Abstract
ObjectivesThe cross-sectional study aimed to assess left ventricular systolic function using global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) and arterial stiffness using cardio-ankle vascular index (CAVI) in Thai adults with rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD).MethodsConfirmed RA patients were selected from a list of outpatient attendees if they were 18 years (y) without clinical, ECG and echocardiographic evidence of CVD, diabetes mellitus, chronic kidney disease, and excess alcoholic intake. Controls were matched with age and sex to a list of healthy individuals with normal echocardiograms. All underwent STE and CAVI.Results60 RA patients (females = 55) were analysed. Mean standard deviation of patient and control ages were 50 ± 10.2 and 51 ± 9.9 y, respectively, and mean duration of RA was 9.0 ± 6.8 y. Mean DAS28-CRP and DAS28-ESR were 2.9 ± 0.9 and 3.4 ± 0.9, respectively. There was no between-group differences in left ventricular ejection fraction (LVEF), LV sizes, LVMI, LV diastolic function and CAVI were within normal limits but all GLSs values was significantly lower in patients vs. controls: 17.6 ± 3.4 vs 20.4 ± 2.2 (p = 0.03). Multivariate regression analysis demonstrated significant correlations between GLSs and RA duration (p = 0.02), and GLSs and DAS28-CRP (p = 0.041).ConclusionsPatients with RA and no clinical CV disease have reduced LV systolic function as shown by lower GLSs. It is common and associated with disease activity and RA disease duration. 2D speckle-tracking GLSs is robust in detecting this subclinical LV systolic dysfunction.
Highlights
Rheumatoid arthritis (RA) is a systemic autoimmune disease, characterised by chronic joint inflammation and destruction
We hypothesized that global longitudinal strain (GLS) and cardio-ankle vascular index (CAVI) may be associated with Left ventricular (LV) functional and structural change, respectively, in patient with rheumatoid arthritis (RA) and no clinical CV disease
He had echocardiographic-LVH (LVMI 122 g/m2 and 110 g/m2 by M-mode and 2-D, respectively) and borderline CAVI (8.8), and (ii) a female who was lost to follow-up; her echocardiogram and CAVI were within normal limits
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune disease, characterised by chronic joint inflammation and destruction. Extra-articular organ involvement, such as the skin, eyes, heart, lungs, and blood vessels may cause clinically significant pathology and affect clinical outcomes and quality of life. Compared to the general population, patients with RA have a 8–15 year reduced life expectancy [1] due principally to cardiovascular complications, most commonly atherosclerotic diseases. GLS) to assess subclinical LV systolic dysfunction [15] and measured the cardio-ankle vascular index (CAVI) to evaluate arterial stiffness (LV afterload). CAVI is a simple bedside tool to estimate the combined stiffness of the aorta, iliac, femoral, and tibial arteries. Arterial stiffness may affect the structure and function of the left ventricle [16]. We hypothesized that GLSs and CAVI may be associated with LV functional and structural change, respectively, in patient with RA and no clinical CV disease
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