Objective : Systemic lupus erythematosus (SLE) can present limitations in exercise capacity and quality of life (QoL) due to various clinical conditions such as, pulmonary disease or heart disease. Tissue Doppler echocardiography (TDE) offers the promise of an objective measure to quantify regional and global ventricular function through the assessment of myocardial velocity data. Objective: This study aimed to assess the intensity of left ventricular (LV) and right ventricular (RV) systolic and diastolic dysfunction in SLE patients by means of TDE and cardiopulmonary exercise (CPX) testing to determine their impact on QoL. Materials and method: 56 SLE patients within two tertiary healthcare centers as well as 50 healthy controls were examined with TDE after exclusion of cardiovascular risk factors. TDE was performed for maximal systolic (S), early diastolic (E`) & late diastolic (A`) velocities of mitral and tricuspid annulus. Pulsed wave (PW) Doppler of mitral & tricuspid valves inflow was done in addition to estimation of left ventricle ejection fraction & assessment of right ventricle systolic function by TAPSE. Disease activity was assessed by Systemic Lupus Activity Measure (SLAM) and Damage Index was assessed by Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cardiopulmonary (CPX) test according to the modified Bruce protocol were performed. Results: SLE patients in both subgroups had more or less similar laboratory data and statistically higher values of ESR, CRP and anticardiolipin (aCL) antibodies compared to controls. LV function showed statistically insignificant EF compared to controls being lower in patients group. E`&A` of mitral annulus are lower in patients group compared to control by TDI. Concerning RV, tricuspid annular plane systolic excursion (TAPSE) was statistically lower than the controls and there was a statistical difference between SLE group Ia and Ib ,also S wave is lower in group Ib compared to group Ia . There was RV diastolic dysfunction in the form of lower E`& A` values compared to control especially in the medial annulus of the tricuspid valve. Higher A wave velocity with PWD of mitral & tricuspid inflow in patients compared to control group. Conclusion: SLE patients have an increased prevalence of subclinical systolic & diastolic LV and RV dysfunction. This results advocates for regular follow up and early screening of SLE patients. Accordingly, treatment focused on improving diastolic heart function may have a possible role in enhancing the quality of life and improving prognosis of SLE patients. |
