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Cardiac involvement in systemic lupus erythematosus: Interest of 2D global longitudinal strain
Sana Chourabi1, Sameh Sayhi1, Selim Ben Ameur1
1Department of Internal Medicine, HMPIT, Tunis, Tunisia.
Insights
Systemic lupus erythematosus (SLE) frequently causes cardiac issues, often without symptoms. Advanced ultrasound techniques like 2D Global Longitudinal Strain (GLS) are crucial for early detection and management of lupus heart disease.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with frequent cardiac involvement, a leading cause of mortality.
- New ultrasound techniques, including transthoracic ultrasound (TTE) with strain evaluation, show promise for detecting cardiac issues in SLE patients.
- Early detection of cardiac involvement in SLE is critical for patient management and outcomes.
Purpose of the Study:
- To determine the frequency and characteristics of cardiac abnormalities in SLE patients using ultrasound.
- To evaluate the benefit of transthoracic ultrasound (TTE) with Global Longitudinal Strain (GLS) for early diagnosis and management of cardiac involvement in SLE.
- To compare ultrasound findings between SLE patients with and without cardiac disease.
Main Methods:
- An observational study conducted over six months involving SLE patients from internal medicine and cardiology departments.
- Cardiac involvement was assessed using transthoracic ultrasound (TTE) combined with 2D-strain imaging.
- Patients were divided into two groups: those with diagnosed heart disease and those without.
Main Results:
- Cardiac manifestations were present in 60% of the 40 SLE patients studied.
- Patients with cardiac involvement more frequently reported dyspnea (67%), pericarditis (37%), and chest pain (25%).
- While left ventricular ejection fraction (LVEF) showed no significant difference, Global Longitudinal Strain (GLS) was significantly altered in patients with cardiac involvement (p=0.01), with a higher frequency of pathological GLS (p<0.01).
Conclusions:
- Cardiac involvement is a common, often asymptomatic complication of SLE.
- Systematic screening for cardiac impairment using advanced echocardiography, specifically 2D GLS, is essential for timely intervention in SLE patients.
- 2D GLS represents a valuable tool for the early detection and management of cardiac complications in systemic lupus erythematosus.
Background:
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease of undetermined etiology. Cardiac involvement is common in SLE and constitutes one of the main causes of mortality. More recently, new ultrasound imaging techniques, such as transthoracic ultrasound (TTE) with strain evaluation, have appeared and seem promising for the detection of cardiac involvement. The objective of our work was to study the frequency and characteristics of ultrasound abnormalities found in lupus patients and to study the benefit of ultrasound with global longitudinal strain (GLS) for early management.
Methods:
It was an observational study of patients followed for SLE at the internal medicine and cardiology department of the HMPIT for 6 months (May-November 2023). The definition of cardiac involvement was by ultrasound. All patients benefited from TTE coupled with 2D-strain. We divided the workforce into two groups: the first group (patients with heart disease) and the second group (patients without heart disease).
Results:
In a series of 40 lupus patients including 33 women and seven men, cardiac manifestations were reported in 60% of patients. In the first group, 29% had palpitations, 25% had chest pain, 67% had dyspnea, 37% had pericarditis, 8% had pulmonary arterial hypertension (PAH) and 12% had myocarditis. The comparative study showed that patients in the first group presented significantly more frequently with dyspnea (p = 0.02), chest pain (p = 0.03) and serositis (p = 0.01) compared to those in the second group. The mean left ventricular ejection fraction (LVEF) did not show a significant difference between the two groups. On the other hand, the average Global Longitudinal Strain (GLS) was significantly altered in the first group (p = 0.01). Furthermore, the frequency of pathological GLS was significantly higher in patients with lupus heart disease (p < 0.01).
Conclusion:
Cardiac involvement during SLE is a frequent and most often asymptomatic complication. A systematic search for this impairment using a high-performance echocardiography examination, namely the 2D GLS, is essential for early treatment.
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