Right ventriculoarterial coupling as a marker of subclinical myocardial damage in rheumatoid arthritis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The lung involvement in autoimmune diseases has been described previously. Currently the incidence of pulmonary hypertension in patients with rheumatoid arthritis (RA) ranges from 1-25%. Right ventriculoarterial coupling (RVAC) is altered early before presenting right ventricular dysfunction and pulmonary hypertension, its measurement in patients with RA has been barely studied. Objectives To determine if there is a difference in RVAC in patients with RA. Analyze if there are differences in patients with normal vs abnormal right RVAC. To investigate if there is an association in patients with RA to present abnormal RVAC. Methods A single-center, analytical, cross-sectional, observational study was performed. Patients with diagnosis of RA were included according to the ACR / EULAR 2010 classification criteria, without any other comorbidity. An ACUSON SC2000 echocardiogram was used. Patients were compared with healthy controls matched by age and gender. The clinical, laboratory and echocardiographic variables were contrasted. Among the echocardiographic variables, the left ventricular ejection fraction, the left ventricular volume index, the left atrial volume index, right ventricular diastolic area, right ventricular fractional area change (RV FAC), right atrial volume, pulmonary artery systolic pressure (PASP), right ventricular free wall longitudinal strain (RVFWLS) and right atrial global longitudinal strain (RAGLS). The RVAC was determined with the RVFWLS / PSAP ratio. A RVAC less than 0.8 was classified as abnormal. The quantitative variables were contrasted with Student"s t-test or Mann-Whitney"s u test, according to the normality of the variables; qualitative variables were compared with x2. The association with an abnormal RVAC was determined with univariate and multivariate analysis. Results Thirty-four patients were included in each group. Among the echocardiographic variables, it was found that patients with RA had a greater right ventricular diastolic area and the PASP; while the RV FAC, the RVFWLS and the RVAC were lower. 68% of the RA patients had an abnormal RVAC, and C-reactive protein (CRP) levels were higher in patients with an abnormal RVAC.  In the multivariate analysis, we found that patients with RA and CRP levels were independently associated to an abnormal RVAC. Conclusion The right ventricular subclinical myocardial damage, determined by the RVAC, is present in patients with rheumatoid arthritis. CRP levels and rheumatoid arthritis were associated with an abnormal ventriculoarterial coupling. Abstract Table 1  Abstract Table 2