Background/Purpose: Systemic lupus erythematosus patients (SLE) have increased cardiovascular risk. Patients with SLE are associated with significant alterations in cardiac structure and function as demonstrated by echocardiography. Insulin resistance (IR), which is higher in SLE patients than controls, adversely impacts left ventricular (LV) remodeling and function at middle age. Although IR may not play as marked role in determining LV dysfunction as is hypertension, the impact of IR on ventricular dysfunction is unknown in SLE patients.

The aim of this research were: 1) to determine the role of speckle tracking echocardiography in early detection of LV dysfunction in SLE and 2) to examine the influence of IR measured by Quantose score on subclinical LV dysfunction using speckle tracking echocardiography in normotensive SLE patients.

Methods: This cross-sectional study included SLE adult women without diabetes mellitus (DM), hypertension or obesity. All participants underwent detailed two- dimensional Doppler and two-dimensional speckle tracking echocardiography.  Global longitudinal strain (GLS%) and global circumferential strain (GCS%) were determined from three standard apical views, using a combination of speckle tracking and tissue Doppler imaging to track regions of interest. The lower limits of normality for the strain components were < 18.5% for the longitudinal strain, and –15.4% for the circumferential. Left ventricular diastolic dysfunction (LVDD) was verified according to current guidelines. Blood sample were drawn to estimate the Quantose score for IR, which is derived from fasting measurements of insulin, α-hydroxybutyrate, linoleoyl-glycerophosphocholine, and oleate, three nonglucose metabolites shown to correlate with insulin-stimulated glucose disposal.

Results: Seventy female patients were included (mean age: 39.0 ± 9.9 years, mean disease duration 11.6 ± 4.9 years, mean disease activity: 1.8 ± 1.4). The frequency of IR was high (65%). Despite a normal ejection fraction in all participants, eleven (15.7%) patients had abnormal LV systolic GLS. Twenty-three (32.8%) patients had LVDD. The GLS% and GCS% did not differ in patients with and without IR (-20.8 ± 3.1 vs. -20.5 ± 2.1; p= 0.61 and  -27.9 ± 4.4 vs. -27.4 ± 3.7; p= 0.57, respectively). The prevalence of LVDD was 38.1% in patients with IR vs. 25.0% in patients without IR (p= 0.30). E/E’ and E/A ratios did not differ significantly between groups (6.6 ± 1.9 vs. 6.6 ± 1.5; p= 0.98 and 1.3 ± 0.3 vs. 1.3 ± 0.2; p= 0.27).

Conclusion: Although IR was high in our patients with SLE, IR was not associated with either left ventricular systolic dysfunction or LVDD in SLE patients without DM or hypertension.

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-assessment-of-left-ventricular-assessment-using-speckle-tracking-echocardiography-and-its-relationship-with-insulin-resistance-in-women-with-systemic-lupus-erythematosus/