Background Patients with rheumatoid arthritis (RA) are at an increased for cardiovascular disease (CVD), however optimal strategies to evaluate for sub-clinical CVD in RA patients are not well characterized. Myocardial strain (S) imaging by echocardiography has increased sensitivity for detecting early abnormalities of cardiac function, and may be an effective screening tool for CVD in RA
Objectives To characterize the ventricular myocardial systolic longitudinal S patterns of RA patients with and without known CVD.
Methods One-hundred RA patients who underwent standard transthoracic echocardiography were selected from a population-based sample. All patients had normal left ventricular (LV) ejection fraction (EF) and visual assessment of right ventricular (RV) function. RA patients were selected on the basis of LV diastolic dysfunction (DD), and categorized as none (40), mild (40), and moderate/severe (20). Longitudinal ventricular systolic S analysis was performed using velocity vector imaging software and compared with a sample of 50 age and gender matched control subjects without CVD or risk factors.
Results The mean age of RA patients and control subjects was 62.1 (±13.2) and 63.2 (±4.7) years respectively (p=0.68), 75 (75%) and 33 (66%) were female, respectively (p=0.25). Among RA patients, the mean duration of disease and C-reactive protein were 10.2 (±6.4) years and 3.9 (±4.4) mg/L, respectively, and 73% were rheumatoid factor positive. Fourteen (14%) RA patients (14%) had a prior history of coronary artery disease. The mean LV EF of RA patients and control subjects was 62.6 (±5.2) % and 63.4 (±3.9) %, respectively (p=0.30). Global LV S (-15.3±3.0% versus -17.2±2.6%, p<0.001) and RV S (-17.6±4.6% versus -19.5±2.8%, p=0.001) were impaired in patients with RA compared to control subjects. In contrast to control subjects in whom LV S was uniform from base to apex (basal –17.4±2.7%, middle –17.5±2.7%, apical –16.8±3.3%, p=0.049), patients with RA had the preserved strain in the base with worst strain in the apical segments (basal –17.0±4.0%, middle –15.1±2.9, and apical –13.9±4.1%, p<0.001). In RA patients, abnormalities in LV and RV S did not correlate with diastolic dysfunction. There was no difference in global LV and RV S in RA patients with and without CVD (–15.4±2.0% versus –15.3±3.1%, p=0.68 and –17.5±3.6% versus –17.6±4.8%, p=0.93). Univariate regression analysis of RA patients demonstrated a significant correlation between global LV S and RA disease severity measures, including; health assessment questionnaire disability index (p=0.022), prior use of oral steroids (p=0.026) and methotrexate (p=0.021), presence of radiographic damage (p=0.042), and history of foot or ankle swelling (p=0.048).
Conclusions Despite normal LV ejection fraction, global longitudinal LV and RV S were impaired in patients with RA compared with healthy control subjects, and were most significantly impaired in the LV apex. Abnormalities in S correlated with RA disease severity. These findings suggest that myocardial S imaging by echocardiography may detect early myocardial dysfunction in patients with RA.
Disclosure of Interest None Declared
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