Three-Dimensional (3D) Speckle Tracking Echocardiography for Evaluation of ventricular function in Patients with Systemic Lupus Erythematosus: Relationship between Duration of Lupus Erythematosus and Left Ventricular Dysfunction by Using Global Longitudinal Strain

Background: Cardiovascular diseases are leading causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cardiac involvement in SLE can often go undetected. Three-dimensional (3D) speckle tracking echocardiography (STE) is a noninvasive imaging technique that can assess the function of the heart’s ventricles in an accurate and reproducible way. This makes it an attractive option for detecting early signs of heart disease in SLE patients. By identifying these subclinical cardiac abnormalities, 3D-STE may help reduce the negative impact of cardiovascular diseases in SLE population. Methods: This cross-sectional study was undertaken to compare the left ventricular (LV) function between patients with SLE compared to age- and gender-matched controls using Two-dimensional (2D) and 3D-STE. A total of 52 SLE patients and 53 controls without any known cardiovascular events were included in the study. Patients’ past medical and drug history were collected through evaluating medical records and questionnaires. 2D and 3D-STE measured various left ventricular parameters. Results: The current study found no significant differences in left ventricle ejection fraction, left ventricle end-diastolic volume, left ventricle end-systolic volume, left ventricle end-diastolic mass, and left ventricle end-systolic mass between the two groups. However, the SLE group exhibited a a significantly lower global longitudinal strain (GLS) compared to the control groupaccording to all types of echocardiographic assessments, including 3D and 2D long-axis strain (LAX), apical 2-chamber (A2C), and apical 4-chamber (A4C) assessments (all P-values<0.05). Furthermore, a good inter- intra-rater reliability was observed regarding the GLS measurement with 3D-STE. Additionally, the study identified a significant correlation between GLS and SLE duration (r (50) = 0.46, P= 0.04). The use of prednisolone and nephrology disorders were also found to impact GLS measurements. Conclusion: Despite a normal LVEF in patients with SLE, GLS measuemetns indicated that LV systolic dysfunction was observed more frequently in SLE patients compared to their healthy counterparts. Therefore, advanced 3D-STE techniques may be useful in identifying subtle abnormalities in LV function in SLE patients.