THU0125 IMPACT OF DISEASE ACTIVITY IN THE LEFT VENTRICULAR SYSTOLIC MYOCARDIAL FUNCTION OF PATIENTS WITH RHEUMATOID ARTHRITIS: A CASE-CONTROL STUDY

Abstract

Background:Patients with Rheumatoid Arthritis (RA) have higher incidence of cardiovascular diseases (CVD) compared to general population. There is controversy about the impact of RA disease activity on left ventricular systolic function (LVSF)1. LVSF may be assessed by conventional methods like left ventricular ejection fraction (LVEF) and myocardial shortening or by novel techniques evaluating myocardial strain such as speckle tracking echocardiography (STE).Objectives:To assess the impact of RA disease activity on LVSF using ejection fraction and myocardial strain by STE.Methods:Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled the 2010 ACR/EULAR classification criteria and matched controls were included. Patients with a poor US window, history of previous CVD (ischemic heart disease, cerebrovascular accident or peripheral arterial disease) and pregnancy were excluded. Individuals were evaluated using two-dimensional speckle tracking echocardiography performed and reviewed by 2 certified echocardiographers. LVEF and myocardial strains (circumferential, longitudinal and radial) were measured; differences were solved by consensus. Descriptive analysis was done with measures of central tendency and dispersion. Student-t and Mann-Whitney U tests were used for comparisons.Results:A total of 140 subjects were included. Demographic and clinical characteristics are shown in Table 1. RA patients were divided in 2 groups, according to disease activity by DAS 28-CRP (remission or low activity and moderate or high activity). Echocardiographic comparisons between RA and controls and between the 2 groups in which RA patients were divided by disease activity are shown in Table 2. The LVEF was lower in RA subjects compared with controls (p=0.022), however LVEF was normal (> 52% in men and >54% in women) in both groups. There was a significant difference in the circumferential strain (CS) between RA patients based on the disease activity by DAS 28-CRP (p=0.006).Table 1.Demographic and clinical characteristics.RA(n= 70)Control(n= 70)PFemale, n (%)67 (95.7)69 (98.6)NSAge, mean ± SD52,4±6,752,0±6,1NSType 2 Diabetes Mellitus, n (%)9 (12.9)7 (10)NSHypertension, n (%)14 (20)16 (22.9)NSDyslipidemia, n (%)16 (22.9)17 (24.3)NSActive smoking, n (%)11 (10.9)8 (16.3)NSDisease duration, years,median (q25 –q75)8.0(3.0-15.0)--DAS-28-PCR, median (q25 –q75)3.2(2.1-3.9)--Table 2.Echocardiographic findingsLVEFPCSPRA, mean ± SD63.0±4.30.022-16.4±4.5NSControls, mean ± SD64.7±3.8-16.2±4.1LVEFPCSPRemission or low disease activity, median (q25 –q75)64.0(60.0-66.0)NS-15.1(-17.2- -12.2)0.006Moderate and high diseases activity, median (q25 –q75)63.0(60.0-66.0)-18.1(-22.0- -13.9)LVEF= Left ventricular ejection fractionCS= Circumferential strainConclusion:The decrease in the circumferential strain depends on the disease activity. Myocardial strain by speckle tracking echocardiography may detect early myocardial dysfunction in RA. It is important for the rheumatologist to establish an appropriate treatment in order to achieve the disease remission or a low disease activity, as there is an impact of the disease activity on the myocardial function.