Clinical Investigation
Identifying Cardiovascular Risk in Systemic Lupus Erythematosus
Left Ventricular Systolic Function in Patients with Systemic Lupus Erythematosus and Its Association with Cardiovascular Events

https://doi.org/10.1016/j.echo.2020.04.018Get rights and content
Under a Creative Commons license
open access

Highlights

  • In SLE patients, LV systolic function as measured by LV GLS is significantly impaired.

  • Impaired LV GLS in SLE patients is associated with cardiovascular events.

  • Assessment of LV GLS may significantly improve risk-stratification in SLE patients.

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with potential cardiovascular involvement. The aim of this study was to assess left ventricular (LV) systolic function in a large cohort of patients with SLE using standard echocardiographic measurements and global longitudinal strain (GLS) by two-dimensional speckle-tracking analysis. Furthermore, the association between echocardiographic parameters and the occurrence of cardiovascular events was assessed.

Methods

A total of 102 patients with SLE (88% women; mean age, 43 ± 14 years) undergoing a dedicated multidisciplinary assessment were analyzed, including echocardiography, at the time of their first visit. A control group consisted of 50 age- and sex-matched healthy subjects.

Results

Compared with control subjects, patients with SLE showed impaired LV systolic function on the basis of LV ejection fraction (51 ± 6% vs 62 ± 6%, P < .001) and by LV GLS (−15 ± 3% vs −19 ± 2%, P < .001). During a median follow-up period of 2 years (interquartile range, 1–6 years), 38 patients (37%) developed cardiovascular events. Kaplan-Meier survival curves showed that patients with SLE with more impaired LV GLS (on the basis of the median value of −15%) experienced higher cumulative rates of cardiovascular events compared with those with less impaired LV GLS (χ2 = 8.292, log-rank P = .004). On multivariate Cox regression analysis, LV GLS demonstrated an independent association with cardiovascular events (hazard ratio, 2.171; 95% CI, 1.015–4.642; P = .046), whereas LV ejection fraction was not significantly associated with the outcome.

Conclusions

In patients with SLE, LV systolic function as measured by LV GLS is significantly impaired and associated with cardiovascular events, potentially representing a new tool to improve risk stratification in these patients.

Keywords

Left ventricular function
global longitudinal strain
systemic lupus erythematosus
cardiovascular outcome

Abbreviations

CAD
Coronary artery disease
CVA
Cerebrovascular accident
GLS
Global longitudinal strain
HR
Hazard ratio
LV
Left ventricular
LVEF
Left ventricular ejection fraction
SLE
Systemic lupus erythematosus
SLEDAI
Systemic lupus erythematosus disease activity index
STE
Speckle-tracking echocardiography

Cited by (0)

Dr. Gegenava has received funding from the European Society of Cardiology in the form of a European Society of Cardiology research grant (application number R-2017-028).

The Department of Cardiology at Leiden University Medical Center has received unrestricted research grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare, and Edwards Lifesciences. Dr. Ajmone-Marsan has received speaking fees from Abbott Vascular.

Drs. T. Gegenava and M. Gegenava contributed equally to this work.

Roberto M. Lang, MD, FASE, served as guest editor for this report.

Conflicts of Interest: None.