| Objective: The purpose of this study was to evaluate right ventricular (RV) regionaland global structural and functional abnormalities in patients with systemic lupuserythematosus (SLE) complicated with pulmonary arterial hypertension (PAH), and toanalyse the relationship between echocardiographic parameters using the real-time3-dimensional echocardiography (RT-3DE) and routine echocardiography.Methods: Sixty patients with SLE and twenty-eight healthy control subjects wereincluded. SLE patients were divided into without PAH group, mild PAH group,moderate to severe PAH group according to pulmonary artery systolic pressure (PASP).PAH was defined as estimated pulmonary artery systolic pressure (PASP)≥35mmHgon echocardiography. All echocardiographic study was performed with SIEMENSACUSON SC-2000ultrasound system. Standard echocardiography was performedfollowing the recommendations of the American Society of Echocardigraphy. RVdiameter, fractional area change (FAC), RV ejection fraction (RVEF-2D), Tei index,tricuspid annular plane systolic excursion (TAPSE) were measured or calculated.Pulsed Doppler RV inflow and Pulsed Doppler tissue imaging at the lateral corner ofthe tricuspid annulus was recorded and measured for peak early inflow velocity(E),annular peak systolic(s)，peak early diastolic (e) and peak late diastolic(a) velocitiesrespectively. Real-time3-dimensional echocardiography (3-DE) with full-volume imaging was acquired for RV end diastolic volume（RVEDVI-3D），end systolicvolume (RVESVI-3D) and ejection fraction (RVEF-3D). All group data was comparedusing analysis of variance with post hoc correlation. Simple linear regression analysiswas used for comparison of conventioal echocardiographic parameters,3-DE RVvolume and RVEF, and RV hemodynamic variables including PASP, pulmonaryvascular resistance (PVR).Results:(1) RV outflow tract diameter in patients with PAH was significantly larger than that innormal contrals (P<0.05); Right atria and RV was significantly larger in moderateto severe PAH group than that in other groups (P<0.05).(2) s, e/a, RVFAC significantly reduced, RV Tei index significantly higher in patientgroups than that in control group (P<0.05in all).(3) RVEDVI-3D，RVESVI-3D and RVEF-3D were reduced obviously in patients withmoderate to severe PAH group compared with other groups(P<0.05).(4) Regression analysis revealed a significant correlation between TAPSE, s, RVFAC,RVTei with PASP (P<0.001for all). RVEF-3D had a positive correlation withTAPSE (P<0.001). PASP, PVR, RVTei and s had a weak relationship withRVEDVI-3D and RVESVI-3D, but not with RVEF-3D.(5) There was a good reproducibility for RVEDVI-3D and RVESVI-3D.Conclusion:(1) RV remodeling occurred in SLE patients with PAH, and right atria and RV weresignificant enlarged in patients with moderate to severe PAH.(2) SLE patients occurred impaired diastolic function and regional systolic dysfunctionat the early stage, and severe at moderate to severe PAH.(3) RT-3DE could be used to quantitatively, easily and accurately assess RV entiresystolic function in patients with SLE. Objective: The aim of this study is to evaluate the regional systolic function of rightventricle (RV) in patients of systemic lupus erythematosus (SLE) by velocity vectorimaging (VVI).Methods: Sixty patients with SLE and twenty-eight healthy control subjects wereincluded. SLE patients were divided into without pulmonary arterial hypertension(PAH) group, mild PAH group, moderate to severe PAH group according to pulmonaryartery systolic pressure (PASP). PAH was defined as estimated pulmonary arterysystolic pressure(PASP)≥35mmHg on echocardiography. Echocardiographic studywas performed with SIEMENS ACUSON SC-2000ultrasound system. Standardechocardiography was performed, and parameters were measured and calculatedfollowing the recommendations of the American Society of Echocardigraphy.Two-dimensional dynamic images of standard apical four chambers were obtained inVVI condition. Using the off-line software, RV free-wall and ventricular septum weredivided into three segements: basal segment, middle segment and apical segment. thelongitudianal and radial systolic peak velocity, displacement, strain and strain rate ofeach segment were measured. All the strain parameters were compared betweencontrol group and patients groups. Simple linear regression analysis was used forcomparison of strain variables and conventioal RV functional and hemodynamicparameters. Receiver operating characteristic curves were constructed using estimatedpulmonary artery systolic pressure(PASP)≥35mmHg as response variable.Results: The baseline clinical characteristics and standard echocardiographic RVparameters of all the subjects were the same as part1. There were significantdifferences in almost all RV strain parameters of RV free wall and ventricular septumbetween the control and SLE patients with or without PAH groups (P<0.05), and theabsolute values of the strain parameters had a trend of decline gradualy, control group> SLE patients without PAH>SLE patients with mild PAH> SLE patients with moderateto severe PAH. GLS、GRS、GLSR、GRSR of RV free wall in patients with SLE werecorrelated negtively with PASP, mPAP, RVTei, and positively with s and RVFAC(P<0.001for all). Receiver operating characteristic curve analysis showed that thestrain parameters of RV free wall and ventricular septum were able to predict PASP≥35mmHg with higher sensitivity and specificity. The intra-and inter-observervariability of all strain parameters was small, showing a high repeatability.Conclusion:(1) RV regiongal systolic function in patients with SLE was impaired at the earlystage and deteriorate with PAH.(2) VVI can sensitively evaluate RV regional systolic function and be used routinelyin clinical practice.(3) The strain parameters of RV free wall and ventricular septum has the potential ofpredicting PAH in a simple and noninvasive way, is suitable for clinicalapplication. |
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