Myocardial dysfunction is linked to endothelial dysfunction in JIA patients: a study of novel aortic circumferential strain.

Background: Accelerated vascular stiffness and myocardial dysfunction in juvenile idiopathic arthritis have been established. However, the relationship between these two conditions remains under investigated in the literature. The aim of this study was to determine whether there is any correlation between the extent of vascular and myocardial involvement in JIA patients.

Methodology: For this purpose, 22 JIA patients and an equivalent number of controls were investigated by flow-mediated dilation (FMD) of the brachial artery and aortic circumferential strain (ACS) for the measurement of vascular function, in addition to 3D speckle tracking echocardiography and global longitudinal strain (GLS) for left ventricular function. The degree of inflammation in JIA patients was estimated via the JADAS-10 score.

Results: Both ACS and FMD were impaired in cases compared with controls (median value in cases 15 vs. 21 in controls); similarly, GLS was significantly reduced in cases (median value 17) compared with controls (22). There was a significant correlation between ACS and GLS, indicating an intimate relationship between both conditions. Impaired vascular relaxibility was associated with increased JADAS scores, suggesting a negative effect of inflammation on accelerated vascular degeneration.

Conclusion: There is currently an increasing body of evidence that cardiovascular disease partly results from low-grade inflammation, and there are also speculations that subtle myocardial dysfunction results from vascular involvement with impaired coronary relaxibility. We believe that this study adds more evidence to the latter. More studies involving more patients, notably at the molecular level, are needed to validate these results and to further understand their mechanisms.