THU0246 ASYMPTOMATIC MYOCARDIAL DYSFUNCTION DETECTED BY SPECKLED TRACKING ECHOCARDIOGRAPHY (STE) IN ACTIVE SLE PATIENTS
Authors: Dhiren Raval, Muzaffar Bindroo, Gayatri Ekbote, Natasha Negalur, Lucky Sharma, Naval Mendiratta, Shruti Bajad, Vinay Singal, Vinayak Agarwal, Rajiva Gupta
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Clinical myocarditis is seen in 10% of SLE patients, but autopsy studies have shown myocardial involvement in up to 50% of patients. Lupus myocarditis may be silent and can be detected by newer echocardiographic technique like STE especially when SLE is active.<sup>(1)</sup> <h3>Objectives</h3> To study asymptomatic myocardial dysfunction by STE in active SLE patients. <h3>Methods</h3> All consecutive active SLE patients having a SLEDAI score ≥ 6 without any cardiac symptoms with disease duration ≤ 5 years aging between 18- 45 years, who attended the Rheumatology and Clinical Immunology department (Outpatient and Inpatient) of Medanta, The Medicity, Gurgaon, from May 2016 to March 2018, were enrolled. They were evaluated for myocardial dysfunction by using a novel ultrasound technique - STE, which was reviewed by one observer cardiologist. Global longitudinal systolic strain (GLSS) was calculated by STE in all patients. GLSS&lt;-19.7 was considered as an indicator of myocardial dysfunction.<sup>(2)</sup> Age and sex matched controls in the form of thirty healthy volunteer subjects were enrolled and their echocardiography findings were compared with active lupus patients. Atherosclerotic risk factors like hypertension, Diabetes Mellitus and age &gt;45 years were excluded to avoid confounding effects. <h3>Results</h3> Fifty eight active lupus patients were analysed. In the cohort female: male ratio was 8.6:1, median duration of disease was 22 months (0.5 - 60) and mean SLEDAI was 11.02 ± 2.30.GLSS was significantly low in active lupus patients compared to healthy controls (p=0.0001) suggestive of myocardial dysfunction. In active lupus patients, abnormal echocardiographic findings (myocarditis, non-bacterial thromboendocarditis, pulmonary arterial hypertension and pericarditis) were seen in 62.1%. Myocardial dysfunction was found in 27 (46.6%), 20 (34.5%) patients had low GLSS with normal left ventricular ejection fraction (LVEF) and these were significantly associated with APLA and anti Sm/RNP antibodies. Multivariate Logistic Regression analysis of myocardial dysfunction with SLEDAI and other system parameters showed that musculoskeletal, CNS, haematological and nephritis were associated with increased risk for developing higher disease activity and myocardial dysfunction, although it was not statistically significant. <h3>Conclusion</h3> Almost half of active lupus patients have silent myocarditis. GLSS is more sensitive in detecting asymptomatic myocardial dysfunction than LVEF.Regular Echocardiography with Speckled tracking should be performed in Lupus patients especially when disease is active. <h3>References</h3> 1Løgstrup BB, Nielsen JM, Kim WY, Poulsen SH. Myocardial oedema in acutemyocarditis detected by echocardiographic 2Dmyocardial deformation analysis. Eur Heart J Cardiovasc Imaging. 2016;17(9):1018-26. 2Yingchoncharoen T, Agarwal S, Popovi? ZB, Marwick TH. Normal ranges of left ventricular strain: A meta-analysis. J Am Soc Echocardiogr. 2013;26(2):185-91. <h3>Disclosure of Interests</h3> None declared