title: Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants.
abstract: OBJECTIVE
  Myocardial damage is frequent and often silent in systemic lupus erythematosus (SLE). The aim of the study was to determine the prevalence of myocardial damage by novel ultrasound techniques and to systematically assess the relationship between subclinical cardiac dysfunction and SLE-related clinical parameters.
  
  
  METHODS
  Seventy-five consecutive SLE patients without evidence of cardiac disease and seventy-three controls underwent standard transthoracic echocardiography using classical and novel ultrasound techniques: tissue Doppler imaging and speckle tracking echocardiography. Patient characteristics, cumulative organ damage and laboratory data were retrieved by medical chart review.
  
  
  RESULTS
  Within the cohort, 89.3% of the patients were female; mean+/-SD age and median (IQR) disease duration were 43.2+/-12.5 years and 8.03(6.3) years, respectively. SLE patients exhibited a significant decrement in endocardial longitudinal strain (-18.4% vs 19.3%, p=0.001) compared with controls. Diastolic dysfunction was detected in 34 (45.3%) of SLE patients. Major determinants of systolic and diastolic dysfunction were hypertension (p=0.023 and p<0.001, respectively), associated antiphospholipid syndrome (APS) (p<0.001 and p<0.001, respectively), cumulative damage accrual (p<0.001 and p=0.003, respectively), and disease duration (p=0.03 and p<0.001, respectively). Notably, anti-Ro antibodies were present in 37% of the SLE patients who had better systolic longitudinal performance. Neither disease activity, nor specific organ involvement, were associated with myocardial impairment.
  
  
  CONCLUSIONS
  Systolic longitudinal and diastolic performance impairments are frequent findings in SLE patients without overt cardiovascular disease. Cumulative organ damage, disease duration, APS, and hypertension are major determinants for early heart involvement in SLE patients.
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Guşetu
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. pop67dana@gmail.com.
authors.forename: Dana
authors.initials: D
authors.lastname: Pop
authors.affiliation: "Iuliu Hatieganu" University of Medicine and Pharmacy; Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
authors.forename: Cristina
authors.initials: C
authors.lastname: Pamfil
authors.affiliation: Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
authors.forename: Raluca
authors.initials: R
authors.lastname: Bǎlaj
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Mureşan
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cismaru
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania.
authors.forename: Roxana
authors.initials: R
authors.lastname: Matuz
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Roşu
authors.affiliation: Department of Cardiology, Clinical Rehabilitation Hospital; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Dumitru
authors.initials: D
authors.lastname: Zdrenghea
authors.affiliation: "Iuliu Hatieganu" University of Medicine and Pharmacy;Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Rednic
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D015203:Reproducibility of Results; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D012680:Sensitivity and Specificity