Evaluation Of Cardiovascular Function In Patients With Systemic Lupus Erythematosus By Ultrasonography

PART I. Evaluation of arterial structure and function in patients with systemic lupus erythematosus by high resolution ultrasonography1. Evaluation of brachial artery endothelial function in patients with systemic lupus erythematosus by high resolution ultrasonographyObjectives To evaluate brachial artery endothelial function in patients with systemic lupus erythematosus with percent change in the brachial artery diameter induced by reactive hyperemia by high resolution ultrasonography.Methods Measurements of brachial artery diameter were performed by high resolution ultrasonography during baseline, reactive hyperemia and sublingual nitroglycerin administration in 42 patients with systemic lupus erythematosus (SLE1 group with hypertention,SLE2 group without hypertention ) and 20 healthy subjects. Percent changes in brachial artery diameter induced by reactive hyperemia and induced by nitroglycerin were calculated.Results The percent change in the brachial artery diameter induced by reactive hyperemia in patients with SLE1 group(6.02±4.98%)was significantly less than that in healthy subjects(14.38±4.01%,P<0.001). The percent change in the brachial artery diameter induced by reactive hyperemia in patients of SLE2 group(9.77±4.14%)was significantly less than that in healthy subjects (P<0.05). The percent change in the brachial artery diameter induced by reactive hyperemia in patients of SLE1 group was significantly less than that in SLE2 group (P<0.05). The percent change in the brachial artery diameter induced by sublingual nitroglycerin in patients of SLE1 group(16.96±7.86%) was significantly less than that in healthy subjects (23.22±4.37%,P<0.05). Conclusions The decreased percent change in the brachial artery diameter induced by reactive hyperemia in patients with systemic lupus erythematosus in comparison with the healthy subjects indicates that brachial endothelial function is impaired in patients with systemic lupus erythematosus. The endothelium independent vasodilation is also impaired in patients with systemic lupus erythematosus.2. Evaluation of common carotid arterial structure and function in patients with systemic lupus erythematosus by high resolution ultrasonographyObjectives To observe the common carotid arterial hemodynamic and structual parameters in patients with systemic lupus erythematosus (SLE) and noninvasively evaluat the early progression of atherosclerosis and arterial elasticity with high resolution ultrasonography.Methods Forty-two patients with SLE (SLE1 group with hypertention, SLE2 group without hypertention) and twenty healthy subjects were studied.The intima media thickness of common carotid artery (IMT),pressure strain elatic modulus (Ep),pressure independent stiffness index (β) and shear rate (SR) were measured and calculated.Results There was no significant difference in the common carotid arterial diameter among the three groups (P >0.05).When compared with the control group(0.58±0.12mm),the IMT of common carotid artery in SLE1(0.70±0.11mm)and SLE2 (0.64±0.11mm)was significantly thicker (P<0.05).The IMT of common carotid artery in SLE1 (0.70±0.11mm)was thicker than that in SLE2(0.64±0.11mm,P<0.05). When compared with the control group, the Ep (666.86±144.43mmHg, 478.21±149.48mmHg VS 382.56±138.74mmHg) andβ(7.72±1.31,6.18±1.13 VS 5.26±1.02)in SLE1 and SLE2 was significantly increased (P<0.05).The SR in SLE1 and SLE2 was lower than that in the control group (30.44±11.84 s-1, 44.93±12.25 s-1VS58.24±11.78 s-1, P<0.05).The SR in SLE1 was also lower than that in SLE2( P<0.05).Conclusions In patients with SLE,the IMT of common carotid artery was thicker,the Ep andβincreased,while the SR was lower.High resolution ultrasonography is of important value in dignosis of vascular complications in patients with SLE.3. Interrelations between the brachial artery endothelial function and the common carotid arterial hemodynamic and structual parameters in patients with systemic lupus erythematosus investigated by high resolution ultrasonography.Objectives To analyze the correlation between the brachial artery endothelial function and the common carotid arterial hemodynamic and structual parameters in patients with systemic lupus erythematosus.Methods Twenty-seven patients with SLE and twenty healthy subjects were studied.The intima media thickness of common carotid artery (IMT),pressure strain elatic modulus (Ep),pressure independent stiffness index (β) and shear rate (SR) were measured. Measurements of brachial artery diameter were performed by high resolution ultrasonography during baseline, reactive hyperemia and sublingual nitroglycerin administration. Percent changes in brachial artery diameter induced by reactive hyperemia and induced by nitroglycerin were calculated. The correlation between the brachial artery endothelial function and the common carotid arterial hemodynamic and structual parameters in patients with systemic lupus erythematosus was analyzed.Results The percent change in the brachial artery diameter induced by reactive hyperemia in patients of SLE group was significantly less than that in healthy subjects (P<0.05). When compared with the control group,the IMT of common carotid artery was thicker,the Ep andβincreased,while the SR was lower ( P<0.05) in patients with SLE.The brachial artery endothelial function was correlated inversely with IMT(r=-0.418,P<0.05) and the Ep (r=-0.44,P<0.05)of common carotid artery. There was positive correlation between the brachial artery endothelial function and the SR(r=0.396,P<0.05) of common carotid artery in SLE.Conclusions The common carotid arterial hemodynamic and structual parameters are related with the brachial artery endothelial function in patients with SLE.PART II. Evaluation of the regional left ventricular systolic function in patients with systemic lupus erythematosus by speckle tracking echocardiographyObjectives To evaluate regional left ventricular longitudinal systolic function in patients with systemic lupus erythematosus by speckle tracking echocardiography.Methods High frame rate two-dimensional images were recorded from the apical left ventricular long-axis view in 32 patients with systemic lupus erythematosus and 32 healthy subjects. The longitudinal strain was measured in the apical views. The left ventricular ejection fraction (EF) was measured by M-mode echocardiography.Results There was no significant difference in EF between the patients with SLE and healthy subjects. The consistency of the longitudinal strain in some segments lost in patients with SLE (P﹤0.05). The left ventricular two-dimensional longitudinal peak strain in SLE group was significantly lower than that in control group in some segments (P﹤0.05).Conclusions The regional myocardial systolic function in patients with SLE is impaired. The speckle tracking echocardiography can be used to assess the regional left ventricular longitudinal systolic function in patients with SLE.