Subclinical ventricular dysfunction in rheumatoid arthritis

Abstract

Introduction

Cardiovascular disease, especially heart failure, is often under diagnosed in patients with rheumatoid arthritis (RA). Heart failure in RA patients presents with distinctives features, such as preserved ejection fraction and higher mortality rates compared to the non-RA population. Despite its accessibility and safety, echocardiography has not been widely recommended for screening in this patient population.

Objective

In our study, we aimed to assess the utility of speckle tracking echocardiography in detecting sub clinical ventricular dysfunction

Method

We conducted a prospective study that included 36 patients with RA who were being treated at the rheumatology department of the military hospital in Tunis. Weal so enrolled 36 control cases who had undergone echocardiography at the cardiology department of the same hospital, selected based on age, sex, and BMI to match the first group.

Results

The mean age of the participants was 51.69 ± 12.14 years, with a predominance of females, resulting in a sex ratio of 0.33. The mean Body mass index (BMI) was28.17 ± 4.27 kg/m². Diabetes mellitus (DM) was the most common comorbidity, occurring in 9 patients (25%). There were no statistically significant differences between the RA and control groups in terms of matching parameters (age, sex, and BMI). No statistically significant differences were observed between the two groups in terms of left ventricular measurements and systolic function, all of which fell within normal ranges, with a median left ventricular ejection fraction (LVEF) of71%. However, the study of diastolic function revealed that 19% of RA patients and 14% of control subjects had grade I diastolic dysfunction, all of whom were over 50 years of age, and none exhibited high filling pressures. When comparing Global Longitudinal Strain (GLS) measurements between the two groups, it was evident that RA patients had significantly lower GLS (P = 0.015) than the control group, and sub clinical left ventricular systolic dysfunction was observed exclusively in RA patients. Age and diabetes mellitus were both found to be correlated with GLS in RA patients. Age at the time of RA diagnosis exhibited a weak correlation with GLS (r = −0.305, P = 0.07).

Conclusion

Rheumatoid arthritis emerges as a risk factor for cardiovascular disease. The study of myocardial deformation offers a valuable method for screening sub clinical myocardial lesions and facilitating early therapeutic intervention.