Evaluation of Left Atrial Function by Real-time 3-D Echocardiography in Patients with Systemic Lupus Erythematosus

Objective. Left atrial function plays a key role in maintaining an optimal cardiac output. Left ventricular diastolic dysfunction has been reported in systemic lupus erythematosus (SLE), but its effect on left atrial function has been largely overlooked. Our aim was to assess left atrial performance using real-time 3-D echocardiography (RT3DE) technology in patients with SLE. Methods. Our study included 102 patients with SLE without any cardiac symptoms, and 32 healthy controls. According to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), all subjects were classified into 3 groups: healthy controls, patients with an SDI = 0, and patients with an SDI >= 1. Results. Left atrial volume indexed to body surface area was dilated in subjects with SLE, whereas the left atrial passive emptying fraction (EF) was lower. Left atrial active EF was significantly higher in the SDI = 0 group than in controls (46.4 +/- 9.1% vs 30.0 +/- 10.3%, p < 0.05); however, it was significantly lower in the SDI >= 1 group than in the SDI = 0 group (41.2 +/- 9.8% vs 46.4 +/- 9.1%, p < 0.05). By multivariate linear analysis, the SDI was independently and positively associated with left atrial volume index and inversely associated with left atrial total function. Conclusion. Our study demonstrated that left atrial mechanical function and volume are impaired in SLE, particularly in patients with an SDI >= 1 and disease activity. RT3DE may have better diagnostic value than traditional echo indexes in detecting subclinical cardiac dysfunction in patients with SLE.