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Prognostic value of speckle-tracking imaging score for patients with childhood-onset systemic lupus erythematosus
Xiaoyuan Feng1, Lian Zhou2, Ping Zhou2
1Department of Echocardiography, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
Insights
Three-dimensional speckle tracking imaging (3D-STI) detects subtle cardiac changes in children with childhood-onset systemic lupus erythematosus (cSLE). The developed STIS score shows promise as a prognostic marker for cSLE patients.
Area of Science:
- Cardiology
- Pediatrics
- Rheumatology
Background:
- Childhood-onset systemic lupus erythematosus (cSLE) can cause subclinical cardiac alterations.
- Early detection of cardiac involvement is crucial for managing cSLE.
- Conventional echocardiography may not reveal early cardiac changes in cSLE.
Purpose of the Study:
- To detect subclinical cardiac alterations in children with cSLE using 3D-STI.
- To develop a prognostic score (STIS) for cSLE based on 3D-STI parameters.
- To evaluate the STIS score's ability to predict clinical outcomes in cSLE.
Main Methods:
- 40 cSLE patients and 40 healthy controls underwent 3D-STI.
- LASSO and logistic regression analyses were used to derive the STIS score.
- Primary outcome was clinical remission at 6 months; secondary outcomes included disease activity and nephritis.
Main Results:
- cSLE patients showed lower lateral longitudinal strain in the left ventricle and atrium.
- The STIS score, derived from four 3D-STI parameters, demonstrated high sensitivity (80.0%) and specificity (87.5%) for cSLE.
- The STIS score significantly correlated with clinical outcomes, including remission, even after adjustment for confounders.
Conclusions:
- 3D-STI is a valuable tool for detecting early, otherwise imperceptible cardiac changes in cSLE.
- The STIS score serves as a useful prognostic marker for predicting clinical outcomes in pediatric patients with cSLE.
Background:
This study aimed to detect subclinical cardiac alterations in children with childhood-onset systemic lupus erythematosus (cSLE) using three-dimensional speckle tracking imaging (3D-STI).
Methods:
The study comprised 40 cSLE patients and 40 healthy controls of similar age and sex. All subjects underwent 3D-STI, and LASSO regression and logistic regression analysis were used to generate a score (STIS) based on the 3D-STI parameters for cSLE. The primary outcome was clinical remission within six months of 3D-STI, while secondary outcomes included severe disease activity, lupus nephritis, and hypocomplementemia.
Results:
There was no significant difference in conventional echocardiographic measures between two groups, however, the lateral longitudinal strain of the left ventricular (LV) and left atrial (LA) was lower in the cSLE group. The final STIS score was derived using four parameters: 0.120 × LV end diastolic mass (g) -0.197 × global longitudinal strain (%) - 0.165 x LA reservoir longitudinal strain (%) + 0.139 x LA conduit longitudinal strain (%). The STIS score had a high sensitivity and specificity for cSLE, at 80.0 % and 87.5 %, respectively. During the 6-month follow-up period following the 3D-STI test, 18 patients (45.0 %) achieved clinical remission, and the STIS had a highly significant correlation with all clinical outcomes even after adjusting for confounding variables.
Conclusions:
3D-STI technology may assist with the detection of otherwise imperceptible changes in cardiac function and the STIS score is a useful prognostic marker for cSLE patients.
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