385 Patients with Systemic Lupus Erythematosus With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain

Abstract

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease modulated by pro-inflammatory cytokines. This state results in a negative inotropic effect on cardiac myocytes and may result in myocardial dysfunction. Mean global longitudinal strain (GLS) is proposed to be a more sensitive measure of cardiac function compared to standard two-dimensional measures of left ventricular (LV) systolic function. We hypothesize SLE patients have subclinical cardiac dysfunction despite normal LV ejection fraction (LVEF) reflected by reduced mean LV-GLS. Consecutive patients (n=103) admitted to our hospital (2013-2018) with a past medical history of SLE were initially evaluated. Patients without a comprehensive transthoracic echocardiogram and those with cardiac disease or impaired LVEF <50% were excluded (n=52). A range of clinical and echocardiographic parameters, including mean LV-GLS, were examined in this cohort (n=51) and compared to age- and gender-matched controls (n=51). GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6). There was no significant difference in baseline clinical characteristics and cardiovascular risk factor profiles between groups. Patients with SLE showed greater LV remodelling through a higher indexed LV Mass (g) (96±34 vs 72±20, p=0.01). Additionally, SLE patients had significantly lower GLS (%) (-16.7±2.8) when compared to healthy controls (-21.3±2) (p<0.0001) despite normal LVEF in both groups. Our results suggest that SLE patients show evidence of subclinical cardiac dysfunction, despite a normal LVEF and absence of cardiac disease. These patients may benefit from routine echocardiographic assessments and early cardiac preventative interventions.