Three-dimensional Echocardiography for the Early Detection of Cardiac Dysfunction in Patients with Rheumatoid Arthritis

Abstract Background Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease. Left atrial (LA) dysfunction is strongly linked to cardiovascular diseases, and the early detection of LA function in patients with RA is vital. Real-time three-dimensional echocardiography (RT-3DE) offers a noninvasive method to assess the structure and function of the LA. Aim of the study To assess LA volumes and phasic function in patients with RA using 3D transthoracic echocardiography. Materials and Methods This prospective case-control study included 162 subjects classified into two groups: Group 1 included 82 patients with RA, subdivided into an active RA group (n = 40) and an inactive RA group (n = 42), and Group 2 included 80 healthy matched controls. All study participants were examined using 2D and 3D transthoracic echo-cardiography. Results Diastolic dysfunction was significantly greater in patients with moderate and severe disease activity than in patients with mild disease activity. RT-3DE analysis of RA groups showed significantly higher maximum, minimum, and pre-atrial LA volumes compared to controls (p <0.01), and these volumes were significantly higher in the active RA group than in the inactive RA group (p <0.01). We also found significantly lower LA passive ejection fraction (EF) and active EF in both RA groups than the control group (p <0.01), and significantly lower total EF in the active RA group than the inactive RA group (p <0.01). Conclusion Patients with RA had increased 3D LA volumes and impaired mechanical function, especially in active RA. RT-3DE provides an accurate measurement of LA volumes and function, being a feasible and reproducible method in clinical applications.