EARLY DETECTION AND ASSESSMENT OF LEFT VENTRICLE DYSFUNCTION IN SYSTEMIC LUPUS ERYTHROMATUS BY DIFFERENT PARAMETERS OF ECHOCARDIOGRAPHY IN BAGHDAD TEACHING HOSPITAL

Abstract

Background: Systemic lupus erythematosus is a severe autoimmune disease which demonstrates variations in incidence, prevalence, disease activity, and prognosis and might affect all body systems. In the circulatory system, the SLE causes myocarditis, pericarditis, endocarditis, valvular lesions, and defects in the conduction system of the heart. Pericarditis is the most commonly recognized cardiac problem in SLE, which is reported in 60% of patients. The most frequent Echocardiographic lesions in SLE patients were valve regurgitations, and might be associated with disease severity and activity. Myocardial dysfunction in SLE is usually multifactorial and may result from immunological injury, ischemia, valvular diseases, or co-existent problems such as HTN.

Objectives: The study aimed to assess the echocardiographic changes in SLE patients, to study the relation of the echocardiographic changes to the disease activity, and to correlate subclinical echocardiographic features of LVD with the clinical, laboratory, and therapeutic profiles of the patients.

Methods: A cross-sectional study was conducted in the Echocardiography Department of Baghdad Teaching Hospital, Baghdad Medical City complex, Baghdad, Iraq. This study included 45 SLE female patients; they enrolled from April 2019 to April 2020. The following Echocardiography parameters of diastole function were studied: E/A ratio, tissue Doppler images (TDI), peak systole velocity (S”), E/e” ratio, and E’ septal, and E’ lateral of early diastole velocity. LVEF was measured by the modified Simpson method. The disease duration and age at first diagnosis were recorded. Laboratory tests workup included complete blood picture (CBC), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and anti-ds DNA.

Results: The most distributed female age group studied was belonged to 31-40 years as (40% of the sample). The mean age was 32.58±10.14 years. The mean BSA= 1.75±0.18m2, overweight was reported in 44.4% of women. Arthritis was found in 82.2% of patients, whereas nephritis was found in 37.8% of patients. Most of the patients received anti-SLE drugs between 1-10 years duration (60%) of them. The hydroxychloroquine (Q) plus corticosteroid were the most drugs used in the treatment of SLE. The LVDD abnormal parameters were: E/A ratio presented in 24.4%, Abnormal S’ was figured in 46.7%, abnormal E/e’ was figured in 8.9%. The E’ septal was abnormal in 31.1%. The E’ lateral was abnormal in 40%. Regarding LA size, LAVI was abnormal in 20.9%. Elevated SPAP was found in 17.8%. The mean PAP was high in 51.1%. The Acceleration time (AT) was abnormal in 33.3%. The LVEF was abnormal in 11.1% of patients; the mean was 59.55±5.35. Left ventricular diastolic dysfunction (LVDD) was found in 18 patients (40%) of the sample studied. LVDD grade I was figured in 24.4%, while grade II was figured in 15.6%.

Conclusions: The SLE patients, increasing age, obese, and females, were more susceptible to the development of LVDD during their life. SLE-arthritis can affected TDI (S’, and E/e’) and LAVI, whereas SLE-nephritis affected more parameters than arthritis which E/A ratio, S’, E/e’ ratio, LAVI, and SPAP. The E’ septal and E’ lateral were mostly parameters affected. The hydroxychloroquine (Q) plus corticosteroid were the most drugs used in the treatment of SLE. Nearly most abnormalities of parameters have a crossing relationship with patients’ demographic features and with SLE characteristics. Women with long or chronic history of SLE have more susceptible to echocardiographic abnormalities.