Session Information
Date: Tuesday, November 12, 2019
Title: RA – Diagnosis, Manifestations, & Outcomes Poster III: Comorbidities
Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Although cardiovascular (CV) risk and mortality are increased in rheumatoid arthritis (RA) and spondyloarthritis (SpA), mechanisms resulting in CV risk excess and stratification are still unclear. Myocardial deformation imaging (expressed as myocardial strain) allows early detection of CV disease (CVD). The objective of the study was to assess subclinical myocardial dysfunction by 2D speckle tracking imaging in patients without known CVD and to compare to controls.
Methods: Two-dimensional and Doppler echocardiography with strain analysis was performed before initiating first biologic DMARD in patients with RA and SpA, and without CVD and CV risk factors (arterial hypertension, diabetes and known atherosclerosis). Myocardial strain measured by 2D speckle tracking echocardiography provides reliable information about regional and global ventricular function. The strain is described as the deformation of an object normalized to its original shape and size. The strain can be analyzed in the longitudinal, circumferential and radial displacements of the left ventricle. Global Longitudinal Strain (GLS), used in this study, is negative due to left ventricular shortening in the course of contraction. The more the contraction is significant, the more the strain is negative. Abnormal GLS was defined by a value > -18.5 %. RA and SpA patients were compared to age- and sex-matched controls with normal echocardiography and no CVD or risk factors. Associations between GLS and disease characteristics were analyzed.
Results: 22 RA patients (mean age 55.9 ± 10.1 years, 77 % women, median disease duration 5.8 years, mean DAS28 4.4 ± 1.3) and 25 axial SpA (mean age 43.3 ± 0.3, 44 % men, mean disease duration 9 years, mean BASDAI 57 ± 12) were analyzed. At baseline, RA patients had worse GLS compared to controls (-20.1 ± 2.2 vs -21.5 ± 1.4, p=0.01). Moreover, GLS was not in the normal range in 5 RA (22.8%), while none of the controls had altered GLS (p=0.02). In SpA patients, mean GLS was not different from controls (-21.7 ± 0.68 vs -20.8 ± 1.7, p=0.60). However, 8 SpA patients (32 %) and 4 controls (16 %) had an abnormal GLS (p=0.01). Among these 8 patients, treatment with TNF inhibitor during 1 year improved GLS (-17.8 ± 1 vs -21.7 ± 1.9 p=0.002) and normalized the value in 6 of the 8 patients. For RA and SpA, no significant associations were found between baseline GLS and disease duration, activity (DAS28, BASDAI, ASDAS-CRP), disability (BASFI, HAQ), systemic inflammation (CRP). Patients with SpA and radiographic sacroiliitis (-19.9 ± 1 vs -22.6 ± 0.68 p=0.05) or HLA B27 positivity (-20.8 ± 0.67 vs -24.5 ± 1.34 p=0.05) had worse GLS.
Conclusion: This study confirms a subclinical myocardial dysfunction in active RA and SpA patients without known CVD and CV risk factors compared to controls. In SpA patients, strain abnormalities seem to be improved with anti-TNF treatment.
To cite this abstract in AMA style:
CLERFOND G, VILLEDON DE NAIDE M, ALLEMAND C, ULMANN L, ESCHALIER R, SOUBRIER M, Pereira B, TOURNADRE A. Subclinical Myocardial Dysfunction Assessed by Strain Imaging in Patients with Rheumatoid Arthritis and Spondyloarthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/subclinical-myocardial-dysfunction-assessed-by-strain-imaging-in-patients-with-rheumatoid-arthritis-and-spondyloarthritis/. Accessed .« Back to 2019 ACR/ARP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-myocardial-dysfunction-assessed-by-strain-imaging-in-patients-with-rheumatoid-arthritis-and-spondyloarthritis/