ASSESSMENT OF MYOCARDIAL FIBROSIS USING ADVANCED ECHOCARDIOGRAPHY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A PILOT STUDY
- Alessandro Giollo (Italy)
Abstract
Background and Aims
The aim of this study was to examine whether speckle tracking echocardiography (STE) and scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) may detect the presence of subclinical myocardial involvement in patients with SLE.
Methods
We consecutively recruited 29 SLE patients (M/F=3/26; age 45±11 years; disease duration 15±10 years; median [IQR] SLEDAI 2 [0-6]) and 32 controls comparable for age, sex, and cardiovascular risk factors. Patients with current cardiac symptoms or prior history of any heart disease were excluded. All participants underwent a complete echocardiography examination including STE and eSCAR.
Results
Global longitudinal strain (GLS) was significantly lower in most myocardial segments in SLE patients than in control subjects, except for the myocardial apical region that was comparable between the two groups. Higher SLEDAI was associated with an impaired GLS-4 chamber (r=0.415, p=0.02). A higher daily dosage of prednisone was also associated with an impaired GLS in the infero-septal myocardial segment (r=0.482, p=0.008). Myocardial scar by eSCAR was observed in 5 (17%) out of 29 SLE patients, mainly in the inferoseptal myocardial segment. A significant association was found between the infero-septal GLS and the presence of scar by eSCAR technique (r=0.662 p<0.001; Figure).
Conclusions
Advanced echocardiography techniques detected the presence of a subclinical myocardial dysfunction in SLE patients with no history of cardiac disease compared to controls. An ‘apical sparing’ GLS pattern was also observed in SLE patients. In about one-fifth of these SLE patients, a myocardial scar by eSCAR technique was also identified, mainly in the infero-septal segments.