Early detection of Asymptomatic Myocardial Dysfunctions in Rheumatoid Arthritis Patients: A New Approach

Abstract

Background: Cases of rheumatoid arthritis [RA] are characterized by a decreased life expectancy, as well as a 50% are at greater risk of developing cardiovascular diseases [CVD] compared to other subjects. Precocious myocardial dysfunction can be detected more accurately and faster with speckle -tracking Echocardiography.The aim of the work: This study attempts to evaluate the function of myocardial Left ventricular [LV] systole via Speckle Tracking Echocardiography [STE] strain imaging in RA cases with the absence of [CVD] and to correlate the results with the disease features.Patients and Methods: A case control study, which recruited 60 RA cases [with a median age of 46.22 ± 8.14 years] without known CVD, as well as 60 healthy controls.Results: Assessment of speckle-tracking for [LV] systolic function revealed diminished Global Longitudinal Strain [GLS] in patient group [-16.80% vs. -22.35%, PP<0.001]. A negative association has been detected between RA as well as GLS duration [r = - 0.301]. Receiver operating characteristics [ROC] curve was utilized to determine the optimal cut-off value GLS value that was -20, with 76.7% sensitivity, 80% specificity, 92% positive predictive value, 63% negative predictive value, as well as with 83.9% diagnostic accuracy.Conclusion: GLS measurement using STE is valuable in detecting impairment of left ventricle systolic function in RA patients, even in the presence of normal ejection fraction. Not only that but also, the degree of systolic function impairment is correlated to RA disease activity. This raises the concern that inappropriate management of RA activity could lead to development of CVD.

Keywords

• rheumatoid arthritis
• speckle tracking
• cardiovascular disease
• left ventricular longitudinal strain