P452Systemic lupus erythematosus: pulmonary hypertension is independently associated with systolic left ventricular dysfunction, assessed by speckle tracking.


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Abstract

Introduction: Pulmonary hypertension (PH) is a serious and frequent co-morbidity in patients with systemic lupus erythematosus (SLE), early in the diagnosis.Aim: To evaluate the relationship between the acceleration time (AT) of pulmonary artery flow and the systo-diastolic function of right (RV) and left (LV) ventricle, based on tissue Doppler imaging (TDI) and speckle tracking.Methods: 26 patients, female sex, mean age: 39 ± 11 years, ambulatory and stable, with SLE for at least one year. Exclusion criteria: patients with decreased LV ejection fraction (<55%, biplane Simpson method), arterial hypertension, ischemic or valvular heart disease. Parameters evaluated: (1) Mitral and tricuspid TDI, characterized by the velocity of systolic (S'), proto-diastolic (E') and late-diastolic (A') waves. (2) RV systolic function characterized by the velocity and the integral of tricuspid S'. (3) LV systolic function characterized by 2D-global strain (GS). Statistics: Pearson correlation coefficient. The AT was categorized into tertiles for multiple comparisons.Results: AT correlated inversely with LV GS (R2=-0.513, p= 0.012) and directly with mitral E' (R2 = 0.534, p= 0.006). The lower the tertile of AT the highest the LV GS (R2 =-0.553, p= 0.006) and the lower the mitral E' (R2 =0.5, p=0.007). AT correlated directly with the integral of S' tricuspid (R2=0.411, p= 0.041). The lower the tertile of AT, the lower the tricuspid E' (R2= 0.47, p= 0.006), S' (R2 =0.449, p=0.025) and integral of S' (R2= 0.534, p= 0.006). Finally, in the multivariable analysis, LV GS was the only independent variable associated with pulmonary artery flow AT (p=0.039).Conclusion: In ambulatory SLE patients lower pulmonary artery flow AT, suggestive of PH, was associated with systo-diastolic LV and the RV dysfunction. Furthermore, in the multivariable analysis, pulmonary artery flow AT was independently associated with systolic left ventricular dysfunction, assessed by speckle tracking.

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