Background
Methods
Study population
Clinical data
Echocardiography
Myocardial speckle-tracking
Statistical analysis
Results
Baseline clinical characteristics
Variable | SLE group (n = 162) | Healthy controls (n = 68) | P-value |
---|---|---|---|
Age (years) | 44.1 ± 16.2 | 43.9 ± 14.5 | 0.952 |
Sex, female (%) | 150 (92.6) | 61 (89.7) | 0.340 |
Height (cm) | 161.7 ± 6.2 | 162.8 ± 5.7 | 0.223 |
Body weight (kg) | 59.4 ± 6.3 | 60.5 ± 5.9 | 0.227 |
Body mass index (kg/m2) | 22.5 (21.9, 23.4) | 22.6 (22.1, 23.1) | 0.304 |
Body surface area (m2) | 1.5 ± 0.1 | 1.6 ± 0.1 | 0.192 |
Heart rate (bpm) | 71.4 ± 9.0 | 69.6 ± 9.1 | 0.194 |
Systolic blood pressure (mm Hg) | 128.4 ± 17.3 | 119.9 ± 10.1 | < 0.001 |
Diastolic blood pressure (mm Hg) | 77.0 (69.0, 90.0) | 75.0 (69.0, 79.0) | 0.025 |
Clinical characteristics | Value |
---|---|
SLE-related factors | |
SLEDAI-2000 score | 9.0 (4.0, 16.0) |
Positive antinuclear antibody (%) | 162 (100.0) |
Positive anti-double-stranded DNA (%) | 68 (42.0) |
Positive anti-Smith antibody (%) | 63(38.9) |
Positive U1-small nuclear ribonucleoprotein (%) | 38 (23.4) |
Positive antiphospholipid antibodies (%) | 28 (17.3) |
C-reactive protein (mg/L) | 16 ± 26 |
Creatinine clearance (mL/min) | 57 ± 34 |
Cardiovascular disease-related factors | |
Hypertension (%) | 49 (30.2) |
Hypercholesterolemia (%) | 37 (22.8) |
Diabetes mellitus (%) | 7 (4.3) |
Had a family history of premature coronary artery disease (%) | 12 (7.4) |
Smoking (%) | 6 (3.7) |
Body mass index > 25 kg/m2 (%) | 8 (4.9) |
Medications | |
Hydroxychloroquine (%) | 95 (58.6) |
Glucocorticoids (%) | 74 (45.6) |
Immunosuppressive drugs (%) | 27 (16.7) |
Biological agents (%) | 18 (11.1) |
Cardiovascular medications | |
ACE inhibitors/ARBs (%) | 30 (18.5) |
Calcium channel blockers (%) | 21 (12.9) |
β-blockers (%) | 11 (6.8) |
Diuretics (%) | 9 (5.6) |
Baseline echocardiographic characteristics
Variable | SLE group (n = 162) | Healthy controls (n = 68) | P-value |
---|---|---|---|
IVSd (mm) | 8.4 ± 1.3 | 7.6 ± 1.1 | < 0.001 |
LVEDd (mm) | 44.5 ± 4.6 | 41.8 ± 3.8 | < 0.001 |
PW (mm) | 7.4 ± 1.0 | 6.8 ± 1.0 | < 0.001 |
EDV (ml) | 87.1 ± 18.3 | 79.5 ± 15.5 | 0.003 |
ESV (ml) | 34.1 ± 8.8 | 29.9 ± 6.9 | 0.001 |
SV (ml) | 53.0 ± 10.9 | 50.2 ± 9.0 | 0.026 |
LVEF (%) | 60.6 ± 4.4 | 62.6 ± 2.4 | 0.007 |
RWT | 0.36 ± 0.04 | 0.34 ± 0.04 | 0.056 |
LVM (g) | 108.9 (86.3, 133.1) | 88.4 (65.1, 101.8) | < 0.001 |
LVMI (g/m2) | 68.4 (54.2, 84.1) | 54.4 (42.5, 64.2) | < 0.001 |
LAVI (ml/m2) | 26.0 ± 5.5 | 24.1 ± 4.7 | 0.086 |
E (cm/s) | 79.5 (68.6, 92.5) | 101.4 (87.6, 105.5) | < 0.001 |
e′ (cm/s) | 12.2 ± 1.8 | 13.1 ± 1.5 | < 0.001 |
E/e′ | 6.6 ± 1.1 | 7.2 ± 1.4 | 0.001 |
sPAP (mm Hg) | 30.0 ± 8.7 | 24.5 ± 5.8 | < 0.001 |
LV diastolic dysfunction (%) | 7 (4.3) | 0 (0) | 0.072 |
Endocardial LS (%) | -22.0 ± 3.4 | -24.8 ± 2.9 | < 0.001 |
Mid-myocardial LS (%) | -19.6 ± 3.1 | -22.4 ± 2.7 | < 0.001 |
Epicardial LS (%) | -18.6 ± 2.8 | -20.5 ± 2.5 | < 0.001 |
LS gradient (%) | -3.4 ± 0.9 | -4.5 ± 1.0 | < 0.001 |
Endocardial CS (%) | -29.7 ± 3.7 | -33.1 ± 3.1 | < 0.001 |
Mid-myocardial CS (%) | -18.1 ± 3.2 | -21.31 ± 2.7 | < 0.001 |
Epicardial CS (%) | -12.4 ± 3.0 | -14.6 ± 2.6 | < 0.001 |
GCS gradient (%) | -17.3 ± 1.1 | -18.5 ± 1.1 | < 0.001 |
Associations between baseline echocardiographic characteristics and cardiovascular events
Clinical and echocardiographic parameter | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
HR(95% CI) | P-value | HR(95% CI) | P-value | |
Age | 1.045 (1.021–1.073) | 0.031 | 1.160 (0.339–3.375) | 0.471 |
Sex, female | 0.728 (0.264–2.011) | 0.540 | ||
Systolic blood pressure | 1.021 (1.005–1.038) | 0.010 | 0.984 (0.959–1.089) | 0.223 |
Diabetes mellitus | 1.320 (0.781–2.170) | 0.312 | ||
SLEDAI-2000 score | 1.030 (1.011–1.050) | 0.008 | 1.019 (0.994–1.044) | 0.162 |
Positive anti-double-stranded DNA | 1.356 (0.813–2.261) | 0.244 | ||
Positive antiphospholipid antibodies | 1.396(0.765–2.548) | 0.277 | ||
Glucocorticoids | 0.956 (0.565–1.618) | 0.868 | ||
IVSd | 0.983 (0.799–1.208) | 0.868 | ||
LVEDd | 0.997 (0.943–1.055) | 0.926 | ||
EDV | 1.006 (0.991–1.021) | 0.462 | ||
LVEF | 0.962 (0.910–1.018) | 0.962 | ||
LVM | 1.001 (0.991–1.021) | 0.802 | ||
E/ e′ | 0.973 (0.784–1.207) | 0.801 | ||
sPAP | 1.064 (1.041–1.088) | < 0.001 | 1.018 (0.848–1.431) | 0.056 |
Endocardial LS | 1.055 (1.031–1.156) | < 0.001 | 1.014 (1.002–1.035) | 0.025 |
LS gradient | 1.076 (0.701–1.645) | 0.738 | ||
Endocardial CS | 2.508 (1.501–4.191) | < 0.001 | 1.051 (1.027–1.077) | < 0.001 |
CS gradient | 1.114 (0.811–1.529) | 0.505 |
Parameter | Cardiovascular events | |||
---|---|---|---|---|
AUC | Sensitivity (%) | Specificity (%) | Cutoff point | |
Endocardial LS | 0.746 | 75.6 | 64.0 | -21.5 (%) |
Mid-myocardial LS | 0.677 | 65.3 | 63.6 | -18.1 (%) |
Epicardial LS | 0.612 | 61.0 | 64.2 | -17.1 (%) |
LS gradient | 0.705 | 70.2 | 63.4 | -3.3 (%) |
Endocardial CS | 0.829 | 82.2 | 74.9 | -29.0 (%) |
Mid-myocardial CS | 0.725 | 75.4 | 66.8 | -18.0 (%) |
Epicardial CS | 0.623 | 58.4 | 70.6 | -12.2 (%) |
CS gradient | 0.715 | 70.8 | 65.4 | -17.1 (%) |