Background/Purpose: Screening for cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) remains controversial, however, there is agreement in considering echocardiography as the most immediate and simple approach to obtain reliable markers of right ventricle (RV) performance. (1) When RV systolic function adaptation fails, the RV becomes uncoupled from pulmonary circulation and dilates to preserve flow output at a price of systemic congestion. It has been reported that evaluation of RV functional state by using the relationship between the tricuspid annular plane systolic excursion (TAPSE) and the pulmonary artery systolic pressure (PASP) as a surrogate for the RV length-force, is of clinical prognostic relevance. (2) Objective: Assess RV function by TAPSE/PASP ratio in RA-patients and as compared to controls.

Methods: A case-control study with Hispanic RA-patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and matching controls were included. Exclusion criteria: poor acoustic window, prior atherosclerotic CV disease and overlap syndromes. Patients were matched using age, sex and CV comorbidities. Transthoracic echocardiogram was performed by a board-certified cardiologist, and reviewed by two cardiologists. TAPSE was measured as the total displacement of the tricuspid annulus (mm) from end-diastole to end-systole and PASP was estimated using the modified Bernoulli equation, according to ASE’s guidelines.

Results: A total of 76 RA-patients and 52 matched controls were included. Demographic and clinical characteristics of both groups are shown in Table 1. As shown in Table 2, the mean TAPSE/PASP ratio was significantly lower in RA-patients than controls (0.89 ± 0.29 vs 1.02 ± 0.28, P=0.016). TAPSE/PASP ratio showed significant correlation with age (r= -0.24, P=0.03) and null correlation with disease duration (r=0.2, P=0.08) and DAS 28-CRP (r=0.05, P=0.69).

Conclusion: TAPSE/PASP was reduced in RA-patients compared to controls. This ratio correlates with RA-patients age. TAPSE/PASP estimated by echocardiography may detect early RV dysfunction in RA. Larger studies are needed to determine the utility of TAPSE/PASP ratio to detect CV disease in Hispanic RA-patients.

1) Fine NM, et al. Evaluation of myocardial function in patients with RA using strain imaging by speckle-tracking echocardiography. Ann Rheum Dis. 2014;73(10):1833–9.

2) Guazzi M, et al. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure. AJP Hear Circ Physiol. 2013;305(9):H1373–81.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/echocardiographic-markers-of-right-ventricle-dysfunction-in-hispanic-patients-with-rheumatoid-arthritis-a-case-control-study/