Yıl: 2016 Cilt: 24 Sayı: 1 Sayfa Aralığı: 20 - 26 Metin Dili: Türkçe

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

Öz:
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
Anahtar Kelime:

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

Öz:
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'
Anahtar Kelime:

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  • Salmon JE, Roman MJ. Accelerated atherosclerosis in systemic lupus erythematosus: implications for patient management. Curr Opin Rheumatol 2001;13:341-4.
  • Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum 2002;46:862-73.
  • Doria A, Sherer Y, Meroni PL, Shoenfeld Y. Inflammation and accelerated atherosclerosis: basic mechanisms. Rheum Dis Clin North Am 2005;31:355-62.
  • Bulkley BH, Roberts WC. The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. A study of 36 necropsy patients. Am J Med 1975;58:243-64.
  • Sherer Y, Shoenfeld Y. Mechanisms of disease: atherosclerosis in autoimmune diseases. Nat Clin Pract Rheumatol 2006;2:99-106.
  • Rhew EY, Ramsey-Goldman R. Premature atherosclerotic disease in systemic lupus erythematosus--role of inflammatory mechanisms. Autoimmun Rev 2006;5:101-5.
  • Petri M, Spence D, Bone LR, Hochberg MC. Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices. Medicine (Baltimore) 1992;71:291-302.
  • Petri M, Perez-Gutthann S, Spence D, Hochberg MC. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med 1992;93:513-9.
  • Brodszki J, Bengtsson C, Länne T, Nived O, Sturfelt G, Marsál K. Abnormal mechanical properties of larger arteries in postmenopausal women with systemic lupus erythematosus. Lupus 2004;13:917-23.
  • Kullo IJ, Malik AR. Arterial ultrasonography and tonometry as adjuncts to cardiovascular risk stratification. J Am Coll Cardiol 2007;49:1413-26.
  • Dart AM, Kingwell BA. Pulse pressure--a review of mechanisms and clinical relevance. J Am Coll Cardiol 2001;37:975-84.
  • Nichols WW, Singh BM. Augmentation index as a measure of peripheral vascular disease state. Curr Opin Cardiol 2002;17:543-51.
  • Perk G, Tunick PA, Kronzon I. Non-Doppler two- dimensional strain imaging by echocardiography--from technical considerations to clinical applications. J Am Soc Echocardiogr 2007;20:234-43.
  • Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997;40:1725.
  • Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 1992;35:630-40.
  • Buyon JP, Petri MA, Kim MY, Kalunian KC, Grossman J, Hahn BH, et al. The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial. Ann Intern Med 2005;142:953-62.
  • Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63.
  • Selzer F, Sutton-Tyrrell K, Fitzgerald S, Tracy R, Kuller L, Manzi S. Vascular stiffness in women with systemic lupus erythematosus. Hypertension 2001;37:1075-82.
  • Valero-Gonzalez S, Castejon R, Jimenez-Ortiz C, Rosado S, Tutor-Ureta P, Vargas JA, et al. Increased arterial stiffness is independently associated with metabolic syndrome and damage index in systemic lupus erythematosus patients. Scand J Rheumatol 2014;43:54-8.
  • Glasser SP, Arnett DK, McVeigh GE, Finkelstein SM, Bank AJ, Morgan DJ, et al. Vascular compliance and cardiovascular disease: a risk factor or a marker? Am J Hypertens 1997;10:1175-89.
  • Kreiger JE, Dzau VJ. Molecular biology of hypertension. Hypertension. 1991;18 (Suppl I):I-3-I-17.
  • Glagov S, Grande JP, Xu CP, Giddens DP, Zarins CK. Limited effects of hyperlipidemia on the arterial smooth muscle response to mechanical stress. J Cardiovasc Pharmacol 1989;14:90-7.
  • Chobanian AV. 1989 Corcoran lecture: adaptive and maladaptive responses of the arterial wall to hypertension. Hypertension 1990;15:666-74.
  • Sengupta PP, Narula J. Reclassifying heart failure: predominantly subendocardial, subepicardial, and transmural. Heart Fail Clin 2008;4:379-82.
  • Frenneaux M, Williams L. Ventricular-arterial and ventricular-ventricular interactions and their relevance to diastolic filling. Prog Cardiovasc Dis 2007;49:252-62.
APA ACAR R, BULUT M, ACAR Ş, EFE S, FİDAN S, YESİN M, İZCİ S, GÜRBÜZ A (2016). 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. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 24(1), 20 - 26.
Chicago ACAR Rezzan Deniz,BULUT MUSTAFA HİLMİ,ACAR Şencan,EFE Süleyman Çağan,FİDAN Serdar,YESİN MAHMUT,İZCİ Servet,GÜRBÜZ Ahmet Seyfettin 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. Türk Göğüs Kalp Damar Cerrahisi Dergisi 24, no.1 (2016): 20 - 26.
MLA ACAR Rezzan Deniz,BULUT MUSTAFA HİLMİ,ACAR Şencan,EFE Süleyman Çağan,FİDAN Serdar,YESİN MAHMUT,İZCİ Servet,GÜRBÜZ Ahmet Seyfettin 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. Türk Göğüs Kalp Damar Cerrahisi Dergisi, vol.24, no.1, 2016, ss.20 - 26.
AMA ACAR R,BULUT M,ACAR Ş,EFE S,FİDAN S,YESİN M,İZCİ S,GÜRBÜZ A 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. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2016; 24(1): 20 - 26.
Vancouver ACAR R,BULUT M,ACAR Ş,EFE S,FİDAN S,YESİN M,İZCİ S,GÜRBÜZ A 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. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2016; 24(1): 20 - 26.
IEEE ACAR R,BULUT M,ACAR Ş,EFE S,FİDAN S,YESİN M,İZCİ S,GÜRBÜZ A "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." Türk Göğüs Kalp Damar Cerrahisi Dergisi, 24, ss.20 - 26, 2016.
ISNAD ACAR, Rezzan Deniz vd. "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". Türk Göğüs Kalp Damar Cerrahisi Dergisi 24/1 (2016), 20-26.