# Update: Heart Failure in Systemic Lupus Erythermatosus
## 4 Electrocardiographic (ECG) and Echocardiographic Changes in SLE  
ECG abnormalities observed in SLE may indicate subclinical cardiac involvement. They may take the form of typical ECG changes that occur in cardiovascular diseases in the general population, as well as abnormalities associated with antibodies characteristic of SLE. On the other hand, [PERSON] et al. found prolonged QTc and QTd intervals that were not significantly associated with disease activity, anti-Ro antibodies, interleukin 18, and interleukin 6 levels in SLE patients treated with hydroxychloroquine and prednisolone [87]. Therefore, ECG abnormalities in SLE patients may be indicative of subclinical cardiac dysfunction. Furthermore, ECG abnormalities may occur even in a relatively stable clinical condition, which poses a formidable diagnostic challenge.  
As far as echocardiography is concerned, subclinical ventricular dysfunction in SLE may manifest as systolic dysfunction and/or diastolic dysfunction [41]. In SLE patients, enlargement of the left atrium, left ventricle in diastole, and increased left ventricular mass index (LVMI) as well as reduced left ventricular systolic and diastolic function, expressed by E/A (the ratio of E-wave to A-wave velocities of mitral inflow) and E/e\({}^{\prime}\) (the ratio of the E-wave velocity of mitral inflow to the e\({}^{\prime}\) velocity of mitral annular motion duringdiastole) indices, were observed [88]. A study conducted in India, including 50 patients with SLE, showed that 12% of patients had diastolic dysfunction [89]. In other studies, Global Longitudinal Strain (GLS) abnormalities were observed even in patients with good clinical condition. GLS measures the percentage deformation (shortening) of myocardial fibers in the longitudinal axis using speckle-tracking echocardiography. GLS disturbances were more pronounced in the active disease stage, suggesting that SLE may significantly affect cardiac function, even in the absence of cardiovascular disease. Diastolic dysfunction and GLS abnormalities were observed in patients with long-term disease activity, confirming the higher risk of cardiovascular disease in this group [36; 41; 42; 43; 84].  
Both systolic and diastolic ventricular dysfunction in SLE is a particularly important issue in the context of subclinical changes, which can nowadays be detected using modern diagnostic methods such as STE and GLS assessment. These techniques seem to be promising tools in the assessment of early cardiac dysfunctions, invisible in conventional echocardiography. Studies present increasingly strong evidence of a correlation between disease activity and the severity of GLS dysfunctions, which may indicate that SLE affects cardiac function already in the subclinical phase. Therefore, speckle tracking echocardiography (STE) and GLS parameter assessment seem to be promising methods for assessing subclinical cardiac dysfunction in SLE [36; 42]. Left ventricular GLS may be a marker of future cardiovascular events, which should be investigated in multicenter, prospective studies [42].  
Reduced left ventricular function on cardiac MRI and its correlation with SLE activity and inflammation. It is worth noting that in cardiac magnetic resonance imaging of SLE patients, a correlation was observed between reduced left ventricular function and disease activity as well as inflammation [90]. The study was conducted on a small number of patients, but it confirms that patients with SLE show a lower LVEF than the control group.  
Positron emission tomography (PET) is a tool for assessing myocardial perfusion and inflammation. The literature describes lower myocardial flow reserve (MFR) values measured by PET in patients with autoimmune rheumatic diseases. In cases where MFR was below 1.5, patients had a worse prognosis, including a higher risk of HF [70]. There is a lack of data for SLE.