Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease

Abstract

Objectives: The cross-sectional study aimed to assess left ventricular systolic function using global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) and arterial stiffness using cardio-ankle vascular index (CAVI) in Thai adults with rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). Methods: Confirmed RA patients were selected from a list of outpatient attendees if they were 18 years (y) without clinical, ECG and echocardiographic evidence of CVD, diabetes mellitus, chronic kidney disease, and excess alcoholic intake. Controls were matched with age and sex to a list of healthy individuals with normal echocardiograms. All underwent STE and CAVI. Results: 60 RA patients (females = 55) were analysed. Mean standard deviation of patient and control ages were 50 ± 10.2 and 51 ± 9.9 y, respectively, and mean duration of RA was 9.0 ± 6.8 y. Mean DAS28-CRP and DAS28-ESR were 2.9 ± 0.9 and 3.4 ± 0.9, respectively. There was no between-group differences in left ventricular ejection fraction (LVEF), LV sizes, LVMI, LV diastolic function and CAVI were within normal limits but all GLSs values was significantly lower in patients vs. controls: 17.6 ± 3.4 vs 20.4 ± 2.2 (p = 0.03). Multivariate regression analysis demonstrated significant correlations between GLSs and RA duration (p = 0.02), and GLSs and DAS28-CRP (p = 0.041). Conclusions: Patients with RA and no clinical CV disease have reduced LV systolic function as shown by lower GLSs. It is common and associated with disease activity and RA disease duration. 2D speckle-tracking GLSs is robust in detecting this subclinical LV systolic dysfunction.

Disease severity affects myocardial functions in patients with treatment‐naive early rheumatoid arthritis

“…We measured disease activity with DAS28‐CRP 14 . Herein, DAS28‐CRP ≥ 5.1 was accepted as severe disease activity 15 …”

“…After that, patients having positivity in both serologic tests and severe disease activity classified the outcome group and were compared with the rest. Predictors chosen from the latter test were analyzed by unique multivariate model 15,19 …”

The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside

“…Although data suggest that ANS imbalance is detrimental for cardiovascular disease, including cardiac arrhythmias, hypertension (137), and increased mortality (138,139), breaking through the original trigger of this vicious circle with ultimate damage of the cardiovascular system is particularly difficult. Moreover, patients with RA without clinical cardiovascular disease have reduced left ventricular systolic function assessed by global longitudinal strain by speckle-tracking echocardiography, and it is related with disease activity (140).…”

Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications

“…In patients with normal ejection fraction (EF), a ratio of E/e’ >14, tissue Doppler e’ velocity of the interventricular septum <7 cm/s or tissue Doppler e’ velocity of the lateral wall >10 cm/s, left atrial volume index >34 mL/m 2 and tricuspid regurgitation maximum velocity >2.8 m/s are findings consistent with elevated filling pressures [ 32 ]. Myocardial dysfunction has been associated with high disease activity and duration in RA [ 33 , 34 ].…”