Abstract 12546: Premature Aortic Stiffness in Systemic Lupus Erythematosus is Associated With Increased Left Ventricular Mass and Diastolic Dysfunction: A Controlled Transesophageal Echocardiographic Study
Background. Patients with systemic lupus erythematosus (SLE) develop premature aortic stiffness and left ventriculardiastolic dysfunction (LVDD). The pathogenesis of LVDD in SLE patients has not been well defined.
Objective. To determine in young adult SLE patients if an association exists between aortic stiffness and LVDD assessed by transesophageal echocardiography (TEE).
Methods. Seventy-six patients with SLE, 91% women, with a mean age of 37±12 and 26 age (34±11) and gender (85% female) matched healthy controls underwent multiplane TEE to assess stiffness of the proximal, mid, and distal descending thoracic aorta by the Pressure-Strain Elastic Modulus (PSEM) as [к(sBP-dBP)/(sD - dD/dD)]/100, where к = 133.3 is a conversion factor from mmHg to Pascal units (U), sBP and dBP and sD and dD are systolic and diastolic blood pressures and aortic diameters, respectively. Assessment of aortic PSEM was immediately preceded or followed by assessment of LV mass and LV diastolic function using current standard parameters.
Results.SLE patients as compared to controls had overall higher aortic PSEM (8.3±4.3 versus 5.4±2.28 U). After simultaneously adjusting for heart rate and mean BP, patients as compared to controls had higher LV mass index (66.7±26.3 versus 54.2±11.4 grams/m 2) and higher mitral A velocity (63.1±23.0 versus 44.8±9.2 cm/sec); lower mitral E/A ratio (1.4±0.6 versus 1.8±0.4) and lower septal-lateral-anterior-and inferior E’ velocities(9.2±2.8, 12.8±4.4, 12.0±3.3, and 10.2±3.1 versus 11.5±2.5, 15.5±3.3, 15.4±2.7, and 12.6±2.4 cm/sec, respectively.); and higher mitral E/septal-lateral-and-average E’ ratios (9.8±4.5, 7.6±4.6, and 8.4±4.2 versus 7.3±2.0, 5.6±1.4, and 6.3±1.5, respectively) (all p≤0.05). Aortic PSEM in SLE patients was positively correlated with LV mass index, mitral A and septal and lateral A’ peak velocities, IVRT, and E/E’ ratios, but was negatively correlated with mitral E/A and E’/A’ ratios and E’ peak velocities (all p≤0.03).
Conclusion.In young patients with SLE, increased aortic stiffness is as an early manifestation of vasculopathy, which may increase LV afterload and then lead to LV hypertrophy and ultimately to LV diastolic dysfunction.
- © 2012 by American Heart Association, Inc.