Evaluation Of Left Ventricular Systolic Function In Patients With Systemic Lupus Erythematosus Using Layer-Specific Two-Dimensional Speckle Tracking Echocardiography

Objective:The purpose of this study was to evaluate the systolic function of the left ventricular of different layers myocardium in patients with systemic lupus erythematosus using layer-specific two-dimensional speckle tracking echocardiography.Methods:A total of 51 SLE patients were selected as the experimental group and the SLEDAI was used to evaluate the disease activity of SLE patients,which were divided into two subgroups:mild and moderate to severe.Meanwhile,30 healthy patients with age and gender matching were collected as the control group.Routine echocardiography and layer-specific two-dimensional speckle tracking echocardiography were performed in both groups,and the related antibody indexes were detected.T-test was used for comparison between two groups,and One-way analysis of variance was used for comparison between several independent samples.Pearson test was used to analyze the correlation between the two variables,and multiple linear regression analysis was used to analyze the independent influencing factors of SLEDAI.The ROC curve of predicting left ventricular systolic function in patients with moderate to severe SLE was plotted with GPLS and GCS.The repeatability test was performed by Bland-Alterman analysis.All results were statistically significant at P<0.05.Results:1.There were no significant differences in age,gender,BMI,BSA,heart rate,systolic blood pressure and diastolic blood pressure between SLE group and control group.2.Compared with the control group,LAESD in SLE group increased(P<0.05).Compared with the control group,E in SLE group was decreased(P<0.05),E/A and E’ were decreased(P<0.01),and E/E’ was increased(P<0.05).3.The GPLS and GCS of the endocardium,midmyocardium and epicardium in the SLE groups was significantly lower than that in the control group(P<0.01).In basal segment and papillary muscle level,the PLS in the subendocardial,midmyocardium and epicardial myocardium of SLE group were lower significantly than that of the control group(P<0.01).At the level of apical segment the PLS in the subendocardial,midmyocardium and epicardial myocardium of SLE group were lower than those in the control group(P>0.05).Compared with the control group,the CS of the endocardium and epicardium in the basal segment of SLE group were decreased(P<0.05),and the CS of the midmyocardium in the basal segment was decreased(P<0.01).Compared with the control group,the CS of the endocardium in the papillary muscle level of SLE group were decreased(P<0.05),and the CS of the midmyocardium and epicardium in the papillary muscle level was decreased(P<0.01).At the level of apical segment,the CS in the subendocardial,midmyocardium and epicardial myocardium of SLE group were lower than those in the control group(P>0.05).The ALS of the SLE group was decreased compared with the control group(P<0.05).4.The GPLS of the endocardium,midmyocardium and epicardium in the moderate to severe SLE group was significantly lower than that in the mild SLE group and the control group(P<0.01).The GPLS of the endocardium,midmyocardium and epicardium in the mild SLE group was lower than that in the control SLE group(P>0.05).The GCS of the midmyocardium in the moderate to severe SLE group was significantly lower than that in the mild group(P<0.01),and the GCS of the endocardium and epicardium in the moderate to severe SLE group was lower than that in the mild group(P>0.05).The GCS of the endocardium,midmyocardium and epicardium in the mild SLE group was lower than that in the control SLE group(P>0.05).The GCS of the endocardium,midmyocardium and epicardium in the moderate to severe SLE group was lower than that in the control SLE group(P<0.01).5.There were no statistically significant differences in the GPLS and GCS of the endocardium,midmyocardium and epicardium between the ACA(-)group and the ACA(+)group(P>0.05).6.Correlation analysis showed that there was a correlation between SLEDAI and GPLS of the endocardium,midmyocardium and epicardium in SLE patients(r=0.387,0.399,0.380,All P<0.01).There was a correlation between SLEDAI and GCS of the endocardium,midmyocardium in SLE patients(r=0.291,0.353,All P<0.05).Correlation analysis showed that there was a correlation between LVEF and GPLS of the endocardium,midmyocardium in SLE patients(r=-0.355,0.306,All P<0.05).In a multivariate regression analysis with GPLS,GCS,LVEF and course of disease included,only GPLS was independently with correlated with SLEDAI.The regression model was as follows:Y=28.13+0.44GPLS.7.The area under the curves(AUCs)of subendocardial,midmyocardial,and subepicardial GPLS in the moderate to severe SLE patients were 0.798,0.780,and 0.738,respectively.The AUCs of subendocardial,midmyocardial,and subepicardial GCS were 0.699,0.757 and 0.674,respectively.Conclusion:The results of this study show that the PLS and CS of left ventricular layers in SLE group are lower than those in the control group in varying degrees.Myocardial involvement in SLE patients is related to lupus activity,and GPLS can be used as an independent predictor of lupus activity.Layer-specific two-dimensional speckle tracking echocardiography provides a better method for early clinical diagnosis of myocardial damage in SLE.