Speckle-tracking Echocardiography is More Sensitive in Detecting Subclinical Myocardial Dysfunction in Patients with Rheumatoid Arthritis

Abstract

Introduction: Patients with rheumatoid arthritis (RA) have shorter life expectancy and their risk of cardiovascular death is more than 50% higher than the rest of the population. Early myocardial dysfunction may be detectable more precisely and sooner using speckle tracking echocardiography. Method: Cross-sectional study enrolled 55 patients with RA (mean age 44.1 years) without known cardiovascular disease and 31 healthy controls, matched for age, sex, blood pressure, BMI and smoking habit. All subjects underwent a standard echocardiographic and Doppler examination (isovolumic contraction and relaxation times (IVCT and IVRT), mitral valve inflow curve (E/A), septal mitral annular motion (e'), and E/e' ratio) as well as the speckle tracking assessment of left ventricle strains and strain rates. Results: In standard echocardiographic examination RA patients exhibited higher indexed left ventricle mass (96.4 ± 20.9 g/m2 vs. 95.8 ± 21.9 g/m2; p=0.013), lower ejection fraction (64 ± 4% vs. 67 ± 4%; p=0.011) and prolonged IVCT (61.5 ± 9.3 ms vs. 53.7 ± 8.95 ms; p=0.001). Diastolic dysfunction was demonstrasted by prolonged IVRT (81.6 ± 9.6 ms vs. 74.6 ± 12.0 ms; p=0.007) as well as by higher E/e’ ratio (8.2 ± 1.8 vs. 7.2 ± 1.5; p=0.009). Speckle tracking method detected decreased global longitudinal epicardial strain (-19.5% vs. -21.5%; p=0.049). Global longitudinal epicardial strain (GLES) correlated with IVCT and IVRT, disease duration and with marker of myocardial damage NTproBNP. RA pts exhibited higher prevalence of markers of myocardial damage (defined as presence NT-proBNP ≥ 125 ng/l or IVRT ≥ 74 ms or IVCT ≥ 57 ms or GLES ≥ -20.0%) 2.2 ± 1.0 vs. 1.3 ± 1.0 (p=0.001), RR 1.97 (95% CI: 1.24–3.15; p=0.004) in comparison with controls. Conclusions: RA patients without known cardiovascular disease exhibited almost two times higher risk for detection of myocardial damage defined as impaired systolic or diastolic function or myocardial contraction deformity parameters or NT-pro-BNP as compared to matched controls. Speckle-tracking echocardiography significantly revealed incipient myocardial dysfunction, which correlates with clinical RA characteristics and other markers of cardiac damage.