Assessment Of Right Ventricular Function In Systemic Lupus Erythematosus Patients By Full-Volume Real-Time Three-Dimensional Echocardiography

Objective: To evaluate the right ventricular function in patients with systemic lupus erythematosus(SLE)by full-volume real-time three-dimensional echocardiography(RT-3DE).Methods: SLE patients were eligible to this study between October 2016 and May 2017 at the Second Affiliated Hospital of Dalian Medical University,the eligibility criteria of SLE diagnosis met the standard of the 2012 revised ACR criteria of SLE.The exclusion criteria were congenital heart disease,cardiomyopathy,valvular heart disease,chronic obstructive pulmonary disease or arrhythmia and so on.Those patients were divided into 3 groups in total 102 cases according to the different degree of pulmonary arterial systolic pressure(PASP),M:F=11:91,age range: 20~52 years old,mean age: 43.2±9.3 years old.Group B included 37 patients(PASP≤30mm Hg,1mm Hg=0.133 k Pa),M:F=4:33,age range: 21~51 years old,mean age:45.3±8.4 years old.Group C included 34 patients(30mm Hg<PASP<50mm Hg),M:F=4:30,age range: 20~52 years old,mean age: 41.3±9.6 years old.Group D included 31 patients(50mm Hg≤PASP),M:F=3:28,age range: 23~51 years old,mean age: 43.3±7.5 years old).PASP was estimated according to the formula: PASP(mm Hg)= 4×V2+right atrial pressure.At the same time,30 age-matched volunteers as control group(group A),group A as healthy volunteers without any familial histories or other medical histories,M:F=3:27,age range: 23~52 years old,mean age: 42.1±10.5 years.All subjects’ heights and weights were recorded and their body surface area(BSA)and body mass index(BMI)were calculated.After a 15-minute rest period in a quiet room,each subject’s blood pressure was measured three times,and from this,the mean blood pressure was calculated.All subjects had a 3-lead surface electrocardiogram in the supine position and recorded their heart rate.An ultrasound system(Vivid E9,GE Medical Health,USA),an M5S-D probe(1.5~4.5 MHz),a 4V-D probe(1.7~3.3 MHz)and a related analysis software were used for the study.All subjects had undergone 2-DE and RT-3DE.The right venticular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE)and tricuspid lateral annular systolic velocity(S’)were all obtained by 2-DE.The right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),right ventricular stroke volume(RVSV)and right ventricular ejection fraction(RVEF)were all obtained by RT-3DE.RVEDV,RVESV and RVSV were standardized by BSA,acquired right ventricular end-diastolic volume index(RVEDVi),right ventricular end-systolic volume index(RVESVi)and right ventricular stroke volume index(RVSVi).All subjects gave their written informed consents after receiving a detailed explanation of the study protocol and the procedures adopted in the study.Results:1.Characteristics parameters: Among the four groups,there were no significant differences in sex ration,age,blood pressure and BMI(all P>0.05).Nevertheless,the heart rate in group D was significantly higher than those of the other three groups(all P<0.05).2.2-DE parameters: There were no significant differences of RVFAC,TAPSE and S’ among group A,B and C(all P >0.05).Compared with group A,B and C,RVFAC,TAPSE and S’ of group D were decreased,the differences were statistically significant(all P<0.05).3.RT-3DE parameters: There were no significant differences of RVEDVi,RVESVi,RVSVi and RVEF among group A,B and C(all P>0.05).Compared with group A,B and C,RVEDVi and RVESVi of group D were increased,while RVSVi and RVEF of group D were decreased,the differences were statistically significant(all P<0.05).Conclusion: RT-3DE could evaluate right ventricular function in SLE patients with moderate to severe pulmonary arterial hypertension.