Background/Purpose: Congestive heart failure (CHF) is a major contributor to morbidity and mortality in patients with 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 can be used to assess early left ventricular (LV) dysfunction. It is critically important to differentiate between the effects of disease and those of biological treatment on LV regional function, since this distinction may have important implications for long-term management of RA. This study aimed to assess LV regional function in RA patients and to determine the impact of biological treatment using global circumferential and longitudinal strain values, assessed by CMR.

Methods: RA patients and controls without cardiac symptoms were enrolled, and those 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 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 CMRI. 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. GLS and GCS were calculated in the 16 LV segments. Group comparisons were made using the Wilcoxon rank sum test, Fisher’s exact test, and Steel test where appropriate.

Results: We compared 100 patients with RA (86% women; mean age, 55.3±10.3 years) with 30 healthy controls (100% women; mean age, 55.7±4.5 years). No statistically significant differences in cardiovascular risk (CV) factors were observed in the characteristics between the patients and the healthy controls. GCS was significantly reduced by 27% in the RA group compared to controls (p=0.017). Furthermore, GCS was significantly lower by 17% in the nbDMARD group than in the bDMARD group (p=0.035). GCS in the RA group was associated with the Simplified Disease Activity Index (SDAI) (p=0.05). 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 22% compared to the control group (p=0.027). GLS in the RA group was not associated with CV risk factors or RA status. GLS was lower by 16% in the nbDMARD group than in the bDMARD group (p=0.049). GLS tended to be associated with the SDAI.

Conclusion: This prospective study assessed LV regional dysfunction in RA, using global circumferential and longitudinal strain values on CMR. Subclinical LV regional dysfunction of GCS and GLS was prominent in RA patients without cardiac symptoms. Biologic treatment may normalize LV regional dysfunction, associated with a reduction in disease activity in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-biological-treatment-on-left-ventricular-regional-dysfunction-in-rheumatoid-arthritis-patients-determined-with-global-circumferential-and-longitudinal-strain-values-using-cardiac-magnetic-re/