Abstract
BACKGROUND: To assess the early alterations in the architecture and performance of the left ventricle for childhood-onset systemic lupus erythematosus (cSLE) patients utilizing three-dimensional speckle tracking imaging (3D-STI). METHODS: The aggregate of 31 cSLE patients were recruited and categorized into two groups based on the SLE disease activity index (SLEDAI) score: the mild-to-moderate group (≤12, n = 14) and the severe group (>12, n = 17). Univariate as well as multivariate logistic regression were used to investigate the relationship between 3D-STI parameters and the activity of the disease. Four diagnostic patterns were employed to amalgamate 3D-STI data (global longitudinal strain, GLS, and left ventricular twist angle, LVtw): isolation, series, parallel, and integration, subsequently leading to the development of a 3D myocardial comprehensive index (3D-MCI). The primary aim was severe disease activity, whereas the secondary objectives were growth failure, lupus nephritis, hypocomplementemia, and serious hematological issues. RESULTS: In the multivariate analysis, GLS and LVtw emerged as significant indicators of severe disease activity (p = 0.028 and p = 0.047). The comprehensive method, which integrates GLS with LVtw value using the logistic algorithm, achieves a balanced sensitivity and specificity of 81.4% and 94.1%, respectively. Subsequently, the 3D-MCI is computed as follows: 7.650-0.367*GLS (%) - 0.281*LVtw (°). Furthermore, the 3D-MCI exhibited a strong significant correlation with both the primary endpoint and the secondary outcomes. CONCLUSIONS: 3D-STI technology may facilitate the early detection of cardiac injury in individuals with cSLE, whereas 3D-MCI serves as suitable prognostic indicators for cSLE patients.