Systolic and diastolic heart function in SLE patients

Margaret Wislowska, D Dereń, M Kochmański, S Sypuła, J Rozbicka
Rheumatology International 2009, 29 (12): 1469-76
Cardiovascular pathology is frequent in systemic lupus erythematosus (SLE). Left ventricular (LV) diastolic dysfunction is its common findings. The aim of the study was to assess the systolic and diastolic function of the left ventricle (LV) in SLE patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Another purpose was to estimate whether there is a correlation between the duration and severity of SLE and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the SLE group and control group, which constituted healthy volunteers. No statistically significant differences in systolic heart function between groups were observed, except for lower values of the fractional shortening (SF 35.9 +/- 1.2 and 37.1 +/- 0.9, P = 0.01) in SLE patients, particularly in long (more than 10 years) disease duration (34.9 +/- 0.6 vs. 37.0 +/- 0.8, P < 0.005) and the value of SLE Disease Activity Index (SLEDAI) higher than six points (35 +/- 0.9 vs. 37.1 +/- 0.5, P < 0.01) Left atrial end-systolic diameter (LA) was greater (3.69 +/- 0.37 vs. 3.5 +/- 0.28, P < 0.05) and the ejection fraction (EF) was lower (64.6 +/- 1.5 vs. 66.3 +/- 1.3, P < 0.05) in SLE subjects of long disease duration than in the controls. SLE patients demonstrated significantly higher late diastolic velocity (A') and lower E'/A' ratio than the control group. No differences were observed in A' values between SLE subset of short disease duration and the controls. Isovolumetric relaxation time in turn was significantly longer and E/A ratio as well as E'/A' ratio lower in SLE of long disease duration versus the short one. In older patients, peak velocity at the time of atrial contraction (A) and A' values were higher and peak early velocity wave (E), early diastolic velocity (E'), E/A ratio and E'/A' ratio lower than in the younger subset. Increased the value of SLEDAI correlated with increased A' and decreased E, E/A ratio and E'/A' ratio in SLE subjects. Further analysis concerning the strong connection of these parameters with patients' age, however, revealed no statistically significant correlation between SLEDAI values and LV diastolic function parameters. In long (>10 years) disease duration LV diastolic properties were worse.


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