الفهرس 
INTRODUCTION AND Aim Of The WorkOnly 14 pages are availabe for public view
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Abstract
This case control cross sectional study was carried out on 90 patients (6 males and 84 females) with systemic lupus erythematosus (SLE), attending Rheumatology and Immunology unit (inpatient and outpatient), Mansoura University Hospital. A control group (Group II) of 30 individuals (3 males and 27 females) of matched age and sex were included. The patient group (Group I) was subdivided according to:
• Patients with lupus Nephritis (36 patients) (Group A) and patients without (54 patients) (Group B).
• Patients without clinical evidence of cardiac involvement (22 patients) (Group C) and patients with (68 patients) (Group D).
All patients underwent a thorough clinical evaluation (History, general examination and systemic examination). Laboratory tests including: CBC, ESR, CRP, serum creatinine, liver function tests, lipid profile, urinalysis and immunological profile (ANA, antidsDNA, anti cardiolipin ab, C3 and C4) were done. Echocardiography: including M-mode, 2-dimensional, conv entional pulsed Doppler and tissue Doppler echocardiography over medial and lateral annular aspects were performed.
Our study showed:
• Cardiac affection was detected clinically in 68 patients (75.6%), pericardial effusion, pulmonary HTN and mitral valve (regurge) were the commonest presentations. Other presentations included Raynaud’s phenomenon, aPL, systemic hypertension, arthritis, alopecia, oral ulcers, psychosis, ischemic cerebral stroke and DVT.
• Most of the cases were positive for ANA, AntidsDNA and low complement was present in 28.95% of cases (all of them had nephritis).
• Anemia, hypoalbuminemia, hyperuricemia, renal impairment and dyslipidemia together with markers of activity and inflammation (ESR, CRP) were found in patient group.
• Left ventricular hypertrophy and dilatation was prevalent among patients (thickened IVS, PW, increased LVEDD) and systolic function is reduced than control.
• Diastolic dysfunction was detected by transmitral Doppler (shortened E, E/A and prolonged DT).
• Tissue Doppler revealed systolic ( shortened b, IVCT and prolonged Tei index) and diastolic dysfunction (prolonged IVRT, shortened Em, Em/Am and prolonged Tei index).
• Increasing disease activity was associated with increased diastolic dysfunction. Disease duration and hypertension affected Tei index (Lateral Tei) while EF wasn’t affected. Tei index provided an estimate of the global ventricular behavior (systolic and diastolic) as it was not influenced by heart rate. Diastolic dysfunction was prevalent in 68 patients (75.6%) in the current study using TDI compared to 46 patients (51.1%) diagnosed with transmitral Doppler alone.
from the aforementioned findings we can conclude that:
1) The determination of myocardial velocities in the longitudinal axis by TDI represents a powerful non invasive tool for assessment of diastolic dysfunction in SLE patients.
2) Increasing disease activity and duration increase diastolic dysfunction incidence.
3) An E/Em value >15 is usually associated with diastolic dysfunction.
Tei index is a good predictor of both systolic and diastolic functions of the heart