underlying chronic inflammation leads to premature atherosclerosis, but also other manifestations such as arrhythmia and heart failure may have a ‘silent’ progress. Traditional cardiovascular risk factors play a secondary role, while disease-specific factors (i.e. disease duration, severity, antibody positivity, persistent disease activity) can directly influence the cardiovascular system. Therefore, early diagnosis is critical to optimize management and to control inflammatory activity and recent data suggest that risk factors (i.e. hypercholesterolemia and hypertension) need intensive treatment as well. With the advent of immunosuppressive agents, most rheumatic diseases are well controlled on treatment, but information related to their cardioprotective efficacy is not well-defined. In this review, we focus on cardiovascular involvement in rheumatic diseases and highlight current evidence which should be of help for the treating physicians. Moreover, cardiotoxicity of immunosuppressive drugs is a rare issue and such potential adverse events will be briefly discussed.
Evolution of cardiac dysfunction in patients with antiphospholipid antibodies and/or antiphospholipid syndrome: A 10-year follow-up study
2014, Seminars in Arthritis and Rheumatism
Citation Excerpt :
Two case reports reported a disappearance of valve vegetations after treatment with oral anticoagulants [47,48]; however, the majority of studies did not find any evidence that treatment with corticosteroids, anticoagulants, or antiplatelet agents could prevent the progression of valvular disease [9–11,14]. Subclinical LV diastolic dysfunction usually preceded systolic dysfunction in previous studies of PAPS patients [36,37] or SLE [34,35] patients and has been associated with longer SLE duration [34] or disease activity [35]. In the same line of evidence, our data suggest that left ventricular diastolic function worsens in PAPS and all SLE groups over time, despite the stable and normal LV systolic function.
To describe the evolution of valve involvement and myocardial dysfunction over time in patients with systemic lupus erythematosus (SLE) with or without antiphospholipid antibodies (aPL) and/or antiphospholipid syndrome (APS).
From an initial cohort of 150 patients assessed by transthoracic echocardiography 10 years ago, 17 patients with primary APS (PAPS), 23 with SLE-associated APS (SLE/APS), 19 with SLE positive for aPL without APS, and 23 with SLE negative for aPL were re-evaluated in the present echocardiography study.
Valvulopathy was detected in 65% of PAPS and 62% of SLE patients with or without aPL. Disease duration [odds ratio (OR), 1.63; 95% confidence interval (CI), 1.13–2.36; p = 0.009 for every 5 years of increase] and presence of SLE/APS (OR, 3.51; 95% CI, 1.27–9.67; p = 0.015) were the only factors associated with the progression of valvular disease in univariate and multivariate analyses. Left ventricular diastolic dysfunction similarly progressed over time, with deceleration time (DT) and isovolumic relaxation time (IVRT) being equally prolonged in each of the four groups (p < 0.05). Right ventricular DT was significantly prolonged in each of the three SLE patient groups (p < 0.001), whereas IVRT increased only in SLE/APS patients (p = 0.040).
Among patients with APS and SLE (with or without aPL), SLE/APS and disease duration were independent factors for valvular disease progression in the present 10-year follow-up echocardiography study. Anticoagulation did not arrest valvular disease progression. Ventricular diastolic dysfunction, primarily of the left ventricle, also progressed over the 10-year period.
Evaluation of left ventricular myocardial function in Egyptian patients with systemic lupus erythematosus: Tissue Doppler study and its relation to disease activity
2013, Egyptian Rheumatologist
Citation Excerpt :
It has been reported [20], that the peak systolic velocity was significantly lower at the septum (6.68 ± 0.99 vs. 8.22 ± 1.51) and at the lateral mitral annulus (7.82 ± 1.92 vs. 9.82 ± 2.05) in the active patients compared to those with inactive disease. Also the isovolumetric relaxation time (IRT) at the septum (p = 0.001) and the lateral mitral annulus (p = 0.003) was found to be prolonged in our active group compared to the inactive group, this finding is supported by other studies [23,24]. Other studies [18,25] reported different findings as they did not find significant differences between active and inactive groups regarding the tissue Doppler parameters.
Systemic lupus erythematosus (SLE) is associated with high cardiovascular morbidity and mortality. It is frequently underestimated by routine imaging techniques. Aim of the work was to determine if new echocardiographic imaging modalities like tissue Doppler, can detect abnormalities in left ventricular function in asymptomatic SLE patients.
Fifty SLE patients were attending the rheumatology department of the Kasr El Aini hospital. All patients were subjected to cardiac, musculoskeletal examination, routine laboratory investigations. Twenty healthy age matched subjects were taken as controls. Ultrasound examination by two dimensional echocardiography and color tissue Doppler were performed on the patients and control to obtain the cardiac chamber diameters, systolic and diastolic myocardial velocities.
SLE patients have an increased prevalence of subclinical LV dysfunction. SLE patients with positive tissue Doppler findings were of old age, had long disease duration, high disease activity and nephritis.
Tissue Doppler velocities have been shown to be a sensitive tool in detecting early myocardial dysfunction before the occurrence of reduced left ventricular ejection fraction (LVEF).

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Doppler echocardiographic evaluation of left ventricular diastolic function in patients with systemic lupus erythematosus

Abstract

Am Heart J

Chest

Am J Med

Am Heart J

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: a study of 36 necropsy patients

Am J Med