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Echocardiographic Assessment of Diastolic Function in Children with Incident Systemic Lupus Erythematosus

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Abstract

The timing and etiology of diastolic impairment in pediatric-onset systemic lupus erythematosus (SLE) are poorly understood. We compared echocardiographic metrics of left ventricular diastolic function in children at SLE diagnosis to controls and identified factors associated with diastolic indices. Echocardiograms of children aged 5–18 years within 1 year of SLE diagnosis and age-/sex-matched controls were retrospectively read by blinded cardiologists. Clinical characteristics were abstracted separately. Z-scores for diastolic indices (E/A, e′, E/e′, and isovolumetric relaxation time (IVRT)) were calculated using published normative data and study controls, and compared using linear mixed-effects models adjusted for blood pressure. Pericardial effusions and valvular disease were also evaluated. Linear regression was used to identify factors associated with diastolic measures. 85 children with incident SLE had echocardiograms performed a median of 6 days after diagnosis (interquartile range (IQR) 1–70). Prior cumulative prednisone exposure was minimal (median 60 mg, IQR 0–1652). SLE cases had lower E/A, lower e′, higher E/e′, and longer IVRT compared to controls. Though none met criteria for Grade I diastolic dysfunction, Z-scores for e′, E/e′, and IVRT were abnormal in 30%, 25%, and 6% of SLE cases, respectively. Greater disease activity was associated with lower septal e′ (p < 0.01), higher E/e′ (p = 0.02), and longer IVRT (p < 0.01). Children with incident SLE have worse diastolic indices at diagnosis compared to peers without SLE, independent of blood pressure and prior to significant prednisone exposure. Longitudinal studies will determine whether diastolic dysfunction develops in this population over time.

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Funding

This work was supported by the National Heart, Lung, and Blood Institute T32-HL007915 (JCC and BRW), F32-HL142176 (JCC), K01HL125521 (LMR), PHA supplement to K01HL125521 (LMR), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases K23-AR071519 (AMK).

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Authors and Affiliations

  1. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 3501 Civic Center Blvd, Colket Translational Research Bldg, #10100-7, Philadelphia, PA, 19104, USA

    Joyce C. Chang, Rui **ao & Pamela F. Weiss

  2. Division of Rheumatology, Children’s Hospital of Philadelphia, 3405 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Joyce C. Chang, Andrea M. Knight & Pamela F. Weiss

  3. Division of Cardiology, Children’s Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Brian R. White, Matthew D. Elias & Laura Mercer-Rosa

  4. Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 2716 South St., Philadelphia, PA, 19146, USA

    Andrea M. Knight & Pamela F. Weiss

  5. Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 2716 South St., Philadelphia, PA, 19146, USA

    Pamela F. Weiss

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  1. Joyce C. Chang
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Chang, J.C., White, B.R., Elias, M.D. et al. Echocardiographic Assessment of Diastolic Function in Children with Incident Systemic Lupus Erythematosus. Pediatr Cardiol 40, 1017–1025 (2019). https://doi.org/10.1007/s00246-019-02107-1

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