Advertisement

Clinical Rheumatology

, Volume 35, Issue 8, pp 1967–1975 | Cite as

Evaluation of cardiac functions in juvenile systemic lupus erythematosus with two-dimensional speckle tracking echocardiography

  • Reyhan DedeogluEmail author
  • Sezgin Şahin
  • Aida Koka
  • Funda Öztunç
  • Amra Adroviç
  • Kenan Barut
  • Dicle Cengiz
  • Özgür Kasapçopur
Original Article

Abstract

The aim of this study was to investigate subclinical systolic and diastolic dysfunction in juvenile-onset systemic lupus erythematosus (j-SLE) patients with speckle tracking echocardiography (STE) and the effects of disease activity on left ventricular (LV) regional functions. Thirty-five patients with j-SLE and 30 healthy children (control group) were evaluated between January and August 2015. STE was performed on all patients and controls. Medical records, including diagnosis criteria, age at diagnosis, and duration of disease, were evaluated. SLE disease activity was assessed using the SLE Disease Activity Index (SLEDAI). j-SLE patients had lower ejection fraction than did control subjects but still within normal range. LV end-diastolic and end-systolic dimensions were significantly larger in j-SLE patients (32.43 ± 3.2 vs 28.3 ± 3.1 and 21.1 ± 1.9 vs 18.9.0 ± 2.2, respectively; p = 0.001). There was a significant reduction in longitudinal strain of LV segments in the j-SLE patients compared with controls. J-SLE patients were further divided into subgroups. Group 1 comprised patients having SLEDAI scores >8 at the onset of disease but who improved with therapy during follow-up. Group 2 included j-SLE patients with SLEDAI scores >8 at diagnosis and persistently >4 at the end of follow-up. In the LV mid-inferior and mid-inferolateral segments, STE strain measurements of group 2 were significantly lower than those of group 1 (15.9 ± 6.4 vs 20.0 ± 4.4, 17.9 ± 7.2 vs 23.2 ± 3.8; p = 0.075, p = 0.055, respectively). Simple and non-invasive STE would be helpful in predicting cardiovascular prognosis with new therapeutic medications/interventions or in objectively comparing the effects of immunosuppressive drugs in comparison with preceding STE evaluation.

Keywords

j-SLE SLEDAI Speckle tracking echocardiography Systolic dysfunction Systolic strain 

Notes

Compliance with ethical standards

All patients and their families were informed, and written informed consent was obtained. The ethics committee of our institution approved the study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

Disclosures

None.

Funding

No funding was received from any public, special commercial sectors for this manuscript.

References

  1. 1.
    Hiraki LT, Benseler SM, Tyrrell PN et al (2008) Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupuserythematosus: a longitudinal study. J Pediatr 152:550–556CrossRefPubMedGoogle Scholar
  2. 2.
    Apte M, McGwin G Jr, Vila LM et al (2008) Associated factors and impact of myocarditis in patients with SLE from LUMINA, a multiethnic US cohort. Rheumatology (Oxford) 47:362–367CrossRefGoogle Scholar
  3. 3.
    Manzi S, Seizer F, Sutton-Tyrrell K et al (1999) Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum 42:51–60CrossRefPubMedGoogle Scholar
  4. 4.
    Manzi S, Meilahn EN, Rairie JE et al (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 145:408–415CrossRefPubMedGoogle Scholar
  5. 5.
    Huang BT, Yao HM, Huang H (2014) Left ventricular remodeling and dysfunction in systemic lupus erythematosus: a three-dimensional speckle tracking study. Echocardiography 3:1085–1094CrossRefGoogle Scholar
  6. 6.
    Mor-Avi V, Lang RM, Badano LP et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/ EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12:167CrossRefPubMedGoogle Scholar
  7. 7.
    GHochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725CrossRefGoogle Scholar
  8. 8.
    Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. a disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–640CrossRefPubMedGoogle Scholar
  9. 9.
    Wang XY, Tang XQ, Huang YJ, Chen WY, Yu XQ (2012) Frequency of established cardiovascular disease and its risk factors in Chinese patients with systemic lupus erythematosus. Clin Rheumatol 31:669–675CrossRefPubMedGoogle Scholar
  10. 10.
    Teichholz LE, Kreulen T, Herman MV, Gorlin R (1976) Problems in echocardiographic volume determinations: echocardiographic angiographic correlations in the presence or absence of asynergy. Am J Cardiol 37:7CrossRefPubMedGoogle Scholar
  11. 11.
    Oh JK (1999) The echo manual. 2nd ed. p. 55Google Scholar
  12. 12.
    Kaluzynski K, Chen X, Emelianov SY et al (2001) Strain rate imaging using two-dimensional speckle tracking. IEEE Trans Ultrason Ferroelectr Freq Control 48:1111–1123CrossRefPubMedGoogle Scholar
  13. 13.
    Reisner SA, Lysyansky P, Agmon Y et al (2004) Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr 17:630–633CrossRefPubMedGoogle Scholar
  14. 14.
    Geyer H, Caracciolo G, Abe H et al (2010) Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 23:351–369CrossRefPubMedGoogle Scholar
  15. 15.
    Oxborough D, Batterham AM, Shave R et al (2009) Interpretation of two-dimensional and tissue Doppler-derived strain (epsilon) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology? Eur J Echocardiogr 10:677–682CrossRefPubMedGoogle Scholar
  16. 16.
    Lee SW, Park MC, Park YB, Choi ST, Lee SK, Park YB (2008) E/E’ ratio is more sensitive than E/A for detection of left ventricular diastolic dysfunction in systemic lupus erythematosus. Lupus 17:195–201CrossRefPubMedGoogle Scholar
  17. 17.
    Yip GW, Shang Q, Tam LS et al (2009) Disease chronicity and activity predicts subclinical left ventricular systolic dysfunction in patients with systemic lupus erythematosus. Heart 95:980–987CrossRefPubMedGoogle Scholar
  18. 18.
    Eidem BW, McMahon CJ, Cohen RR et al (2004) Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiog 17:212–221CrossRefGoogle Scholar
  19. 19.
    Allam NT, Darweesh HA, Hamadnallah N et al (2013) Evaluation of left ventricular myocardial function in Egyptian patients with systemic lupus erythematosus: tissue Doppler study and its relation to disease activity. Egypt Rheumatol 35:217–223CrossRefGoogle Scholar
  20. 20.
    Cacciapuoti F, Galzerano D, Capogrosso P et al (2005) Impairment of left ventricular function in systemic lupus erythematosus evaluated by measuring myocardial performance index with tissue Doppler echocardiography. Echocardiography 22:315–319CrossRefPubMedGoogle Scholar
  21. 21.
    Buss SJ, Wolf D, Korosoglou G et al (2010) Myocardial left ventricular function in patients with systemic lupus erythematosus: new insights from tissue Doppler and strain imaging. J Rheumatol 37:79–86CrossRefPubMedGoogle Scholar
  22. 22.
    Teixeira AC, Bonfa E, Herskowictz N et al (2010) Early detection of global and regional left ventricular dysfunction in systemic lupus erythematosus: the role of echocardiography. Rev Bras Rheumatol 50:16–30CrossRefGoogle Scholar
  23. 23.
    Brunner HI, Gladman DD, Ibañez D et al (2008) Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 58:556–562CrossRefPubMedGoogle Scholar
  24. 24.
    Levy DM, Kamphuis S (2012) Systemic lupus erythematosus in children and adolescents. Pediatr Clin North Am 59:345–364CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Biering-Sorensen T, Hoffmann S, Mogelvang R, Iversen AZ, Galatius S, Fritz-Hansen T (2014) Myocardial strain analysis by 2-dimensional speckle tracking echocardiography ımproves diagnostics of coronary artery stenosis in stable angina pectoris circulation. Cardiovasc Imag 7:58–65CrossRefGoogle Scholar
  26. 26.
    Eek C, Grenne B, Brunvand H, Aakhus S, Endresen K, Otto A (2010) Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. Eur J Echocardiogr 11:501–508CrossRefPubMedGoogle Scholar
  27. 27.
    Winter R, Jussila R, Nowak J, Brodin LA (2007) Speckle tracking echocardiography is a sensitive tool for the detection of myocardial ischemia: a pilot study from the catheterization laboratory during percutaneous coronary intervention. J Am Soc Echocardiogr 20:974–981CrossRefPubMedGoogle Scholar
  28. 28.
    Tucker LB, Uribe AG, Fernández M, Vila LM, McGwin G, Apte M et al (2008) Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case control study within LUMINA, a multiethnic US cohort (LUMINALVII). Lupus 17:314–322CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Schanberg LE, Sandborg C, Barnhart HX et al (2009) Understanding premature atherosclerosis in pediatric SLE: risk factors of increased Carotid Intima Medial Thickness (CIMT) in the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) cohort. Arthritis Rheum 60:1496–1507CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Canpolat N, Kasapcopur O, Caliskan S et al (2013) Ambulatory blood pressure and subclinical cardiovascular disease in patients with juvenile-onset systemic lupus erythematosuts. Pediatr Nephrol 28:305–313CrossRefPubMedGoogle Scholar
  31. 31.
    Leal GN, Silva KF, Lianza AC et al. (2015) Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study. Scand J Rheumatol 1–8Google Scholar
  32. 32.
    Becker M, Bilke E, Kuhl H et al (2006) Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart 92:1102–1108CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2016

Authors and Affiliations

  • Reyhan Dedeoglu
    • 1
    Email author
  • Sezgin Şahin
    • 2
  • Aida Koka
    • 1
  • Funda Öztunç
    • 1
  • Amra Adroviç
    • 2
  • Kenan Barut
    • 2
  • Dicle Cengiz
    • 3
  • Özgür Kasapçopur
    • 2
  1. 1.Pediatric Cardiology, Cerrahpasa Medical Faculty, Department of Pediatric CardiologyIstanbul UniversityIstanbulTurkey
  2. 2.Pediatric Rheumatology, Cerrahpasa Medical Faculty, Department of Pediatric CardiologyIstanbul UniversityIstanbulTurkey
  3. 3.Department of StatisticsIstanbul Commerce UniversityIstanbulTurkey

Personalised recommendations