POS1392 TISSUE DOPPLEROGRAPHY AS A DIAGNOSTIC TOOL FOR MYOCARDIAL DYSFUNCTION IN PATIENTS WITH RHEUMATIC DISEASES

Abstract

BackgroundPathology of the cardiovascular system has a significant impact on the mortality rate in the population of patients with rheumatic diseases, including rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Involvement of the cardiovascular system determines the course and prognosis of many rheumatic diseases. In the general population, left ventricular diastolic dysfunction is an independent predictor of mortality and symptomatic chronic heart failure. However, routine screening for diastolic dysfunction is rarely performed in patients with RA and AS, especially in those who do not have clinical symptoms.Objectivesto identify early preclinical signs of myocardial dysfunction in patients with RA and AS.Methods142 people with verified rheumatic diseases were examined. All patients were divided into 2 groups. The first group consisted of patients with RA - 95 pts (average age 46.5±11.1 years). The second group consisted of patients with AS, 47 pts (average age 42.3±10.3 years). The control group included 70 healthy individuals (average age 43.7±12.1 years). All patients underwent standard laboratory and instrumental diagnostic tests, which included joint radiography (group 1), magnetic resonance imaging of the spine and ileosacral joints (group 2). In addition, we performed echocardiography and tissue dopplerography of the heart on the GE Vivid E9 ultrasound machine.ResultsThe parameters e’L, e’S, e’R were the lowest in patients with RA (9.95 [8; 12], 8.2 [6; 10], 12 [10; 14], respectively) compared to both the group with AS (11.1 [9; 13.7], 9.8 [7.2; 12], 13.1 [12; 14], respectively), and with the control group (12.1 [10; 14], 9.8 [8; 11], 13.4 [11; 15], respectively) (p<0.005). This indicates a significant deterioration in the diastolic function of both ventricles in patients with RA. We found a similar picture when comparing the systolic velocities of the fibrous ring of the left and right atrioventricular openings S’L, S’S, S’R. In the group of patients with RA, these parameters were the smallest (9.1 [8; 10], 7.4 [7; 8], 12.9 [12; 14], respectively) compared to the other two groups (p<0.0005). These results indicate a significant deterioration in the diastolic and systolic function of both ventricles in patients with RA. Diastolic dysfunction of both the left ventricle (25.3%) and both ventricles (16.8%) was more common among patients with RA compared to the control group (5.7%, 0%, respectively) (p<0.01). The same pattern was found in the group with AS: 17 and 10.6%, respectively (p<0.01). At the same time, there were no statistically significant differences between the 1st and 2nd groups. In addition, the calculation of the relative risk showed that the presence of RA 4.42 times increases the risk of developing diastolic dysfunction of the left ventricle compared with control group (CI 1.6-12.2). It should be noted that in the control group, diastolic dysfunction of the left ventricle was diagnosed only type 1, whereas among people with RA out of 24 pts, 10 had a pseudonormal type, and among patients with AS out of 8 pts, it was detected in four pts.ConclusionPatients with RA and AS are characterized by deterioration of the diastolic function of the left ventricle or both ventricles simultaneously. Quantitative characteristics obtained during tissue dopplerography confirm these changes. In addition, in people with RA, there is also a decrease in the systolic function of both ventricles. Thus, in order to detect early myocardial dysfunction in patients with RA and AS, it is advisable to conduct not only two-dimensional echocardiography, but also tissue dopplerography.