Diagnostic implication of left atrial stiffness index in patients with SLE with left ventricular diastolic dysfunction

OBJECTIVE: The left atrial stiffness index (LASI) has been proven to be a promising marker for assessing left atrial (LA) and left ventricular diastolic functions. This study aimed to evaluate the implication of LASI in diagnosing left ventricular diastolic dysfunction (LVDD) in patients with SLE. METHODS: 145 patients diagnosed with SLE were enrolled and subdivided into two groups based on the absence of concomitant lupus nephritis (LN). Additionally, a control group comprising 57 healthy volunteers was recruited. Speckle tracking echocardiography (STE) was performed in all participants. Conventional parameters and the LA strains were obtained, and LASI was calculated. RESULTS: (1) Patients with SLE presented significantly increased LA size and reduced function, with a significant increase in LASI, especially in those with concomitant LN. (2) LASI was positively correlated with age, interventricular end-diastolic septal thickness (IVSd) and E/e' (mitral E peak velocity to e' peak velocity) average, and negatively correlated with LA total emptying fraction (LATEF), LA passive emptying fraction (LAPEF), glomerular filtration rate (GFR), LA reservoir strain (LASr) and LA conduit strain (LAScd). Multivariate analysis showed that age, IVSd, maximum LA size and SLE activity index were independent determinants of LASI. (3) LASI demonstrated superior diagnostic performance for LVDD compared with E/e' average, LATEF, LASr and LAScd, with an area under the curve of 0.919. CONCLUSIONS: LASI can effectively reflect changes in LA function in patients with SLE and provide superior diagnostic accuracy compared with other parameters and LA strains for LVDD. Therefore, LASI could be a potential marker for the early detection of LVDD in patients with SLE.