Detection Of Myocardial Injury By CMR Functional Parameters And 3D Strain In Patients With HFpEF SLE

Purpose:This study aimed to detect the difference between patients with systemic lupus erythematosus（SLE）in heart failure with preserved ejection fraction（HFp EF）and patients with SLE without heart failure using cardiovascular magnetic resonance（CMR）cardiac function multi-parameter and ascertain optimal strain cutoffs for the diagnosis of HFp EF SLE.Materials and Methods:Prospectively included SLE inpatients from the First Affiliated Hospital of Guangxi Medical University from June 2019 to August2020,healthy volunteers as control group,underwent CMR cardiac film examination.We used CVI⁴² to post-process the left/right ventricular function,the volume and area of the left/right atrium and the left ventricular 3D strain.Patients who met the diagnosis of HFp EF were in the HFp EF SLE group,and those without heart failure were in the SLE group.The statistical differences of parameters were compared among the three groups.The receiver operating characteristic curve was used to ascertain optimal strain cutoffs for the diagnosis of HFp EF SLE.Results:15 cases in the HFp EF SLE group,53 cases in the SLE group and 30cases in the volunteer group were included in this study.Left ventricular ejection fraction（LVEF）among three groups:HFp EF SLE group<SLE group<volunteer group.The mean bias of LVEF in HFp EF SLE group and volunteer group were49.15±2.99%,65.25±0.91%.The median LVEF in SLE group was 59.30%,interquartile range10.4%（P<0.001）.The RVEF of the HFp EF SLE group was smaller than those of the SLE group and the volunteer group.The mean bias of LVEF in HFp EF SLE group,SLE group and volunteer group were40.95±3.39%,51.21±1.26%and 53.06±1.38%（P<0.05）.The volume and area of the left/right atrium were larger than those of the control group.Except for the apical peak radial strain（ARS）,the absolute values of the strain parameters in circumferential and longitudinal strain of the peak basal,middle,apical and global left ventricle were significantly lower than those of the volunteer group（P<0.05）.The absolute value of circumferential strain among the volunteer group,HFp EF SLE group and SLE group showed decreasing changes（P<0.05）.The global peak longitudinal strain（GLS）showed the highest diagnostic value for the differentiation of HFp EF SLE patients from SLE patients and healthy volunteers（AUC=0.755,cutoff value,-13.29%,sensitivity,100.00%,specificity,49.40%）.The global peak Circumferential strain（GCS）showed the highest diagnostic value for the differentiation of HFp EF SLE patients from SLE patients and healthy volunteers（AUC=0.700,cutoff value,-17.86%,sensitivity,46.67%,specificity,91.57%）.Conclusion:LVEF,RVEF can be used to evaluate the myocardial injury of patients with SLE.The area and volume of the left/right atriums of patients with SLE were larger than those of the volunteer group.The longitudinal strain and circumferential strain of basal,middle,apical segment and the global left ventricle were injury in patients with SLE.The circumferential strain in HFp EF SLE patients will further impair.It is more appropriate to control the absolute value of3D GLS above 13%and the absolute value of GCS above 18%.