title: The implication of tissue Doppler echocardiography and cardiopulmonary exercise in early detection of cardiac dysfunction in systemic lupus erythematosus patients.
abstract: OBJECTIVE
  Systemic lupus erythematosus (SLE) can present limitations to exercise capacity and quality of life (QoL) because of various clinical conditions, such as pulmonary disease or heart disease. Tissue Doppler echocardiography (TDE) offers the promise of an objective measurement to quantify regional and global ventricular function through the assessment of myocardial velocity data. This study aimed to assess the intensity of left ventricular (LV) and right ventricular (RV) systolic and diastolic dysfunction in SLE patients by means of TDE and cardiopulmonary exercise (CPX) testing to determine their impact on QoL.
  
  
  METHODS
  Overall, 56 SLE patients within two tertiary healthcare centers as well as 50 healthy controls were examined with TDE after the exclusion of cardiovascular risk factors. TDE was performed for maximal systolic (S), early diastolic (E'), and late diastolic (A') velocities of the mitral and tricuspid annulus. Pulsed wave (PW) Doppler of mitral and tricuspid valve inflow was performed in addition to the estimation of the left ventricle ejection fraction and assessment of right ventricle systolic function by tricuspid annular plane systolic excursion (TAPSE). Disease activity was assessed by the Systemic Lupus Activity Measure (SLAM), and the damage index was assessed by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). CPX tests according to the modified Bruce protocol were performed.
  
  
  RESULTS
  SLE patients in both subgroups had more or less similar laboratory data and statistically higher values of ESR, CRP, and anticardiolipin (aCL) antibodies compared to the control group. LV function showed statistically insignificant EF compared to the control group, being lower in the patient group. Tissue Doppler image revealed that E' and A' of the mitral annulus were lower in the patient group than in the control group. Concerning RV, TAPSE in the patient group was statistically lower than in the control group, and there was a statistical difference between SLE groups Ia and Ib; also, S wave was lower in group Ib than in group Ia. RV diastolic dysfunction in the form of lower E' and A' values was observed for the SLE group compared to the control group, especially in the medial annulus of the tricuspid valve. A higher A wave velocity with PWD of mitral and tricuspid inflows was observed in the patient group compared to the control group.
  
  
  CONCLUSIONS
  SLE patients have an increased prevalence of subclinical systolic and diastolic LV and RV dysfunction. This result advocates for regular follow-up and early screening of SLE patients. Accordingly, treatment focused on improving diastolic heart function may have a role in enhancing QoL and improving the prognosis of SLE patients.
authors.affiliation: Department of Physical Medicine and Rheumatology, Benha University School of Medicine, Qalubiya, Egypt.
authors.forename: Basant M
authors.initials: BM
authors.lastname: Elnady
authors.affiliation: Department of Cardiology, National Heart Institute, Giza, Egypt.
authors.forename: Ayman Saeed Mohamed
authors.initials: AS
authors.lastname: Abdelghafar
authors.affiliation: Department of Cardiology, Al Azhar University, Cairo, Egypt.
authors.forename: El Shazly Abdul
authors.initials: ES
authors.lastname: Khalik
authors.affiliation: Department of Internal Medicine, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
authors.forename: Mohammed Mesfer
authors.initials: MM
authors.lastname: Algethami
authors.affiliation: Department of Nephrology, King Abdulaziz Specialist Hospital, Qurwa, Saudi Arabia.
authors.forename: A S
authors.initials: AS
authors.lastname: Basiony
authors.affiliation: Taif University, Taif, Saudi Arabia.
authors.forename: Mona Dhaif Allah
authors.initials: MD
authors.lastname: Al-Otaibi
authors.affiliation: Taif University, Taif, Saudi Arabia.
authors.forename: Maram Eidhah
authors.initials: ME
authors.lastname: Al-Otaibi
keywords: LV and RV diastolic dysfunction; Systemic lupus erythematosus; cardiopulmonary exercise test; tissue Doppler echocardiography