Background/Purpose Insulin resistance (IR), which adversely impacts left ventricular (LV) remodeling and function in middle-aged patients.¹ Although IR may not play as marked a role in determining LV dysfunction as hypertension, the impact of IR on ventricular dysfunction is unknown in SLE patients.² The aims of this study were: 1) to determine the role of speckle tracking echocardiography in the early detection of LV dysfunction in SLE and 2) to examine the influence of IR measured by the Quantose score on subclinical LV dysfunction using speckle tracking echocardiography in normotensive SLE patients.

Methods This cross-sectional study included SLE adult women without diabetes mellitus (DM), hypertension or obesity. All participants underwent detailed two- dimensional Doppler and two-dimensional speckle tracking echocardiography. Global longitudinal strain (GLS%) and global circumferential strain (GCS%) were determined. LV diastolic dysfunction (LVDD) was verified according to current guidelines. Blood samples were drawn to estimate the Quantose score for IR, (derived from insulin, α-hydroxybutyrate, linoleoyl-glycerophosphocholine, and oleate).

Results Sixty-nine patients were included (mean age: 38.9±9.9 years, mean disease duration 10.8±4.7 years). Despite a normal ejection fraction in all participants, ten (14.5%) patients had abnormal LV systolic GLS. The frequency of IR was high (65%). The GLS% and GCS% did not differ in patients with and without IR (-20.8±3.1 vs. -20.5±2.1; p=0.61 and -25.9±8.4 vs. -24.4±9.3; p=0.47, respectively). The prevalence of LVDD was 38.1% in patients with IR vs. 25.0% in patients without IR (p=0.30). E/e’ and E/A ratios did not differ significantly between groups (5.8±1.6 vs. 5.7±1.9; p=0.86 and 1.3±0.3 vs. 1.3±0.3; p=0.27).

Conclusions Although IR was high in our patients with SLE, IR was not associated with either LV systolic dysfunction or LVDD in SLE patients without DM or hypertension.

References

1. Demmer R.T., Allison M.A., Cai J., et al. Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). Circ Cardiovasc Imaging 2016;9;e005032.

2. Tso T.K., Huang W.N. Elevation of fasting insulin and its association with cardiovascular disease risk in women with systemic lupus erythematosus. Rheumatol Int 2009;29;735–74.