Background/Purpose: Individuals with RA have a 1.5-2.0 fold higher risk of developing congestive heart failure (CHF) than the general population. It is important to understand more about subclinical left ventricular (LV) dysfunction, which can be a strong predictor of clinical CHF. There is an increasing interest in using noninvasive cardiac imaging biomarkers to diagnose subclinical myocardial dysfunction. Feature tracking cardiac magnetic resonance (CMR) imaging is a novel post­processing technique increasingly being used to assess regional myocardial function. Especially, LV global longitudinal peak systolic strain (GLS) is a prognostic indicator of adverse cardiovascular outcomes in various patient populations, and global circumferential peak systolic strain (GCS) is a predictor of CHF in the general population. We previously reported that a high prevalence of myocardial abnormalities assessed by CMR were observed in patients with RA. Our current prospective study aimed to evaluate the association of regional function with myocardial abnormalities by using feature tracking CMR imaging in patients with RA without cardiac symptoms.

Methods: Patients with RA without cardiac symptoms were enrolled. Patients with RA and control subjects with no history and/or clinical findings of systemic and pulmonary hypertension, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia underwent contrast CMR imaging. Patients with RA received conventional synthetic DMARD (csDMARD) or biologic DMARD (bDMARD). All study subjects underwent evaluation of LV regional function, as measured by feature tracking CMR imaging. The GLS and GCS were calculated by the feature tracking of cine MRI in 6 segments of the mid-slice of the left ventricle. Late gadolinium enhancement (LGE) was obtained to assess myocardial fibrosis. Group comparisons were made using the Wilcoxon rank sum test, Fisher exact test, and Steel test, as appropriate. Multivariable linear regression analyses of the correlates were performed.

Results: We evaluated 70 patients with RA (88% women; mean age, 55.2±9.0 years); 30% of them had positive LGE. The GCS in the LGE positive group decreased more than that in the LGE negative group (p=0.001). However, the GLS tended to decrease in the LGE positive group compared to the LGE negative group. The GCS was associated with the LGE positive group (p=0.05). However, RA characteristics were not associated with the GCS. The GLS tended to be associated with the LGE positive group (p=0.07). The GCS was decreased more in the csDMARD group than in the bDMARD group (p=0.04). However, there were no differences in the GLS between the csDMARD and bDMARD groups. Results of multivariable analysis showed that the GCS was independently associated with positive LGE (area under the curve 0.75).

Conclusion: This is the first study to report an association between LV regional function and myocardial abnormalities in patients with RA. LV regional dysfunction may predict the myocardial abnormalities observed in patients with RA without cardiac symptoms. Longitudinal studies are required to determine whether the GCS predicts those who will develop clinical CHF.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/global-circumferential-strain-by-assessed-a-feature-tracking-cardiac-magnetic-resonance-cmr-imaging-was-associated-with-myocardial-fibrosis-in-ra-patients/