Background/Purpose: The aim of this study was to evaluate left ventricular myocardial function with two- dimensional speckle tracking echocardiography (STE), in addition to conventional Doppler and tissue Doppler echocardiography, in order to detect subclinical left ventricular myocardial dysfunction in patients with RA.

Methods: The study involved 30 outpatients who fulfilled the 2010 ACR/EULAR) criteria for RA (11 males and 19 females; mean age 54.63±9.36 years, median disease duration 2 years), at baseline at after 18 months of treatment with anti-TNF drugs and 30 healthy controls matched in terms of age, gender and other anthropometric characteristics. All patients underwent a complete physical examination and routine laboratory analysis. Disease activity was assessed by means of Disease activity score 28 (DAS 28). Cardiovascular (CV) risk profiles were assessed by means of standard ECG, conventional and stress trans-thoracic echocardography with the measurement of CFR, carotid ultrasonography and pulse wave velocity (PWV). Two-dimensional echocardiographic images were obtained using the apical 4-chamber view at a high frame rate of 70-80 frames/s, and three cardiac cycles were stored in cine-loop format for off-line analysis using commercially available QLAB 9 software (Philips Medical System, USA) in order to assess end-systolic LV longitudinal strain (ε).

Results:

None of the patients showed any signs or symptoms of CV disease, pulmonary involvement, or any other complication. The patients’ mean LVEF and E/A ratios were respectively 58.43±3.07% and 0.75±0.35, which were not significantly different from those of the controls (60.45±5.24 % and 0.85±0.29); however, although within the normal range. The results of the speckle tracking analysis were significantly different between the two groups, with global longitudinal strain deformation in the apical 4-chamber view (Long. ε 4c) being significantly lower in the RA patients (Long ε 4c %: median 18.78, IQR 15.80-20.82 vs 20.16, IQR 19.03-21.89; p<0.05). Right and left pulse wave velocity (PWV) (PWV right, m/sec: median 7.92, IQR 7.14-8.60 vs 6.85, IQR 6.41-7.88; p=0.07 and PWV left, m/sec: median 7.90, IQR 6.99-8.16 vs 6.85, IQR 6.36-7.84; p=0.06) and right and left coronary intima media thickness (cIMT) (cIMT right, mm: median 0.90, IQR 0.75-1.08 vs 0.75, IQR 0.50-0.85; p<0.05 and cIMT left, mm: median 0.89, IQR 0.74-0.99 vs 0.74, IQR 0.49-0.85; p<0.05) values were all higher in the RA patients, and the differences of cIMT were statistically significant. Furthermore a significant improvement in Long. ε 4c of LV in RA patients at 18 months of the biological treatment was observed (Long. ε 4c %: median 18.78, IQR 15.80-20.82 vs 19.24, IQR 17.02-21.29 p<0.01) at FUP, such as a minimal reduction of arterial stiffness and cIMT parameters (p=NS).

Conclusion: LV myocardial longitudinal ε measured by means of speckle tracking echocardiography was impaired in RA patients in the absence of any clinical evidence of CV disease and echocardiographic evaluations negative. This data suggests an early myocardial alteration, but further studies are required to define more precise methods of assessing CV disease in RA population.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/non-invasive-imaging-methods-for-evaluating-the-cardiovascular-involvement-in-patients-with-rheumatoid-arthritis-before-and-after-18-months-of-treatment-with-anti-tnf-drugs/