Background/Purpose: Cardiac involvements cause of morbidity and mortality globally in rheumatoid arthritis (RA). Myocardial disease is typically clinically silent, only manifesting as myocardial dysfunction after an extended preclinical phase. Feature tracking (FT) cardiac magnetic resonance (CMR) imaging could reliably be used to assess myocardial function in patients with early dysfunction. Left ventricular (LV) global longitudinal peak systolic strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations. Global circumferential peak systolic strain (GCS) is a predictor of congestive heart failure. We sought to measure GLS and GCS by using FT-CMR approach in RA patients without cardiac symptoms. Furthermore, we aimed to evaluate the association of GLS and GCS with RA status and severity.

Methods: RA patients and controls without cardiac symptoms were enrolled. RA patients 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 a non-contrast CMR. Patients with RA were administered non-biologic disease-modifying antirheumatic drugs (nbDMARDs) or biologic DMARDs (bDMARDs). All subjects underwent evaluation of LV regional function, as measured by FT-CMR. GLS and GCS were calculated in the sixteen segments of the whole LV. Group comparisons were made using the Wilcoxon rank sum test, Fisher’s exact test and Steel test where appropriate.

Results: We compared 90 patients with RA (95% women; mean age, 59.5±9. 0 years) with 30 healthy controls (100% women; mean age, 55.7±4.5 years). No statistically significant differences were observed in the characteristics between the patients and the healthy controls in cardiovascular risk (CV )factors. GCS was significantly reduced by 31% in the RA group compared to controls (p=0.011). Furthermore, GCS was significantly lower in the nbDMARD than in the bDMARD group (p=0.04). GCS in the RA group was associated with the Simplified Disease Activity Index (SDAI) and levels of matrix metalloprotease 3 (MMP3) (p=0.03, p=0.02, respectively). GCS in the RA group was not associated with CV risk factors or other RA status. GLS in the RA group was significantly reduced by 21% compared to the control group (p=0.05). GCS in the RA group was not associated with CV risk factors or RA status. GLS tended to be lower in the bDMARD group than in the nbDMARD group. GLS tended to be associated with only the SDAI.

Conclusion: This prospective study is among the largest studies of LV regional dysfunction in RA, assessed by FT-CMR, and the only study to explore the multivariable associations of RA characteristics with CMR-assessed GSC and GLS. Subclinical LV regional dysfunction was prominent in the RA patients without cardiac symptoms. We demonstrated the association of GCS with disease activity and MMP3. Longitudinal studies are required to track whether the regional dysfunction we observed predict those destined to develop clinical cardiac involvements.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/detection-of-left-ventricular-regional-function-in-rheumatoid-arthritis-patients-without-cardiac-symptons-as-assessed-by-feature-tracking-cardiac-magnetic-resonance-imaging/