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


METHODS
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.
a Department of Radiology, Children's Institute, Hospital das Clínicas , São Paulo University Medical School.
G N
GN
Leal
a Department of Radiology, Children's Institute, Hospital das Clínicas , São Paulo University Medical School.
K F
KF
Silva
a Department of Radiology, Children's Institute, Hospital das Clínicas , São Paulo University Medical School.
A C
AC
Lianza
b Rheumatology Unit, Children's Institute, Hospital das Clínicas, Faculty of Medicine , University of São Paulo.
M F
MF
Giacomin
c Institute of Radiology, Hospital das Clínicas , São Paulo University Medical School.
J L
JL
Andrade
b Rheumatology Unit, Children's Institute, Hospital das Clínicas, Faculty of Medicine , University of São Paulo.
K
K
Kozu
d Department of Rheumatology, Faculty of Medicine , University of São Paulo , São Paulo , Brazil.
E
E
Bonfá
b Rheumatology Unit, Children's Institute, Hospital das Clínicas, Faculty of Medicine , University of São Paulo.
C A
CA
Silva
D000293:Adolescent; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055815:Young Adult