Mahmut YESİN, Mustafa BULUT, Rezzan Deniz ACAR, Şencan ACAR, Servet İZCİ, Süleyman Çağan EFE, Serdar FİDAN, Ahmet Seyfettin GÜRBÜZ

Systemic lupus erythematosus disease activity index is related with increased aortic stiffness and decreased left ventricular longitudinal strain as shown by two-dimensional speckle tracking echocardiography

Bu çalışmada, sistemik lupus eritematozus hastalarında aort sertlik derecesinin artıp artmadığı ve bunun sol ventrikül global pik sistolik boylamsal gerginlik ve hastalık aktivite indeksi ile ilişkisi olup olmadığı araştırıldı.Çalışma planı: Şubat 2014 - Nisan 2014 tarihleri arasında kliniğimizde tedavi edilen 43 ardışık sistemik lupus eritematozus hastası (8 erkek, 35 kadın; ort. yaş 42±12 yıl; dağılım 29-67 yıl) ve 30 kontrol deneği (7 erkek, 23 kadın; ort. yaş 42±15 yıl; dağılım 20-60 yıl) çalışmaya dahil edildi. Aortik nabız dalga hızı karotis-femoral yöntemi ile ölçüldü. Aortik artış indeksi basınçtaki artış ve santral nabız basıncı arasındaki oran olarak hesaplandı. Global pik sistolik boylamsal gerginlik apikal dört boşluk görüntülemedeki altı segmentin gerginlik değerlerinin ortalaması alınarak hesaplandı.Bul gu lar: Global pik sistolik boylamsal gerginlik değeri sistemik lupus eritematozus hastalarında kontrol grubundan istatistiksel olarak anlamlı şekilde düşük idi (sırasıyla -19±3.1'e karşı -21±3.3, p=0.009). E/e' ile değerlendirilen sol ventrikül diyastolik fonksiyon sistemik lupus eritematozus hastalarında daha yüksek idi (13±4.3'e karşı 11±3.6, p=0.025). Aortik nabız basıncı, aortik artış, aortik artış indeksi ve nabız dalga hızı değerleri sistemik lupus eritematozus hastaları ve kontrol grubu arasında istatistiksel olarak anlamlı şekilde farklı idi. Nabız dalga hızı global pik sistolik boylamsal gerginlik ile negatif (b= -0.35, p=0.033), sistemik lupus eritematozus hastalık aktivite indeksi (r=0.40, p=0.006) ve E/e' ile pozitif ilişkili idi (r=0.431, p=0.001). Sistemik lupus eritematozus hastalık aktivite indeksi global pik sistolik boylamsal gerginlik ile negatif ilişkili idi (r= -0.45, p=0.002).So nuç: Bu çalışma sistemik lupus eritematozus hastalarında hastalık aktivite skorunun aort sertliği, global pik sistolik boylamsal gerginlik ve sol ventrikül diyastolik disfonksiyonu ile anlamlı olarak ilişkili olduğuna işaret etmektedir. Daha düşük hastalık aktivitesi olan hastalar daha düşük nabız dalga hızı ve aortik artışa ve daha yüksek global pik sistolik boylamsal gerginlik ve E/e'ye sahipti

İki boyutlu ekokardiyografide benek takibi analiz yöntemi ile gösterildiği gibi, sistemik lupus eritematozus hastalık aktivite indeksi artmış aort sertliği ve azalmış sol ventrikül boylamsal gerginlik ile ilişkilidir

This study aims to investigate whether the degree of stiffness of the aorta is increased and if this has a relationship with left ventricular global peak systolic longitudinal strain and disease activity index in patients with systemic lupus erythematosus.Methods: Forty-three consecutive patients with systemic lupus erythematosus (8 males, 35 females; mean age 42±12 years; range 29 to 67 years) and 30 control subjects (7 males, 23 females; mean age 42±15 years; range 20 to 60 years) who were treated in our clinic between February 2014 and April 2014 were enrolled in the study. Aortic pulse wave velocity was measured by the carotid to femoral method. Aortic augmentation index was calculated as the ratio between the augmented pressure and the central pulse pressure. Global peak systolic longitudinal strain was calculated by averaging the strain values of the six segments in the apical four-chamber view.Results: Global peak systolic longitudinal strain value was statistically significantly lower in systemic lupus erythematosus patients than the control group (-19±3.1 vs. -21±3.3, p=0.009, respectively). Left ventricular diastolic function which was assessed by E/e' was higher in patients with systemic lupus erythematosus (13±4.3 vs. 11±3.6, p=0.025). Values of aortic pulse pressure, aortic augmentation, aortic augmentation index, and pulse wave velocity were statistically significantly different between systemic lupus erythematosus patients and control group. Pulse wave velocity was negatively associated with global peak systolic longitudinal strain (b= -0.35, p=0.033) and positively correlated with systemic lupus erythematosus disease activity index (r=0.40, p=0.006) and E/e' (r=0.431, p=0.001). Systemic lupus erythematosus disease activity index was negatively correlated with global peak systolic longitudinal strain (r= -0.45, p=0.002).Conclusion: This study indicates that disease activity score is significantly associated with aortic stiffness, global peak systolic longitudinal strain, and left ventricular diastolic function in patients with systemic lupus erythematosus. Patients with lower disease activity had lower pulse wave velocity and aortic augmentation, and higher global peak systolic longitudinal strain and E/e'

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