Early assessment of subclinical myocardial injury in systemic lupus erythematosus by two-dimensional longitudinal layer speckle tracking imaging

Reduced Left Ventricular Function on Cardiac MRI in SLE Patients Correlates with Measures of SLE Disease Activity and Inflammation

Background

Women with SLE have an elevated risk of CVD morbidity and mortality and frequently report chest pain in the absence of obstructive CAD. Echocardiographic studies often demonstrate reduced LV function, correlating with higher disease activity. We used cardiac MRI (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers and cardiac function in female SLE patients.

Methods

Women with SLE reporting chest pain with no obstructive CAD (n=13) and reference controls (n=22) were evaluated using stress-rest cMRI to measure LV structure, function, tissue characteristics, and myocardial perfusion reserve index (MPRI). Coronary microvascular dysfunction (CMD) was defined as MPRI <1.84. Serum samples were analyzed for inflammatory markers. Relationships between clinical and cMRI values of SLE subjects were assessed, and groups were compared.

Results

40% of SLE subjects had MPRI < 1.84 on cMRI. Compared to controls, SLE subjects had higher LV volumes and mass and lower LV systolic function. SLICC DI was related to worse cardiac function and higher T1. CRP was related to higher cardiac output and a trend to better systolic function, while ESR and fasting insulin were related to lower LV mass. Lower fasting insulin levels correlated with increased ECV.

Conclusions

Among our female SLE cohort, 40% had CMD, and SLICC DI correlated with worse cardiac function and diffuse fibrosis. Higher inflammatory markers and low insulin levels may associate with LV dysfunction. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE patients.

Three-dimensional echocardiography and strain cardiac imaging in patients with prediabetes and type 2 diabetes mellitus

Background

Several studies using two-dimensional speckle tracking echocardiography (2D-STE) have confirmed the presence of left ventricular (LV) systolic dysfunction in patients with diabetes mellitus (DM), but there is a paucity of studies on whether three-dimensional (3D)-STE is superior to 2D-STE. The aim of this study was to evaluate the clinical value of 3D-STE in assessing subclinical LV systolic dysfunction in prediabetic and diabetic patients with preserved LV ejection fraction (LVEF) and to investigate the independent risk factors for this medical disorder.

Methods

This study included 40 diabetic patients, 35 prediabetic patients, and 33 healthy volunteers. All participants underwent LV peak systolic strain analysis using 3D- and 2D-STE, and the receiver operating characteristic (ROC) curve was constructed to determine the clinical diagnostic value of strain parameters for evaluating subclinical LV dysfunction in patients with prediabetes and type 2 DM (T2DM). Regression models were established to analyze independent risk factors for subclinical LV systolic dysfunction in patients with prediabetes and diabetes.

Results

The results of the 3D-STE-based analysis showed that the global longitudinal strain (GLS) of the control, prediabetic, and diabetic groups were (18.64%±2.43%, 15.21%±1.49%, and 13.49%±2.36%, respectively), global circumferential strain (GCS) was (18.09%±2.37%, 14.62%±1.75%, and 12.95%±2.20%, respectively), global area strain (GAS) was (31.30%±3.88%, 27.51%±3.31%, and 24.80%±3.86%, respectively), and global radial strain (GRS) was (49.18%±5.91%, 39.17%±4.55%, and 35.72%±7.19%, respectively). All 3D-STE global strain parameters gradually decreased from the controls, through the prediabetic group to the diabetic group, and there was statistical significance between the three groups (P<0.001). The area under the curve (AUC) of the 3D-STE global strain parameters (GLS, GCS, GAS, and GRS) were 0.898, 0.831, 0.863, and 0.868, respectively. The AUC of the 2D-STE global strain parameters (GLS and GCS) were 0.867 and 0.636, respectively. Multivariate regression analysis identified increased glycosylated hemoglobin A1c (HbA1c) and body mass index (BMI) as independent risk factors for subclinical LV systolic dysfunction.

Conclusions

Prediabetic and diabetic patients with preserved LVEF are at risk of subclinical LV systolic dysfunction. 3D-STE is a reliable imaging technique for evaluating early damage to LV myocardial mechanics. Early control of blood glucose (Glu) levels and weight can effectively prevent heart failure in the prediabetic and diabetic populations.

Reduced left ventricular function on cardiac MRI of SLE patients correlates with measures of disease activity and inflammation

Background

Women with SLE have an elevated risk of cardiovascular disease. Many women with SLE frequently report chest pain in the absence of obstructive coronary artery disease (CAD) due to coronary microvascular dysfunction (CMD), a form of ischemia with no obstructive CAD. Echocardiographic studies have shown that SLE patients have reduced left ventricular (LV) function, which may also correlate with higher SLE disease activity scores. As such, we used cardiac magnetic resonance imaging (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers, and cardiac function in female SLE patients.

Methods

We performed stress cMRI in women with SLE and chest pain with no obstructive CAD (n=13, all met ACR 1997 criteria,) and reference controls (n=22) using our published protocol. We evaluated LV function, tissue characterization (T1 mapping, ECV), and delayed enhancement, using CV142 software (Circle Cardiovascular Imaging Inc, Calgary, AB, Canada). Myocardial perfusion reserve index (MPRI) was calculated using our published protocol. SLEDAI and SLICC Damage Index (DI) were calculated per validated criteria. Serum samples were analyzed for inflammatory markers and autoantibodies. Wilcoxon rank-sum test was performed on clinical values with CMD and no CMD SLE subjects, and on cMRI values with all SLE subjects and controls. Correlation analysis was done on clinical values, and cMRI values on all SLE subjects.

Results

Overall, 40% of SLE subjects had MPRI values < 1.84, consistent with CMD. Compared to controls, SLE subjects had significantly lower LVEF, and higher LVESVi and LVMi. Corresponding to this, radial, longitudinal, and circumferential strain were significantly lower in the SLE subjects. In correlation analysis of serum inflammatory biomarkers to cMRI values in the SLE subjects, SLICC DI was related to worse cardiac function (lower radial, circumferential and longitudinal strain) and higher T1 time. Additionally, fasting insulin and ESR were negatively correlated with LVMi. Fasting insulin also negatively correlated with ECV. CRP had a positive association with LVESV index and CI and a negative association with longitudinal strain.

Conclusions

Among women with SLE with chest pain and no obstructive CAD, 40% have CMD. While evaluations of known inflammatory markers (such as CRP and ESR) predictably correlated with decreased cardiac function, our study found that decreased fasting insulin levels as a novel marker of diminished LV function. In addition, low insulin levels were observed to correlate with increased LVMi and ECV, suggesting a cardioprotective effect of insulin in SLE patients. We also noted that SLICC DI, an assessment of SLE damage, correlates with cardiac dysfunction in SLE. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE, particularly in patients with high SLICC DI, ESR and CRP and low fasting insulin levels.