Abstract 14734: Characterisation and Prognostic Relevance of Left Ventricular Global Longitudinal Strain in Patients With Systemic Lupus Erythematosus

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease modulated by pro-inflammatory cytokines, which may result in myocardial dysfunction. Mean global longitudinal strain (GLS) is proposed to be a more sensitive measure of cardiac function in comparison to standard two-dimensional measures of left ventricular (LV) systolic function. Quantification of subclinical cardiac function, with impairment of LV-GLS, right ventricular free wall strain (RV-FWS), left atrial strain (LAs), and its prognostic relevance in patients with SLE is undefined. Hypothesis: SLE patients have evidence of subclinical cardiac dysfunction and the presence of impaired LV-GLS in this population portends a poor prognosis. Methods: Consecutive patients admitted to our institution with known history of SLE (> 1-year disease activity) were examined. Patients with pre-existing cardiac disease, LV ejection fraction (EF) <50% and those without comprehensive transthoracic echocardiograms were excluded. Mean GLS was performed offline using vendor-independent software (TomTec v4.6) and compared to age-, gender- and risk factor- matched controls. SLE patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events. Results: A total of 51 patients with SLE were compared to 51 matched controls. No significant differences in baseline demographics, medications and laboratory investigations was observed. Patients with SLE showed evidence of subclinical cardiac dysfunction with significantly lower LV-GLS (%) (-16.7±2.8 vs -21.3±2, p<0.01), lower RV FWS (%) (-21.2±4.8 vs -28.8±4.7, p<0.01) and LAs (%) (31.9±6.7 vs 35.5±6.1, p<0.01) when compared to controls, despite normal LVEF, RV FAC and LAEF. On analysis of outcomes of SLE patients, a total of 11 (21.6%) patients suffered the composite end-point during a mean follow-up of 48 months. Of interest, LV-GLS was a predictor of the composite outcome on log-rank test and cox regression analysis (p<0.01). Conclusions: Our results suggest that SLE patients display evidence of subclinical cardiac dysfunction via a reduction in LV GLS, RV-FWS and LAs. Impairment in LV-GLS is associated with adverse cardiovascular outcomes in this population.