Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis

Author(s): Mouna Brahem, Hassen Ibn Hadj Amor, Rihab Sarraj*, Imen Touil, Salma Kraiem, Ramzi Rouabhia, Ella Hmaier, Ghassen Haj Mbarek, Ameni Ben Salem, Imen Mlouki, Sana Mhamdi, Haifa Hachfi and Mohamed Younes

Volume 20, Issue 1, 2024

Published on: 22 August, 2023

Page: [72 - 81] Pages: 10

DOI: 10.2174/1573397119666230727111601

Price: $65

Abstract

Objective: In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA).

Methods: We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique.

Results: Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01).

Conclusion: Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.

« Previous Next »
Graphical Abstract

[1]
van der Woude D, van der Helm-van Mil AHM. Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2018; 32(2): 174-87.
[http://dx.doi.org/10.1016/j.berh.2018.10.005] [PMID: 30527425]
[2]
Littlejohn EA, Monrad SU. Early diagnosis and treatment of rheumatoid arthritis. Prim Care - Clin Off Prac 2018; 45(2): 237-55.
[http://dx.doi.org/10.1016/j.pop.2018.02.010]
[3]
Conforti A, Di Cola I, Pavlych V, et al. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev 2021; 20(2): 102735.
[http://dx.doi.org/10.1016/j.autrev.2020.102735] [PMID: 33346115]
[4]
Buleu F, Sirbu E, Caraba A, Dragan S. Heart involvement in inflammatory rheumatic diseases: A systematic literature review. Medicina (Kaunas) 2019; 55(6): 249.
[http://dx.doi.org/10.3390/medicina55060249] [PMID: 31174287]
[5]
Dodo-Siddo MN, Diao M, Ndiaye MB, et al. Étude des paramètres échocardiographiques de la polyarthrite rhumatoïde noire africaine asymptomatique au plan cardiovasculaire: étude transversale de 73 cas sénégalais. Ann Cardiol Angeiol (Paris) 2016; 65(2): 71-6.
[http://dx.doi.org/10.1016/j.ancard.2015.01.015] [PMID: 25702242]
[6]
Naseem M, Samir S, Ibrahim IK, Khedr L, Shahba AAE. 2-D speckle-tracking assessment of left and right ventricular function in rheumatoid arthritis patients with and without disease activity. J Saudi Heart Assoc 2019; 31(1): 41-9.
[http://dx.doi.org/10.1016/j.jsha.2018.10.001] [PMID: 30559579]
[7]
Hua C, Combe B. Les nouveaux critères de classification ACR/EULAR 2010 pour un diagnostic plus précoce de la polyarthrite rhu-matoïde. Revue du Rhumatisme Monographies 2017; 84(4): 337-42.
[http://dx.doi.org/10.1016/j.monrhu.2017.07.001]
[8]
Fransen J, van Riel PLCM. The disease activity score and the EULAR response criteria. Rheum Dis Clin North Am 2009; 35(4): 745-57. [vii-viii.]
[http://dx.doi.org/10.1016/j.rdc.2009.10.001] [PMID: 19962619]
[9]
Transthoracic Doppler echocardiography: Main indications and conditions of realization. Health Technology Assessment 2012.
[10]
Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the use of echocardiography in adult hypertension: A report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Eur Heart J Cardiovasc Imaging 2015; 16(6): 577-605.
[PMID: 25995329]
[11]
Klimczak C. Pulmonary arterial pressures 120 traps in Echocardiogra In. Elsevier 2019; pp. 205-19.
[12]
Donal E. New techniques for studying left ventricular functionGeneral Reviews Imaging 2014; 20-3.
[13]
Sengupta PP, Korinek J, Belohlavek M, et al. Left ventricular structure and function: Basic science for cardiac imaging. J Am Coll Cardiol 2006; 48(10): 1988-2001.
[http://dx.doi.org/10.1016/j.jacc.2006.08.030] [PMID: 17112989]
[14]
Gallet B. How to evaluate the diastolic function of the left ventricle by Doppler echocardiography in the year 2000 La Lettre du Cardiologue 2000; 324.
[15]
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the american society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr 2016; 29(4): 277-314.
[http://dx.doi.org/10.1016/j.echo.2016.01.011] [PMID: 27037982]
[16]
Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation 1984; 69(3): 506-11.
[http://dx.doi.org/10.1161/01.CIR.69.3.506] [PMID: 6692512]
[17]
Shenavar Masooleh I, Zayeni H, Haji-Abbasi A, et al. Cardiac involvement in rheumatoid arthritis: A cross-sectional study in Iran. Indian Heart J 2016; 68(3): 332-5.
[http://dx.doi.org/10.1016/j.ihj.2015.08.030] [PMID: 27316486]
[18]
Coşkun S, Özoran K, Mermerci B, Aydoǧdu S, Keleş T. Cardiac involvement in patients with rheumatoid arthritis. APLAR J Rheumatol 2005; 8(1): 23-31.
[http://dx.doi.org/10.1111/j.1479-8077.2005.00118.x]
[19]
Cioffi G, Ognibeni F, Dalbeni A, et al. High prevalence of occult heart disease in normotensive patients with rheumatoid arthritis. Clin Cardiol 2018; 41(6): 736-43.
[http://dx.doi.org/10.1002/clc.22926] [PMID: 29869800]
[20]
Rodrigues P, Ferreira B, Fonseca T, et al. Subclinical ventricular dysfunction in rheumatoid arthritis. Int J Cardiovasc Imaging 2021; 37(3): 847-59.
[http://dx.doi.org/10.1007/s10554-020-02057-3] [PMID: 33052554]
[21]
Kontzias A, Barkhodari A, Yao Q. Pericarditis in Systemic Rheumatologic Diseases. Curr Cardiol Rep 2020; 22(11): 142.
[http://dx.doi.org/10.1007/s11886-020-01415-w] [PMID: 32910306]
[22]
Thadani U, Iveson JMI, Wright V. Cardiac tamponade, constrictive pericarditis and pericardial resection in rheumatoid arthritis. Medicine (Baltimore) 1975; 54(3): 261-70.
[http://dx.doi.org/10.1097/00005792-197505000-00006] [PMID: 1143088]
[23]
Guedes C, Bianchi-Fior P, Cormier B, Barthelemy B, Rat AC, Boissier MC. Cardiac manifestations of rheumatoid arthritis: A case-control transesophageal echocardiography study in 30 patients. Arthritis Rheum 2001; 45(2): 129-35.
[http://dx.doi.org/10.1002/1529-0131(200104)45:2<129::AIDANR164>3.0.CO;2-K] [PMID: 11324775]
[24]
Beckhauser AP, Vallin L, Burkievcz CJ, Perreto S, Silva MB, Skare TL. Valvular involvement in patients with rheumatoid arthritis. Acta Reumatol Port 2009; 34(1): 52-6.
[PMID: 19449476]
[25]
Roldan CA, DeLong C, Qualls CR, Crawford MH. Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. Am J Cardiol 2007; 100(3): 496-502.
[http://dx.doi.org/10.1016/j.amjcard.2007.03.048] [PMID: 17659935]
[26]
Kumar KVSH, Renjith AS, Marwaha V, Aggarwal N, Koshy V, Singal VK. Prevalence of left ventricular dysfunction in rheumatoid arthri-tis. J Family Med Prim Care 2017; 6(3): 622-6.
[http://dx.doi.org/10.4103/2249-4863.214431] [PMID: 29417020]
[27]
Costanza E, Cioffi G, Ognibeni F, et al. Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic pa-tients with rheumatoid arthritis without overt cardiac disease Diastolic dysfunction in rheumatoid arthritis 2019; 89: 1-8.
[28]
Cavazzana I, Vizzardi E, Franceschini F. Diastolic dysfunction in rheumatoid arthritis: A usual travel-mate? Monaldi Arch Chest Dis 2019; 89(3): 89.
[http://dx.doi.org/10.4081/monaldi.2019.1137] [PMID: 31505913]
[29]
Lehmonen L, Vuorinen AM, Koivuniemi R, et al. One-year follow up study detects myocardial changes with cardiovascular magnetic resonance tagging in active rheumatoid arthritis. Acad Radiol 2018; 25(4): 476-85.
[http://dx.doi.org/10.1016/j.acra.2017.10.017] [PMID: 29199058]
[30]
Benacka O, Benacka J, Blazicek P, et al. Speckle tracking can detect subclinical myocardial dysfunction in rheumatoid arthritis patients. Bratisl Med J 2017; 118(1): 28-33.
[http://dx.doi.org/10.4149/BLL_2017_006] [PMID: 28127980]
[31]
Atzeni F, Gianturco L, Boccassini L, Sarzi-Puttini P, Bonitta G, Turiel M. Noninvasive imaging methods for evaluating cardiovascular involvement in patients with rheumatoid arthritis before and after anti-TNF drug treatment. Future Sci OA 2019; 5(6): FSO396.
[http://dx.doi.org/10.2144/fsoa-2018-0108] [PMID: 31285841]
[32]
Løgstrup BB, Masic D, Laurbjerg TB, et al. Left ventricular function at two-year follow-up in treatment-naive rheumatoid arthritis patients is associated with anti-cyclic citrullinated peptide antibody status: A cohort study. Scand J Rheumatol 2017; 46(6): 432-40.
[http://dx.doi.org/10.1080/03009742.2016.1249941] [PMID: 28121216]
[33]
Lo Gullo A, Rodríguez-Carrio J, Gallizzi R, Imbalzano E, Squadrito G, Mandraffino G. Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Prog Cardiovasc Dis 2020; 63(3): 327-40.
[http://dx.doi.org/10.1016/j.pcad.2020.03.005] [PMID: 32201285]
[34]
Practical measurement of the E/Ea ratio in the diagnosis of HF with preserved LVEF. Reperes Pratiques 2006.
[35]
Rudominer RL, Roman MJ, Devereux RB, et al. Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction. Arthritis Rheum 2009; 60(1): 22-9.
[http://dx.doi.org/10.1002/art.24148] [PMID: 19116901]
[36]
Kobayashi H, Kobayashi Y, Giles JT, Yoneyama K, Nakajima Y, Takei M. Tocilizumab treatment increases left ventricular ejection frac-tion and decreases left ventricular mass index in patients with rheumatoid arthritis without cardiac symptoms: Assessed using 3.0 tesla cardiac magnetic resonance imaging. J Rheumatol 2014; 41(10): 1916-21.
[http://dx.doi.org/10.3899/jrheum.131540] [PMID: 25128513]
[37]
Daïen CI, Fesler P, du Cailar G, et al. Etanercept normalises left ventricular mass in patients with rheumatoid arthritis. Ann Rheum Dis 2013; 72(6): 881-7.
[http://dx.doi.org/10.1136/annrheumdis-2012-201489] [PMID: 22872022]
[38]
Sadeghi S, Granton JT, Akhavan P, et al. Survival in rheumatoid arthritis-associated pulmonary arterial hypertension compared with idio-pathic pulmonary arterial hypertension. Respirology 2015; 20(3): 481-7.
[http://dx.doi.org/10.1111/resp.12464] [PMID: 25583377]
[39]
Shariff N, Kumar A, Narang R, Malhotra A, Mukhopadhyaya S, Sharma SK. A study of pulmonary arterial hypertension in patients with rheumatoid arthritis. Int J Cardiol 2007; 115(1): 75-6.
[http://dx.doi.org/10.1016/j.ijcard.2006.01.013] [PMID: 16737753]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy