Early Assessment of Right Ventricular Function in Systemic Lupus Erythematosus Patients using Strain and Strain Rate Imaging

Abstract Background: Right ventricular function is a crucial factor of the prognosis of systemic lupus erythematosus (SLE). Objectives: To evaluate the right ventricular function in SLE patients with different degrees of pulmonary hypertension (PH) by strain and strain rate imaging. Methods: A total of 102 SLE patients and 30 healthy volunteers were studied between October 2015 and May 2016. Patients were divided into three groups according to pulmonary artery systolic pressure (PASP) estimated by echocardiography: group control (A); PASP ≤ 30 mmHg (group B, n = 37); PASP 30-50 mmHg (mild PH; group C, n = 34); and PASP ≥ 50 mmHg (moderate-to-severe PH; group D, n = 31). Longitudinal peak systolic strain (ε) and strain rate (SR), including systolic strain rate (SRs), early diastolic strain rate (SRe) and late diastolic strain rate (SRa) were measured in the basal, middle and apical segments of the right ventricular free wall in participants by two-dimensional speckle tracking echocardiography (2D-STE) from the apical four-chamber view. A p < 0.05 was set for statistical significance. Results: The parameters of ε, SRs, SRe, and SRa were significantly decreased in groups C and D compared with groups A and B. The ε of each segments was significantly lower in group D than in group C, while there were no differences in SRs, SRe and SRa between groups C and D. Conclusions: Strain and strain rate imaging could early detect the right ventricular dysfunction in SLE patients with PH, and provide important value for clinical therapy and prognosis of these patients. (Arq Bras Cardiol. 2018; [online].ahead print, PP.0-0)

摘要 背景：右心室功能是系统性红斑狼疮（systemic lupus erythematosus, SLE）患者预后的关键影响因素。目的：采用应变及应变率成像技术，评估不同程度肺动脉高压（pulmonary hypertension, PH）的SLE患者的右心室功能。方法：本研究于2015年10月至2016年5月期间纳入102例SLE患者及30名健康志愿者。根据超声心动图估算的肺动脉收缩压（pulmonary artery systolic pressure, PASP）将患者分为四组：对照组（A组）；PASP ≤30 mmHg组（B组，n=37）；PASP 30~50 mmHg组（轻度PH，C组，n=34）；以及PASP ≥50 mmHg组（中重度PH，D组，n=31）。采用心尖四腔切面的二维斑点追踪超声心动图（two-dimensional speckle tracking echocardiography, 2D-STE），测量受试者右心室游离壁基底段、中段及心尖段的纵向峰值收缩应变（ε）与应变率（SR），包括收缩期应变率（SRs）、舒张早期应变率（SRe）及舒张晚期应变率（SRa）。本研究设定统计学显著性阈值为p<0.05。结果：与A、B两组相比，C、D两组的ε、SRs、SRe及SRa参数均显著降低。D组各节段的ε均显著低于C组，但C、D两组间的SRs、SRe及SRa无显著差异。结论：应变及应变率成像可早期检出合并PH的SLE患者的右心室功能异常，可为此类患者的临床治疗及预后评估提供重要参考价值。（《巴西心脏病学杂志（Arq Bras Cardiol）》2018年；[在线优先出版]，页码0-0）