背景:系统性红斑狼疮(SLE)是一个多系统,自身免疫性疾病有潜在的心血管参与。层特异性应变(LSS)分析是一种新方法,可以早期检测细微的左心室(LV)收缩功能障碍。这项研究的目的是使用常规超声心动图测量以及LSS的纵向应变(LS)和周向应变(CS)评估SLE患者的LV收缩功能。此外,评估了超声心动图参数与心血管事件发生之间的关联.
方法:共有162例SLE患者(SLE组)接受了专门的多学科评估,包括超声心动图,在他们第一次访问时进行了分析。对照组由68名年龄和性别匹配的健康受试者组成。心内膜上的LS和CS,心肌中部,测量17个心脏段的心外膜层。跨壁应变梯度计算为心内膜层和心外膜层之间的收缩期应变差异。
结果:与对照组相比,SLE患者的LV射血分数明显降低,LS,各层次的CS值(P<0.05);LVLS和CS梯度均低于对照组(P<0.05)。在83个月的中位随访期间(四分位数范围:64-95个月),59例患者(36.4%)发生心血管事件。使用多元Cox回归分析,我们发现LV心内膜LS(风险比,1.014;95%CI,1.002-1.035;P=0.025)和CS(危险比,1.051;95%CI,1.027-1.077;P<0.001)显示与心血管事件独立相关;而左心室射血分数与心血管事件无显著相关。Kaplan-Meier存活曲线显示,SLE患者具有较低的LV心内膜LS和CS(基于-21.5%和-29.0%的临界值,分别)与左心室心内膜LS和CS较高的患者相比,心血管事件的累积发生率更高。
结论:在SLE患者中,通过LV心内膜LS和CS测得的LV收缩功能明显低于对照组,并且与心血管事件有关。可能代表一种新技术来改善这些患者的风险分层。
BACKGROUND: Systemic lupus erythematosus (SLE) is a multisystem, autoimmune disease with potential cardiovascular involvement. Layer-specific strain (LSS) analysis is a new method that allows early detection of subtle left ventricular (LV) systolic dysfunction. The aim of this study was to evaluate LV systolic function in patients with SLE using conventional echocardiographic measurements and longitudinal strain (LS) and circumferential strain (CS) by LSS. Furthermore, the association between echocardiographic parameters and the occurrence of cardiovascular events was assessed.
METHODS: A total of 162 patients with SLE (the SLE group) who underwent a dedicated multidisciplinary assessment, including echocardiography, were analyzed at the time of their first visits. The control group consisted of 68 age- and sex-matched healthy subjects. LS and CS on endocardial, mid-myocardial, and epicardial layers at 17 cardiac segments were measured. Transmural strain gradient was calculated as the differences in systolic strain between the endocardial and epicardial layers.
RESULTS: Compared with control subjects, patients with SLE had significantly lower LV ejection fraction, LS, and CS values in all layers (P < 0.05); LV LS and CS gradient were all lower than control subjects (P < 0.05). During a median follow-up period of 83 months (interquartile range: 64-95 months), 59 patients (36.4%) developed cardiovascular events. Using multivariate Cox regression analysis, we found that LV endocardial LS (hazard ratio, 1.014; 95% CI, 1.002-1.035; P = 0.025) and CS (hazard ratio, 1.051; 95% CI, 1.027-1.077; P < 0.001) demonstrated independent associations with cardiovascular events; whereas LV ejection fraction was not significantly associated with cardiovascular events. The Kaplan-Meier survival curves showed that patients with SLE with lower LV endocardial LS and CS (based on the cutoff values of -21.5% and -29.0%, respectively) experienced higher cumulative rates of cardiovascular events compared with those with higher LV endocardial LS and CS.
CONCLUSIONS: In patients with SLE, LV systolic function measured by LV endocardial LS and CS were significantly lower than that of the control group and were associated with cardiovascular events, potentially representing a new technology to improve risk stratification in these patients.