Systemic lupus erythematosus disease activity index is related with increased aortic stiffness and decreased left ventricular longitudinal strain as shown by two-dimensional speckle tracking echocardiography

Abstract

Background: This study aims to investigate whether the degree of stiffness of the aorta is increased and if this has a relationship with left ventricular global peak systolic longitudinal strain and disease activity index in patients with systemic lupus erythematosus. Methods: Forty-three consecutive patients with systemic lupus erythematosus (8 males, 35 females; mean age 42 +/- 12 years; range 29 to 67 years) and 30 control subjects (7 males, 23 females; mean age 42 +/- 15 years; range 20 to 60 years) who were treated in our clinic between February 2014 and April 2014 were enrolled in the study. Aortic pulse wave velocity was measured by the carotid to femoral method. Aortic augmentation index was calculated as the ratio between the augmented pressure and the central pulse pressure. Global peak systolic longitudinal strain was calculated by averaging the strain values of the six segments in the apical four-chamber view. Results: Global peak systolic longitudinal strain value was statistically significantly lower in systemic lupus erythematosus patients than the control group (-19 +/- 3.1 vs. -21 +/- 3.3, p= 0.009, respectively). Left ventricular diastolic function which was assessed by E/e' was higher in patients with systemic lupus erythematosus (13 +/- 4.3 vs. 11 +/- 3.6, p= 0.025). Values of aortic pulse pressure, aortic augmentation, aortic augmentation index, and pulse wave velocity were statistically significantly different between systemic lupus erythematosus patients and control group. Pulse wave velocity was negatively associated with global peak systolic longitudinal strain (beta= -0.35, p= 0.033) and positively correlated with systemic lupus erythematosus disease activity index (r= 0.40, p= 0.006) and E/e' (r= 0.431, p= 0.001). Systemic lupus erythematosus disease activity index was negatively correlated with global peak systolic longitudinal strain (r= -0.45, p= 0.002). Conclusion: This study indicates that disease activity score is significantly associated with aortic stiffness, global peak systolic longitudinal strain, and left ventricular diastolic function in patients with systemic lupus erythematosus. Patients with lower disease activity had lower pulse wave velocity and aortic augmentation, and higher global peak systolic longitudinal strain and E/e'.