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Background <p>Cardiac involvement is an important but often underrecognized manifestation of juvenile systemic lupus erythematosus (J-SLE). Conventional echocardiography may miss early myocardial dysfunction, while advanced techniques such as speckle-tracking echocardiography can detect subclinical abnormalities.</p> Objective <p>To evaluate cardiac involvement in J-SLE using conventional echocardiography, tissue Doppler imaging, and speckle-tracking echocardiography, and to assess its relation to disease-related parameters and non-causal associations with overt heart failure status during follow-up.</p> Methods <p>This observational study, with baseline cross-sectional assessment and a 6-month follow-up reassessment, included 70&#xa0;J-SLE patients aged ≤ 18 years. Patients were classified into three groups: Group I, no cardiac dysfunction; Group II, overt heart failure; and Group III, subclinical cardiac dysfunction. All patients underwent clinical, laboratory, and echocardiographic assessment, fractional shortening (FS), ejection fraction (EF), myocardial performance index (MPI), tissue Doppler imaging (TDI) diastolic indices, and global longitudinal strain (GLS). Follow-up findings were analyzed as descriptive, non-causal associations.</p> Results <p>The cohort was predominantly female (78.6%), with a mean age of 10.45 ± 1.39 years. At presentation, significant differences were found among groups in FS, EF, S wave, MPI, E/A, E/E, DT, and GLS abnormalities (all <i>p</i> = 0.001), as well as pericardial effusion (<i>p</i> = 0.047). At follow-up, GLS (<i>p</i> &lt; 0.001) and E/A ratio (<i>p</i> = 0.015) remained significantly different across groups. In Group II, both FS and GLS correlated significantly with A/C ratio (<i>p</i> = 0.021 and <i>p</i> = 0.001), ESR (<i>p</i> = 0.001 and <i>p</i> &lt; 0.001), C3 (<i>p</i> = 0.001 and <i>p</i> &lt; 0.001), and C4 (<i>p</i> = 0.001 and <i>p</i> &lt; 0.001). In Group III, GLS correlated with A/C ratio (<i>p</i> = 0.003), Hb (<i>p</i> = 0.029), SLEDAI-2&#xa0;K (<i>p</i> &lt; 0.001), and SDI (<i>p</i> = 0.048), while FS correlated with ESR (<i>p</i> = 0.002). Overt heart failure status during follow-up was non-causally associated with systolic BP &gt; 90th centile (<i>p</i> = 0.007), diastolic BP &gt; 90th centile (<i>p</i> = 0.029), higher A/C ratio (<i>p</i> = 0.041), anti-cardiolipin IgM positivity (<i>p</i> = 0.015), and lupus anticoagulant positivity (<i>p</i> = 0.001).</p> Conclusion <p>Cardiac involvement is frequent in J-SLE. GLS and diastolic indices appear to be sensitive markers of myocardial dysfunction and may aid early risk stratification. Associations with overt heart failure status during follow-up should be interpreted as non-causal and hypothesis-generating.</p>

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Echocardiographic assessment of cardiac dysfunction in juvenile systemic lupus erythematosus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Huda Marzouk,
  • Amr Ahmed Fathalla,
  • Areej Helmy,
  • Hebat Allah Atef Rashad

摘要

Background

Cardiac involvement is an important but often underrecognized manifestation of juvenile systemic lupus erythematosus (J-SLE). Conventional echocardiography may miss early myocardial dysfunction, while advanced techniques such as speckle-tracking echocardiography can detect subclinical abnormalities.

Objective

To evaluate cardiac involvement in J-SLE using conventional echocardiography, tissue Doppler imaging, and speckle-tracking echocardiography, and to assess its relation to disease-related parameters and non-causal associations with overt heart failure status during follow-up.

Methods

This observational study, with baseline cross-sectional assessment and a 6-month follow-up reassessment, included 70 J-SLE patients aged ≤ 18 years. Patients were classified into three groups: Group I, no cardiac dysfunction; Group II, overt heart failure; and Group III, subclinical cardiac dysfunction. All patients underwent clinical, laboratory, and echocardiographic assessment, fractional shortening (FS), ejection fraction (EF), myocardial performance index (MPI), tissue Doppler imaging (TDI) diastolic indices, and global longitudinal strain (GLS). Follow-up findings were analyzed as descriptive, non-causal associations.

Results

The cohort was predominantly female (78.6%), with a mean age of 10.45 ± 1.39 years. At presentation, significant differences were found among groups in FS, EF, S wave, MPI, E/A, E/E, DT, and GLS abnormalities (all p = 0.001), as well as pericardial effusion (p = 0.047). At follow-up, GLS (p < 0.001) and E/A ratio (p = 0.015) remained significantly different across groups. In Group II, both FS and GLS correlated significantly with A/C ratio (p = 0.021 and p = 0.001), ESR (p = 0.001 and p < 0.001), C3 (p = 0.001 and p < 0.001), and C4 (p = 0.001 and p < 0.001). In Group III, GLS correlated with A/C ratio (p = 0.003), Hb (p = 0.029), SLEDAI-2 K (p < 0.001), and SDI (p = 0.048), while FS correlated with ESR (p = 0.002). Overt heart failure status during follow-up was non-causally associated with systolic BP > 90th centile (p = 0.007), diastolic BP > 90th centile (p = 0.029), higher A/C ratio (p = 0.041), anti-cardiolipin IgM positivity (p = 0.015), and lupus anticoagulant positivity (p = 0.001).

Conclusion

Cardiac involvement is frequent in J-SLE. GLS and diastolic indices appear to be sensitive markers of myocardial dysfunction and may aid early risk stratification. Associations with overt heart failure status during follow-up should be interpreted as non-causal and hypothesis-generating.