Cardiac involvement in systemic lupus erythematosus: Interest of 2D global longitudinal strain

Abstract

Background

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease of undetermined etiology. Cardiac involvement is common in SLE and constitutes one of the main causes of mortality. More recently, new ultrasound imaging techniques, such as transthoracic ultrasound (TTE) with strain evaluation, have appeared and seem promising for the detection of cardiac involvement. The objective of our work was to study the frequency and characteristics of ultrasound abnormalities found in lupus patients and to study the benefit of ultrasound with global longitudinal strain (GLS) for early management.

Methods

It was an observational study of patients followed for SLE at the internal medicine and cardiology department of the HMPIT for 6 months (May-November 2023). The definition of cardiac involvement was by ultrasound. All patients benefited from TTE coupled with 2D-strain. We divided the workforce into two groups: the first group (patients with heart disease) and the second group (patients without heart disease).

Results

In a series of 40 lupus patients including 33 women and seven men, cardiac manifestations were reported in 60% of patients. In the first group, 29% had palpitations, 25% had chest pain, 67% had dyspnea, 37% had pericarditis, 8% had pulmonary arterial hypertension (PAH) and 12% had myocarditis. The comparative study showed that patients in the first group presented significantly more frequently with dyspnea (p = 0.02), chest pain (p = 0.03) and serositis (p = 0.01) compared to those in the second group. The mean left ventricular ejection fraction (LVEF) did not show a significant difference between the two groups. On the other hand, the average Global Longitudinal Strain (GLS) was significantly altered in the first group (p = 0.01). Furthermore, the frequency of pathological GLS was significantly higher in patients with lupus heart disease (p < 0.01).

Conclusion

Cardiac involvement during SLE is a frequent and most often asymptomatic complication. A systematic search for this impairment using a high-performance echocardiography examination, namely the 2D GLS, is essential for early treatment.

Keywords

Systemic lupus erythematosus echocardiography 2D strain heart disease

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References

Louzir

Othmani

Ben Abdelhafidh

. Systemic lupus erythematosus in Tunisia. National multicenter study. About 295 observations. Rev Med Internal 2003; 24(12): 768–774.

Harouna

Aboudib

Bouissar

, et al. Cardiac manifestations in systemic lupus erythematosus. Rev Med Internal 2016; 37: A240.

Nikdoust

Bolouri

Tabatabaei

, et al. Early diagnosis of cardiac involvement in systemic lupus erythematosus via global longitudinal strain (GLS) by speckle tracking echocardiography. J Cardiovasc Thorac Res 2018; 10(4): 231–235.

Mavrogeni

Dimitroulas

Kitas

. Multimodality imaging and the emerging role of cardiac magnetic resonance in autoimmune myocarditis. Autoimmun Rev 2012; 12(2): 305–312.

DiMinno

Forte

Tufano

, et al. Speckle tracking echocardiography in patients with systemic lupus erythematosus: a meta-analysis. Eur J Intern Med 2020; 73: 16–22.

Restivo

Candiloro

Daidone

, et al. Systematic review and meta-analysis of cardiovascular risk in rheumatological disease: symptomatic and non-symptomatic events in rheumatoid arthritis and systemic lupus erythematosus. Autoimmun Rev 2022; 21(1): 102925.

Gargiulo

Marsico

Parente

, et al. Ischemic heart disease in systemic inflammatory diseases. An appraisal. Int J Cardiol 2014; 170(3): 286–290.

Galve

Candell Riera

Pigrau

, et al. Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus. N Engl J Med 1988; 319(13): 817–823.

Ghriss

Ben Yahia

Ben Haj Ali

, et al. Particularities of pericarditis in systemic lupus erythematosus. Rev Med Internal 2021; 42: A102.

10.

Law

Thong

Lian

, et al. Acute lupus myocarditis: clinical features and outcome of an oriental case series. Lupus 2005; 14(10): 827–831.

11.

Apt

McGwin

Vilá

, et al. Associated factors and impact of myocarditis in patients with SLE from LUMINA, a multiethnic US cohort (LV). Rheumatology 2008; 47(3): 362–367.

12.

Miner

Kim

. Cardiac manifestations of systemic lupus erythematosus. Rheum Dis Clin N Am 2014; 40(1): 51–60.

13.

Hajji

Barbouche

Harzallah

, et al. Pericarditis during lupus: about 89 cases. Rev Med Internal 2015; 36: A128.

14.

Bakos

Ostenfeld

Markstad

, et al. A comparison between radial strain evaluation by speckle-tracking echocardiography and cardiac magnetic resonance imaging, for assessment of suitable segments for left ventricular lead placement in cardiac resynchronization therapy. Europace 2014; 16(12): 1779–1786.

15.

Seo

Ishizu

Aonuma

. Current status of 3-dimensional speckle tracking echocardiography: a review from our experiments. J Cardiovasc Ultrasound 2014; 22(2): 49–57.

16.

Leal

Silva

Lianza

, et al. Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study. Scand J Rheumatol 2016; 45(3): 202–209.

17.

Guşetu

Pop

Pamfil

, et al. Subclinical myocardial impairment in SLE: insights from novel ultrasound techniques and clinical determinants. Med Ultrasound 2016; 18(1): 47–56.

18.

Huang

Yao

Huang

. Left ventricular remodeling and dysfunction in systemic lupus erythematosus: a three dimensional speckle tracking study. Echocardiography 2014; 31(9): 1085–1094.