AB0577 LEFT VENTRICULAR DYSSYNCHRONY IN SUBJECTS WITH DIFFERENT SLE PHENOTYPES

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 1486
• Main Authors: Shahab, F., Zachrisson, H., Svensson, C., Aneq, M., Sjöwall, C., Kylhammar, D.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Limited 01.06.2023
• Subjects: Antiphospholipid syndrome; Arteriosclerosis; Autoimmune diseases; Cardiovascular system; Cerebral infarction; Congestive heart failure; Ejection fraction; Fibrosis; Joints; Lupus; Lupus nephritis; Mechanical properties; Myocardial infarction; Nephritis; Phenotypes; Systemic lupus erythematosus; Ventricle
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.2710

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease with highly heterogenous clinical presentation involving, e.g., skin, joints, kidneys and the cardiovascular system. In prospective studies, the incidence rates of myocardial infarction and stroke in patients with SLE have been shown to be high, but more knowledge is needed regarding early myocardial involvement and affection of the right ventricle in different SLE phenotypes.ObjectivesThe aim of the present study was to investigate differences of left- and right ventricular systolic function in three, well-defined SLE phenotypes, i.e. skin- and joint involvement, lupus nephritis antiphospholipid syndrome (APS), respectively.MethodsTransthoracic echocardiograms were performed in 60 subjects with SLE (three age- and sex-matched groups of subjects with either skin- and joint involvement, lupus nephritis or APS, respectively) included in the SLEVASK [1] cohort which represents a subgroup of the regional quality register Clinical Lupus Register in North-Eastern Gothia (Swedish acronym: KLURING). There were 54 women and 6 men, and the median age was 48.5 (range 28-68y) years. Left- and right ventricular dimensions and standard systolic function parameters were measured according to international guidelines. Left and right ventricular longitudinal strain and left ventricular mechanical dispersion, defined as the standard deviation of time to maximal myocardial shortening were measured by a commercially available software. Three subjects with clinically manifest heart failure were excluded.ResultsThere were no significant differences in left- or right ventricular dimensions, left ventricular ejection fraction or measures of right ventricular systolic function between the three groups. Left ventricular global longitudinal strain was reduced in subjects with nephritis (p=0.012), as compared to those with skin- and joint involvement and there was a trend for lower strain also among subjects with APS (p=0.078). Left ventricular mechanical dispersion was increased among subjects with APS (p=0.015) and nephritis (p=0.032), as compared to those with skin- and joint involvement (Table 1).ConclusionReduced left ventricular global longitudinal strain and greater mechanical dispersion, a sign of a more heterogonous contraction, among SLE patients with nephritis and APS indicate more severe cardiac involvement, as compared to those with skin- and joint involvement. A greater degree of mechanical dispersion is thought to reflect myocardial fibrosis and future studies should investigate the pathogenesis of such sub-clinical impairment of cardiac function in SLE and its impact on long-term prognosis.Reference[1]Svensson C, Eriksson P, Zachrisson H, Sjöwall C. High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus. Front Med (Lausanne) 2020;7:581336Table 1.Lupus nephritisAPSJoint- and skin involvementp-valueLVEDDI (mm/m2)26 (25-28)26 (24-27)27 (26-28)p=nsLVEDVI (ml/m2)58 (46-65)53 (55-62)57 (49-67)p=nsLVEF (%)57 (56-59)57 (55-59)58 (56-61)p=nsLV-GLS (%)-20 (-21--18)-20 (-21--19)-21 (-23--20)p=0.030LVMD (ms)38 (31-46)38 (32-50)32 (27-35)p=0.037RVOTD (mm)32 (27-34)31 (27-36)28 (26-31)p=nsRVITD (mm)35 (31-36)36 (31-38)33 (31-37)p=nsTAPSE (mm)23 (20-25)22 (20-25)22 (21-25)p=nsRV s’ (cm/s)13 (11-16)13 (11-15)15 (12-16)p=nsRV-GLS (%)-22 (-24--20)-21 (-23--19)-23 (-24--21)p=nsRV-FWS (%)-26 (-27--24)-25 (-27--23)-26 (-30--24)p=nsValues are median with interquartile range (IQR). Abbreviations: LVEDDI = left ventricular end-diastolic diameter index; LVEDVI = left ventricular end-diastolic volume index; LVEF = left ventricular ejection fraction; LV-GLS = left ventricular global longitudinal stain; LVMD = left ventricular mechanical dispersion; ns = not significant; RVOT = Right ventricular outflow tract diameter; RVITD = Right ventricular inflow tract diameter; TAPSE = tricuspid annular plane systolicAcknowledgements:NIL.Disclosure of InterestsNone Declared.