title: Disease chronicity and activity predict subclinical left ventricular systolic dysfunction in patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  This study investigates parameters that could predict subclinical cardiac dysfunction in systemic lupus erythematosus (SLE) in the absence of valvular, clinical coronary artery and pericardial disease.
  
  
  METHODS
  A case-control trial.
  
  
  METHODS
  Rheumatology clinic, a university teaching hospital.
  
  
  METHODS
  Eighty-two female SLE patients (49 (SD 9) years) and 82 female normal subjects (49 (13) years) matched for age, body mass index, blood pressure and heart rate.
  
  
  METHODS
  All underwent standard echocardiography and tissue Doppler imaging.
  
  
  METHODS
  Twenty-two (27%) patients had evidence of impaired left ventricular (LV) long-axis function with mean myocardial peak systolic velocity (Sm) of basal six segments <4.4 cm/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) vs 44 (9); p = 0.043) and had a higher prevalence of hypertension (46% vs 22%; p = 0.034), longer disease duration >10 years (82% vs 50%, p = 0.01), higher disease activity score (73% vs 48% for Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)> or =1, p = 0.049) and end-organ damage index (64% vs 47% with Systemic Lupus International Collaborating Clinics Damage Index (SLICC)> or =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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, SH Ho Cardiovascular and Stroke Centre, Institute of Vascular Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PR China.
authors.forename: G W-K
authors.initials: GW
authors.lastname: Yip
authors.forename: Q
authors.initials: Q
authors.lastname: Shang
authors.forename: L-S
authors.initials: LS
authors.lastname: Tam
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.forename: E K-M
authors.initials: EK
authors.lastname: Li
authors.forename: J W-H
authors.initials: JW
authors.lastname: Fung
authors.forename: C-M
authors.initials: CM
authors.lastname: Yu
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*