Decrease of left ventricular function measured by speckle-tracking echocardiography based on systemic lupus erythematosus severity in children.

INTRODUCTION: Systemic lupus erythematosus in children generally manifests more severely with a more aggressive disease course. Cardiac involvement in systemic lupus erythematosus often does not show specific signs and symptoms, but speckle-tracking echocardiography can detect cardiac dysfunction. This study aimed to determine the differences in left ventricular function as measured by speckle-tracking echocardiography in children with various severity of systemic lupus erythematosus activity. METHODS: A cross-sectional study of 49 children diagnosed with systemic lupus erythematosus are currently undergoing outpatient or inpatient care at Dr Hasan Sadikin General Hospital, Bandung, from May 2023 to June 2023. Disease activity was assessed by Mexican Version of the Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) with a score of 2-5 classified as mild activity, 6-9 as moderate, and ≥10 as severe. Each subject underwent conventional echocardiography and speckle-tracking echocardiography with a Philips EPIQ machine performed by a Pediatric Cardiologist Consultant 10 days after inclusion. RESULTS: Fifteen (30.6%) subjects had mild disease activity, and 34 (69.4%) subjects had moderate disease activity. Most subjects (81.96%) were female with an average age of 15 years. The mean ejection fraction and fractional shortening as well as the median E/A ratio in the mild and moderate disease activity groups were not significantly different (65.76 versus 67.38%, 35.73 versus 37.11%, 1.6 versus 1.5%, respectively, p > 0.005). The global longitudinal strain in the moderate activity group was reduced more significantly than in the mild activity group (-16.58 versus -19.65, p = 0.008). CONCLUSION: Left ventricular function as measured by speckle-tracking echocardiography was lower in children with moderate systemic lupus erythematosus activity than those with mild disease activity.

The correlation of anxiety and depression with C3 and C4 Levels and systemic lupus erythematosus activity.

BACKGROUND: Anxiety and depression are psychosomatic disorders that are frequently observed in chronic conditions such as systemic lupus erythematosus (SLE). Anxiety and depression can be induced by immunological and neurotransmitter dysregulation, which is characterized by hypothalamic-pituitary-adrenal (HPA) axis dysfunction, production of proinflammatory cytokines, and activation of complement in the blood, such as C3 and C4. The causes of anxiety and depression in SLE are complex, ranging from neuropsychiatric involvement to drug adverse effects. Detecting anxiety and depression symptoms in SLE patients is critical to preventing disability from impacting quality of life. OBJECTIVE: To assess the relationship between anxiety and depression symptomatology, SLE disease activity with levels of C3 and C4 in Cipto Mangunkusumo National Hospital. METHODS: This study used a cross-sectional design. The study included 120 SLE patients from Cipto Mangunkusumo National Hospital, aged 18 to 60 years. All patients were requested to complete a Hospital Anxiety and Depression Scale (HADS) questionnaire to assess their anxiety and depression symptoms. Subjects with anxiety and depression were assessed for disease activity using the Mexican Systemic Lupus Erythematosus Systemic Disease Activity (Mex-SLEDAI), and blood samples were collected to test complement C3 and C4 levels. Spearman's correlation test was used to examine the relationship between HADS scores, Mex-SLEDAI, and C3 and C4 levels. RESULTS: The results of the study showed a very weak statistically significant negative correlation between anxiety symptoms based on HADS and C3 levels (r = -0.189; p = 0.038) and a weak correlation between anxiety symptoms and C4 levels (r = -204; p = 0.026). Depressive symptoms based on HADS revealed a very poor connection and no statistical significance with levels of C3 (r = -0.056; p = 0.546) and C4 (r = -0.068; p = 0.461). Anxiety (r = 0.06; p = 0.173) and depression (r = 0.031; p = 0.753) symptoms have a weak and insignificant positive connection with SLE activity. CONCLUSION: C3 and C4 serum levels appeared to decrease when the presence of anxious symptoms increased. There was no significant correlation in SLE disease activity between anxious and depressed patients.

Deformación miocárdica de la aurícula izquierda en pacientes con lupus eritematoso sistémico / Left Atrial Strain in Patients With Systemic Lupus Erythematosus

Antecedentes: En los pacientes con lupus eritematoso sistémico (LES) la disfunción diastólica del ventrículo izquierdo (DDVI) puede ser la única manifestación de involucro cardiaco anticipando una disfunción sistólica. Se ha visto que la deformación miocárdica de la aurícula izquierda (AI), mediante el strain longitudinal global de la AI (SLGAI), puede llegar a ser de utilidad en valorar la función diastólica. Objetivo: Evaluar la función de la AI mediante la deformación miocárdica en pacientes con LES. Comparar el strain de la AI en pacientes con LES activos, inactivos y controles. Métodos: Se incluyeron 50 pacientes con LES y se compararon con controles sanos pareados por edad y sexo. Se midió por ecocardiograma transtorácico la deformación miocárdica mediante el SLGAI, el strain de las 3 fases del ciclo de la AI y la tasa de strain. La diferencia entre los grupos se analizó de forma univariante. Resultados: El SLGAI en pacientes con LES fue menor que en los controles sanos (41,6% vs. 50,5%; p=0,02), así como también fue menor en las 3 fases del ciclo de la AI. No hubo diferencias en la tasa de strain en ambos grupos (LES 2,5s−1 vs. controles sanos 2,75s−1; p=0,1). También se encontró que el SLGAI fue menor en pacientes activos en comparación con controles e inactivos. Conclusiones: Los pacientes con LES tienen menor deformación miocárdica de la AI, lo que se expresa como una menor función diastólica correlacionando con daño miocárdico subclínico precoz.(AU)

Background: In patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. Objective: To evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. Methods: Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. Results: LAGLS in SLE patients was less than in the controls (41.6% vs. 50.5%; p=.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5s−1 vs. controls 2.75s−1; p=.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. Conclusions: SLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.(AU)

Left Atrial Strain in Patients With Systemic Lupus Erythematosus. / Deformación miocárdica de la aurícula izquierda en pacientes con lupus eritematoso sistémico.

BACKGROUND: In patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. OBJECTIVE: To evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. METHODS: Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. RESULTS: LAGLS in SLE patients was less than in the controls (41.6% vs. 50.5%; p=.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5s-1 vs. controls 2.75s-1; p=.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. CONCLUSIONS: SLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Medición de la actividad lúpica y daño acumulado en pacientes con lupus eritematoso sistémico / Measurement of lupus activity and cumulative damage in patients with systemic lupus erythematosus

Introducción: medir la actividad de la enfermedad y el daño irreversible en pacientes con lupus eritematoso sistémico es de vital importancia para evaluar las medidas de desenlace del paciente y su pronóstico, las diferencias entre grupos de pacientes y las respuestas a nuevos tratamientos. Objetivo: determinar el grado de actividad lúpica y daño acumulado en un grupo de pacientes con lupus eritematoso sistémico. Método: se realizó un estudio observacional, descriptivo, de corte transversal, en el Hospital Universitario Mártires del 9 de Abril de Sagua la Grande, provincia Villa Clara, en el periodo comprendido de enero de 2013 a septiembre de 2018. La muestra, seleccionada de manera no probabilística por criterios, quedó conformada por 53 pacientes con diagnóstico de lupus eritematoso sistémico. Resultados: la media de puntajes de la escala MEX-SLEDAI fue de 5.8±3.7 puntos (rango 1-17 puntos). El 37.7 por ciento de los pacientes presentó actividad leve, sólo el 1.9 por ciento presentó actividad muy severa y el 17 por ciento se encontraba en remisión o sin actividad. Los dominios del índice SLICC/ACR más afectados fueron el musculoesquelético (17.0 por ciento), el cardiovascular (17.0 por ciento) y el cutáneo (15.1 por ciento). Conclusiones: los pacientes estudiados mostraron un predominio de actividad leve a moderada de la enfermedad según MEX-SLEDAI. La presencia de daño cardiovascular fue superior a la reportada por otros estudios. Se encontró correlación significativa entre la presencia de actividad lúpica y daño acumulado(AU)

Introduction: measuring the activity of the disease and the irreversible damage in patients with systemic lupus erythematosus is of vital importance to evaluate the outcome measures of the patient and their prognosis, the differences between groups of patients and the responses to new treatments. Objective: to determine the degree of lupus activity and accumulated damage in a group of patients with systemic lupus erythematosus. Method: an observational, descriptive, cross-sectional study was conducted at the Mártires del 9 de Abril University Hospital in Sagua la Grande, Villa Clara province, in the period from January 2013 to September 2018. The sample, selected in a non-probabilistic manner by criteria, was composed of 53 patients with a diagnosis of systemic lupus erythematosus. Results: the mean score of the MEX-SLEDAI scale was 5.8 ± 3.7 points (range 1-17 points). 37.7 percent of the patients presented mild activity, only 1.9 percent presented very severe activity and 17 percent were in remission or without activity. The most affected areas of the SLICC / ACR index were musculoskeletal (17.0 percent), cardiovascular (17.0 percent) and cutaneous (15.1 percent. Conclusions: the patients studied showed a predominance of mild to moderate disease activity according to MEX-SLEDAI. The presence of cardiovascular damage was higher than that reported by other studies. A significant correlation was found between the presence of lupus activity and accumulated damage(AU)