الفهرس 
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Abstract
Cardiovascular pathology is frequent in systemic lupus erythematosus (SLE). Ventricular diastolic dysfunction is considered one of its common findings and may preceed systolic dysfunction with overt morbidity and mortality. There is some evidence that antiphospholipids (aPL), namely anticardiolipins (aCL) and lupus anticoagulant (LA), may be accompanied by a decrease in the systolic and diastolic function of the left ventricle. Probably, some of this effect may be independent of valvular disease, but there is limited evidence so far. Furthermore, it is reported that diastolic function of the right ventricle is strongly associated with the presence of antiphospholipid syndrome (APS) and aCL antibodies.
This is a cross-sectional study conducted on 65 consecutive patients with SLE being treated either as inpatients or following up as outpatients at the Pediatric Rheumatology Clinic, Cairo University Specialized Pediatric Hospital.
The study aimed at evaluating the prevalence of echocardiographically documented diastolic dysfunction of the right and left ventricles in patients with SLE, with and without aPL antibodies and to examine whether these antibodies are associated with diastolic dysfunction independently of systolic dysfunction and significant valvular disease.
All patients fulfilled at least four of the American College of Rheumatology (ACR) criteria for diagnosis of SLE, all patients were subjected to full history taking, thorough physical examination, CXR, ECG, full laboratory investigations including CBC, electrolytes, urine analysis ESR, ANA, anti ds DNA and antiphospholipid antibodies (aCL and LA) were withdrawn on the same day or within one week before echocardiographic examination.
All patients were subjected to pulsed, continuous, colour Doppler echocardiography with simultaneous synchronized ECG monitoring. Three patients were excluded from the study, either due to systolic dysfunction or severe valvular disease.
This cross-sectional study included 62 patients with SLE, of whom, 45 patients (72.6%) were females and 17 (27.4%) were males, with a female: male ratio of 2.6:1, a mean age of 14.8 + 4.9 years (range 6-28 years), age at diagnosis ranged from 4-15 years with a mean of 10.3 + 2.7 years and mean duration of follow up of 4.5 + 4.2 years (median: 3 years), ranging: 0.7-18 years.
30 patients (48.4%) had +ve aPL antibodies, the majority of patients showed diastolic dysfunction especially of the left ventricle: 44 patients (71%) showed increased A velocity.
The E/A ratio was inverted in 31 patients (50%), with shortening of the left ventricular deceleration time in 50 patients (80.6%), shortening of LV IVRT in 25 patients (40.3%) and prolongation of LV IVRT in 29 patients (46.8%). The left ventricular Tei index was increased in 26 patients.
Regarding the right ventricle, 12.9% of patients showed increased A velocity, the E/A ratio was inverted in 4 patients (6.5%) and was increased in 6 patients showing restrictive pattern of diastolic dysfunction with shortening of RV DT in 42 patients (67.7%) and shortening of RV IVRT in 16/62 patients (25.8%). The right ventricular Tei index was increased in 14 patients (22.6%) denoting global right ventricular dysfunction.
The left ventricular diastolic indices (including A wave, E/A ratio, the LV IVRT) and LV Tei index were significantly more affected than the right ventricular diastolic indices.
The use of mycophenolate mofetil showed significantly less impairment of the E wave and the Tei index.
Hypertension and the use of high doses of steroids are major risk factors in the development of diastolic dysfunction.
No significant association was found between aPL and diastolic impairment