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Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography

Echo Research & Practice volume 4, pages 1–19 (2017)Cite this article

Abstract

Aims Lupus myocarditis occurs in 5–10% of patients with systemic lupus erythematosus (SLE). No single feature is diagnostic of lupus myocarditis. Speckle tracking echocardiography (STE) can detect subclinical left ventricular dysfunction in SLE patients, with limited research on its utility in clinical lupus myocarditis. We report on STE in comparison to conventional echocardiography in patients with clinical lupus myocarditis.

Methods and results A retrospective study was done at a tertiary referral hospital in South Africa. SLE patients with lupus myocarditis were included and compared to healthy controls. Echocardiographic images were reanalyzed, including global longitudinal strain through STE. A poor echocardiographic outcome was defined as final left ventricular ejection fraction (LVEF) <40%. 28 SLE patients fulfilled the criteria. Global longitudinal strain correlated with global (LVEF: r=-0.808; P=0.001) and regional (wall motion score: r=0.715; P<0.001) function. In patients presenting with a LVEF =50%, global longitudinal strain (P=0.023), wall motion score (P=0.005) and diastolic function (P=0.004) were significantly impaired vs controls. Following treatment, LVEF (35–47% (P=0.023)) and wall motion score (1.88–1.5 (P=0.017)) improved but not global longitudinal strain. Initial LVEF (34%; P=0.046) and global longitudinal strain (-9.5%; P=0.095) were lower in patients with a final LVEF <40%.

Conclusions This is the first known report on STE in a series of patients with clinical lupus myocarditis. Global longitudinal strain correlated with regional and global left ventricular function. Global longitudinal strain, wall motion score and diastolic parameters may be more sensitive markers of lupus myocarditis in patients presenting with a preserved LVEF =50%. A poor initial LVEF and global longitudinal strain were associated with a persistent LVEF <40%. Echocardiography is a non-invasive tool with diagnostic and prognostic value in lupus myocarditis.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa

    Riëtte Du Toit MBChB MMed

  2. Division Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa

    Phillip G. Herbst MBChB MRCP FCP, Annari van Rensburg MBChB MMed FCP, Hendrik W. Snyman MBChB DipPEC MMed FCP & Anton F. Doubell MBChB MMed FCP BSc PhD

  3. Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa

    Helmuth Reuter MBChB MRCP MMed FCP FRCP PhD

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  1. Riëtte Du Toit MBChB MMed
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  2. Phillip G. Herbst MBChB MRCP FCP
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  3. Annari van Rensburg MBChB MMed FCP
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Correspondence to Riëtte Du Toit MBChB MMed.

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Du Toit, R., Herbst, P.G., van Rensburg, A. et al. Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography. Echo Res Pract 4, 1–19 (2017). https://doi.org/10.1530/ERP-17-0005

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Echo Research & Practice

ISSN: 2055-0464

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