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Evaluation of left ventricular function by vector flow mapping in females with systemic lupus erythematosus

Clinical Rheumatology volume 40, pages 4049–4060 (2021)Cite this article

Abstract

Objectives

Compare the intraventricular hemodynamics of 60 females with systemic lupus erythematosus (SLE) and 61 healthy female controls, and determine cardiac function changes using vector flow mapping (VFM).

Methods

To determine the effect of pulmonary artery pressure changes on left ventricular function, SLE patients were divided into a normal pulmonary artery pressure group (S1, n=24) and an elevated pulmonary artery pressure group (S2, n=36). The energy loss (EL) at each segment of the left ventricular chamber (total, basal, middle, and apical segments) during each period of the cardiac cycle (isovolumic contraction, rapid ejection, rapid filling, reduced filling, atrial contraction) was determined.

Results

The S1 group had significantly more vortices than the control group during the rapid ejection, rapid filling, and atrial contraction periods (p<0.01), and the maximum vortex areas in the S1 and S2 groups were smaller than in the control group during rapid filling and atrial contraction periods (p<0.05). Compared with the control group, the S2 group had greater EL during the systole and diastole periods (p<0.01). EL in the S1 group was significantly greater than in the control group during systole (p<0.01). During the rapid filling period, the EL was positively correlated with septal E′ (r=0.784, p<0.01), and during the atrial contraction period, EL was positively correlated with septal E/e′ (r=0.812, p<0.01) and A (r=0.715, p<0.01).

Conclusion

VFM of patients with SLE can comprehensively, rapidly, and efficiently evaluate changes of myocardial mechanics and intracardiac hemodynamics and provide quantitative analysis of complex intracardiac blood flow.

Key points

• Vector flow mapping (VFM) is a new non-invasive ultrasound technique that evaluates changes of myocardial mechanics and intracardiac hemodynamics, and provides quantitative analysis of complex intracardiac blood flow.

• This study showed that vortex and energy loss may provide more sensitive detection of cardiac dysfunction than conventional echocardiographic indexes in patients with systemic lupus erythematosus.

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Data availability

The datasets generated and analyzed in the present study are available from the corresponding author upon reasonable request.

Abbreviations

ACR:

the American College of Rheumatolgy

ANA:

antinuclear antibodies

AZA:

azathioprine

BSA:

body surface area

CMR:

cardiac magnetic resonance

CRP:

C-reactive protein

CsA:

ciclosporin A

CYC:

cyclophosphamide

DBP:

diastolic pressure

2D:

two-dimensional

EL:

energy loss

ERA:

endothelin receptor antagonist

ESR:

erythrocyte sedimentation rate

echo-PIV:

echo-particle image velocimetry

eGFR:

estimated glomerular filtration rate

FAC:

fractional area change

FBS:

fasting blood glucose

FK506:

tacrolimus

HCQ:

hydroxychloroquine

HR:

heart rate

IgA:

immunoglobulin A

IgG:

immunoglobulin G

IgM:

immunoglobulin M

LAD:

left atrial diameter

LEF:

leflunomide

LV:

left ventricular

LVEDD:

left ventricular end-diastolic diameter

LVEDV:

left ventricular end-diastolic volume

LVEF:

left ventricular eject fraction

LVESD:

left ventricular end-systolic diameter

MMF:

mycophenolate mofetil

MTX:

methotrexate

PAH:

pulmonary arterial hypertension

PASP:

pulmonary artery systolic pressure

PDE-5i:

phosphodiesterase 5 inhibitor

PGs:

prostaglandin analogs

Pro-BNP:

pro-brain natriuretic peptide

PW:

pulsed-wave

RAD:

right atrial diameter

RVD:

right ventricular diameter

SBP:

systolic pressure

SLE:

systemic lupus erythematosus

SLEDAI:

SLE disease activity index

TAPSE:

tricuspid annular plane systolic excursion

TCH:

total cholesterol

TDI:

tissue Doppler imaging

TV:

tricuspid regurgitation velocity

VFM:

vector flow mapping

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Funding

This work was supported by National Natural Science Foundation of China (Grant No. 81871359).

Author information

Authors and Affiliations

  1. Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China

    Yingying Wang, Jian Hong & Di Xu

  2. Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, China

    Rongbin Yu

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  2. Jian Hong
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  4. Di Xu
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Contributions

YW, JH, RY, and DX conceived and designed research; YW, JH, and DX collected data and conducted research; YW and RY analyzed and interpreted data; YW wrote the initial paper; DX, YW, and RY revised the paper; DX had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Rongbin Yu or Di Xu.

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This study was approved by the local Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethics standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethics standards.

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Written informed consent was obtained from all individual participants included in this study.

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Wang, Y., Hong, J., Yu, R. et al. Evaluation of left ventricular function by vector flow mapping in females with systemic lupus erythematosus. Clin Rheumatol 40, 4049–4060 (2021). https://doi.org/10.1007/s10067-021-05747-y

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