Evaluation of Left Ventricular Function in Patients with Systemic Lupus Erythematosus: Association of Tissue Doppler and Strain Imaging with Disease Activity

Background: Systemic lupus erythematosus (SLE) is a connective tissue disorder with cardiovascular involvement associated with high morbidity and mortality. Routine echocardiography often misses early myocardial involvement. We intend to use tissue Doppler imaging (TDI), strain and strain rate imaging to reveal subclinical myocardial dysfunction in asymptomatic females with SLE; and its correlation with disease activity and anticardiolipin antibodies. Materials and Methods: Forty-three female SLE patients without cardiac symptoms or signs and matched healthy control group (n = 20) underwent standard echocardiography, TDI, strain and strain rate imaging. Disease activity of SLE was assessed using the SLE disease activity index (SLEDAI); ≥6 points were considered active. Results: Mean age of SLE patients was 29.86 years with a mean SLEDAI score of 4.36 ± 4.5. Standard two dimensional-Echocardiogram parameters were similar to healthy controls. SLE was associated with significantly impaired systolic myocardial velocities of left ventricle measured by TDI; medial S': 8.5 ± 1.2 versus 9.6 ± 1.0 cm/s, P = 0.007; lateral S': 9.2 ± 1.7 versus 11.4 ± 1.6 cm/s, P = 0.012); and decrease in strain (−17.2% ± 2.2% vs. −20.95% ± 2.1%; P < 0.001) and strain rate (P < 0.05). There was no significant difference with the presence of anti-cardiolipin antibodies. Patients with higher disease activity had decreased systolic myocardial velocity on TDI and strain imaging as compared to low activity patients. Conclusion: Asymptomatic SLE patients showed impairment of left ventricular systolic and diastolic function compared to healthy controls. TDI and strain imaging detects early subclinical myocardial involvement that correlates with disease activity. Such evidence of early myocardial involvement needs further evaluation to reclassify SLE disease activity and guide management.