Echocardiographic strain analysis reflects impaired ventricular function in youth with pediatric‐onset systemic lupus erythematosus
Background Strain analysis with speckle‐tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric‐onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with p...
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| Published in | Echocardiography (Mount Kisco, N.Y.) Vol. 37; no. 12; pp. 2082 - 2090 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
01.12.2020
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| Subjects | |
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| Abstract | Background
Strain analysis with speckle‐tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric‐onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with pSLE to controls, and assessed the relationship between strain, disease activity, and other noninvasive measures of cardiovascular health.
Methods
Twenty pSLE subjects ages 9–21 underwent comprehensive cardiovascular testing, including 2D speckle‐tracking echocardiography, ambulatory blood pressure monitoring (ABPM), peripheral endothelial function testing, pulse wave velocity and analysis, and carotid ultrasound. Longitudinal apical‐4 chamber (LSA4C) and midpoint circumferential strain (CSmid) were compared to that of 70 healthy controls using multivariable linear regression. Among pSLE subjects, Pearson correlation coefficients were calculated to evaluate relationships between global longitudinal or circumferential strain and other measures of cardiovascular health.
Results
Average SLE disease duration was 3.2 years (standard deviation [SD] 2.1). 2/20 pSLE subjects had persistent disease activity, and only one met criteria for hypertension by ABPM. LSA4C was significantly reduced in pSLE subjects compared to controls (mean −18.3 [SD 3.2] vs −21.8% [SD 2.2], P‐value <.001). There was no significant difference in CSmid (−24.8 [SD 3.7] vs −25.7% [SD 3.4], P = .29). Among pSLE subjects, decreased nocturnal blood pressure dipping on ABPM was associated with reduced global circumferential strain (r −0.59, P = .01).
Conclusions
Longitudinal myocardial deformation is impaired in pSLE patients despite clinical remission and may represent early myocardial damage. Strain analysis should be considered in addition to standard echocardiographic assessment during follow‐up of patients with pSLE. |
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| AbstractList | BACKGROUNDStrain analysis with speckle-tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric-onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with pSLE to controls, and assessed the relationship between strain, disease activity, and other noninvasive measures of cardiovascular health. METHODSTwenty pSLE subjects ages 9-21 underwent comprehensive cardiovascular testing, including 2D speckle-tracking echocardiography, ambulatory blood pressure monitoring (ABPM), peripheral endothelial function testing, pulse wave velocity and analysis, and carotid ultrasound. Longitudinal apical-4 chamber (LSA4C ) and midpoint circumferential strain (CSmid ) were compared to that of 70 healthy controls using multivariable linear regression. Among pSLE subjects, Pearson correlation coefficients were calculated to evaluate relationships between global longitudinal or circumferential strain and other measures of cardiovascular health. RESULTSAverage SLE disease duration was 3.2 years (standard deviation [SD] 2.1). 2/20 pSLE subjects had persistent disease activity, and only one met criteria for hypertension by ABPM. LSA4C was significantly reduced in pSLE subjects compared to controls (mean -18.3 [SD 3.2] vs -21.8% [SD 2.2], P-value <.001). There was no significant difference in CSmid (-24.8 [SD 3.7] vs -25.7% [SD 3.4], P = .29). Among pSLE subjects, decreased nocturnal blood pressure dipping on ABPM was associated with reduced global circumferential strain (r -0.59, P = .01). CONCLUSIONSLongitudinal myocardial deformation is impaired in pSLE patients despite clinical remission and may represent early myocardial damage. Strain analysis should be considered in addition to standard echocardiographic assessment during follow-up of patients with pSLE. Background Strain analysis with speckle‐tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric‐onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with pSLE to controls, and assessed the relationship between strain, disease activity, and other noninvasive measures of cardiovascular health. Methods Twenty pSLE subjects ages 9–21 underwent comprehensive cardiovascular testing, including 2D speckle‐tracking echocardiography, ambulatory blood pressure monitoring (ABPM), peripheral endothelial function testing, pulse wave velocity and analysis, and carotid ultrasound. Longitudinal apical‐4 chamber (LSA4C) and midpoint circumferential strain (CSmid) were compared to that of 70 healthy controls using multivariable linear regression. Among pSLE subjects, Pearson correlation coefficients were calculated to evaluate relationships between global longitudinal or circumferential strain and other measures of cardiovascular health. Results Average SLE disease duration was 3.2 years (standard deviation [SD] 2.1). 2/20 pSLE subjects had persistent disease activity, and only one met criteria for hypertension by ABPM. LSA4C was significantly reduced in pSLE subjects compared to controls (mean −18.3 [SD 3.2] vs −21.8% [SD 2.2], P‐value <.001). There was no significant difference in CSmid (−24.8 [SD 3.7] vs −25.7% [SD 3.4], P = .29). Among pSLE subjects, decreased nocturnal blood pressure dipping on ABPM was associated with reduced global circumferential strain (r −0.59, P = .01). Conclusions Longitudinal myocardial deformation is impaired in pSLE patients despite clinical remission and may represent early myocardial damage. Strain analysis should be considered in addition to standard echocardiographic assessment during follow‐up of patients with pSLE. Strain analysis with speckle-tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric-onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with pSLE to controls, and assessed the relationship between strain, disease activity, and other noninvasive measures of cardiovascular health. Twenty pSLE subjects ages 9-21 underwent comprehensive cardiovascular testing, including 2D speckle-tracking echocardiography, ambulatory blood pressure monitoring (ABPM), peripheral endothelial function testing, pulse wave velocity and analysis, and carotid ultrasound. Longitudinal apical-4 chamber (LS ) and midpoint circumferential strain (CS ) were compared to that of 70 healthy controls using multivariable linear regression. Among pSLE subjects, Pearson correlation coefficients were calculated to evaluate relationships between global longitudinal or circumferential strain and other measures of cardiovascular health. Average SLE disease duration was 3.2 years (standard deviation [SD] 2.1). 2/20 pSLE subjects had persistent disease activity, and only one met criteria for hypertension by ABPM. LS was significantly reduced in pSLE subjects compared to controls (mean -18.3 [SD 3.2] vs -21.8% [SD 2.2], P-value <.001). There was no significant difference in CS (-24.8 [SD 3.7] vs -25.7% [SD 3.4], P = .29). Among pSLE subjects, decreased nocturnal blood pressure dipping on ABPM was associated with reduced global circumferential strain (r -0.59, P = .01). Longitudinal myocardial deformation is impaired in pSLE patients despite clinical remission and may represent early myocardial damage. Strain analysis should be considered in addition to standard echocardiographic assessment during follow-up of patients with pSLE. Abstract Background Strain analysis with speckle‐tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric‐onset systemic lupus erythematosus (pSLE). We compared left ventricular (LV) systolic deformation (measured by strain) in children and adolescents with pSLE to controls, and assessed the relationship between strain, disease activity, and other noninvasive measures of cardiovascular health. Methods Twenty pSLE subjects ages 9–21 underwent comprehensive cardiovascular testing, including 2D speckle‐tracking echocardiography, ambulatory blood pressure monitoring (ABPM), peripheral endothelial function testing, pulse wave velocity and analysis, and carotid ultrasound. Longitudinal apical‐4 chamber (LS A4C ) and midpoint circumferential strain (CS mid ) were compared to that of 70 healthy controls using multivariable linear regression. Among pSLE subjects, Pearson correlation coefficients were calculated to evaluate relationships between global longitudinal or circumferential strain and other measures of cardiovascular health. Results Average SLE disease duration was 3.2 years (standard deviation [SD] 2.1). 2/20 pSLE subjects had persistent disease activity, and only one met criteria for hypertension by ABPM. LS A4C was significantly reduced in pSLE subjects compared to controls (mean −18.3 [SD 3.2] vs −21.8% [SD 2.2], P ‐value <.001). There was no significant difference in CS mid (−24.8 [SD 3.7] vs −25.7% [SD 3.4], P = .29). Among pSLE subjects, decreased nocturnal blood pressure dipping on ABPM was associated with reduced global circumferential strain ( r −0.59, P = .01). Conclusions Longitudinal myocardial deformation is impaired in pSLE patients despite clinical remission and may represent early myocardial damage. Strain analysis should be considered in addition to standard echocardiographic assessment during follow‐up of patients with pSLE. |
| Author | Xiao, Rui Mercer‐Rosa, Laura Chang, Joyce C. Tinker, Craig Natarajan, Shobha S. Fedec, Anysia Meyers, Kevin E. Knight, Andrea M. Wang, Yan Weiss, Pamela F. |
| AuthorAffiliation | 2 Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146, United States 4 Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States 9 Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada 1 Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States 10 Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA 19146, United States 5 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States 7 Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada 6 Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States 8 SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada 3 Department of Pediatrics, Universi |
| AuthorAffiliation_xml | – name: 1 Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States – name: 2 Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146, United States – name: 6 Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States – name: 10 Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA 19146, United States – name: 3 Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States – name: 4 Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States – name: 5 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States – name: 7 Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada – name: 8 SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada – name: 9 Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada |
| Author_xml | – sequence: 1 givenname: Joyce C. orcidid: 0000-0002-1691-4814 surname: Chang fullname: Chang, Joyce C. email: changj2@email.chop.edu organization: University of Pennsylvania Perelman School of Medicine – sequence: 2 givenname: Yan surname: Wang fullname: Wang, Yan organization: Children's Hospital of Philadelphia – sequence: 3 givenname: Rui surname: Xiao fullname: Xiao, Rui organization: University of Pennsylvania Perelman School of Medicine – sequence: 4 givenname: Anysia surname: Fedec fullname: Fedec, Anysia organization: Children's Hospital of Philadelphia – sequence: 5 givenname: Kevin E. surname: Meyers fullname: Meyers, Kevin E. organization: Children's Hospital of Philadelphia – sequence: 6 givenname: Craig surname: Tinker fullname: Tinker, Craig organization: Children's Hospital of Philadelphia – sequence: 7 givenname: Shobha S. surname: Natarajan fullname: Natarajan, Shobha S. organization: Children's Hospital of Philadelphia – sequence: 8 givenname: Andrea M. surname: Knight fullname: Knight, Andrea M. organization: University of Toronto – sequence: 9 givenname: Pamela F. surname: Weiss fullname: Weiss, Pamela F. organization: University of Pennsylvania – sequence: 10 givenname: Laura surname: Mercer‐Rosa fullname: Mercer‐Rosa, Laura organization: Children's Hospital of Philadelphia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33009676$$D View this record in MEDLINE/PubMed |
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| Keywords | myocardial strain systemic lupus erythematosus left ventricular dysfunction speckle-tracking echocardiography pediatrics |
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| Notes | Funding information This work was supported by the Lupus Foundation of America Gary S. Gilkeson Career Development Award (JCC), the National Institutes of Health F32‐HL142176 (JCC), and by Grant Number UL1TR001878 from the National Center for Advancing Translational Sciences, NIH. Support for LMR from NIH K01‐HL125521 and PHA supplement to K01‐HL125521 (LMR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the LFA or the NIH. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Author Contributions: JCC, LMR, AMK, KEM and PFW contributed to the study conception and design. JCC, YW, AF, and KEM performed the data collection. JCC, RX, and LMR performed the data analysis, and JCC drafted the manuscript. All authors critically revised the manuscript and approved the final version. |
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Strain analysis with speckle‐tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric‐onset... Strain analysis with speckle-tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric-onset systemic lupus... Abstract Background Strain analysis with speckle‐tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in... BACKGROUNDStrain analysis with speckle-tracking echocardiography shows promise as a screening tool for silent myocardial dysfunction in pediatric-onset... |
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| SubjectTerms | echocardiography left ventricular dysfunction myocardial strain pediatrics speckle‐tracking systemic lupus erythematosus |
| Title | Echocardiographic strain analysis reflects impaired ventricular function in youth with pediatric‐onset systemic lupus erythematosus |
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