ABC | Volume 111, Nº1, July 2018

Original Article Early Assessment of Right Ventricular Function in Systemic Lupus Erythematosus Patients using Strain and Strain Rate Imaging Runlan Luo, Hongyan Cui, Dongmei Huang, Lihua Sun, Shengda Song, Mengyao Sun, Guangsen Li Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical, Dalian, Liaoning – China Mailing Address: Guangsen Li • Department of Ultrasound, the sencond Affiliated Hospital of Dalian Medical University. 116027, Dalian, Liaoning – China E-mail: liguangsen009@163.com Manuscript received July 11, 2017, revised manuscript March 07, 2018, accepted March 07, 2018 DOI: 10.5935/abc.20180091 Abstract Background: Right ventricular function is a crucial factor of the prognosis of systemic lupus erythematosus (SLE). Objectives: To evaluate the right ventricular function in SLE patients with different degrees of pulmonary hypertension (PH) by strain and strain rate imaging. Methods: A total of 102 SLE patients and 30 healthy volunteers were studied between October 2015 and May 2016. Patients were divided into three groups according to pulmonary artery systolic pressure (PASP) estimated by echocardiography: group control (A); PASP ≤ 30 mmHg (group B, n = 37); PASP 30-50 mmHg (mild PH; group C, n = 34); and PASP ≥ 50 mmHg (moderate-to-severe PH; group D, n = 31). Longitudinal peak systolic strain ( ε ) and strain rate (SR), including systolic strain rate (SRs), early diastolic strain rate (SRe) and late diastolic strain rate (SRa) were measured in the basal, middle and apical segments of the right ventricular free wall in participants by two-dimensional speckle tracking echocardiography (2D-STE) from the apical four-chamber view. A p < 0.05 was set for statistical significance. Results: The parameters of ε , SRs, SRe, and SRa were significantly decreased in groups C and D compared with groups A and B. The ε of each segments was significantly lower in group D than in group C, while there were no differences in SRs, SRe and SRa between groups C and D. Conclusions: Strain and strain rate imaging could early detect the right ventricular dysfunction in SLE patients with PH, and provide important value for clinical therapy and prognosis of these patients. (Arq Bras Cardiol. 2018; 111(1):75-81) Keywords: Ventricular Function, Right / physiology; Lupus Erythematosus, Systemic;Hypertension, Pulmonary; Echocardiography. Introduction Systemic lupus erythematosus (SLE) is a chronic, autoimmune disorder involving multiple organs and systems, such as lung, muscle, skin, joint and heart, especially the right ventricle. Moreover, right ventricular (RV) function is a crucial factor for the prognosis of SLE patients. 1 Pulmonary hypertension (PH) is a common, severe, and devastating complication of SLE, and its prevalence varies between 0.5 and 43%. 2 It is an independent factor for SLE, with a 3-year survival rate of 44.9%. 3 SLE combined with PH can cause RV dysfunction, and its mortality is closely related to the RV function. 4 Thereby, early detection of subclinical RV dysfunction is important for the establishment of treatment strategy and improvement of prognosis in SLE patients with PH. Although cardiac magnetic resonance and radionuclide angiography are considered gold standards for the assessment of RV systolic function, echocardiography is still widely used for its simplicity, low price, and non-invasiveness. 5 However, assessment of the right ventricle is limited due to its thin wall and complex anatomy – a triangular shape from the lateral view, and a crescent shape from section view. 6 It has been documented that two-dimensional speckle tracking echocardiography (2D-STE) derived strain and strain rate imaging, a novel technique with less dependence on the angle and intra/inter-observer variability, could reliably and qualitatively detect early subclinical RV dysfunction. 7-9 In this study, strain refers in particular to the longitudinal peak systolic strain ( ε ), and represents the degree of myocardial deformation. Strain rate (SR) is the shortening velocity of the myocardium, i.e. , it represents the change in deformation over time. 10 SR includes systolic SR (SRs), early diastolic SR (SRe) and late diastolic strain rate (SRa), which reflect cardiac contraction during systole and diastole, respectively. 11 In this study, we aimed to assess the RV function through strain and SR by 2D-STE in SLE patients with PH estimated by echocardiography. Methods Study Subjects A total of 102 SLE patients (M:F = 11:91; aged 20‑52 years, mean age: 43.2 ± 9.3 years) and 30 age-matched healthy 75