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Detection of myocardial dysfunction using global longitudinal strain with speckle-tracking echocardiography in patients with vs without rheumatoid arthritis: a systematic review and meta-analysis

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Abstract

Objectives

Rheumatoid arthritis (RA) is a systemic autoimmune disorder primarily involving the peripheral joints. Systemic involvement can occur, including myocardial dysfunction. Speckle tracking echocardiography (STE) is a novel diagnostic study which is recently being used to detect subclinical cardiac dysfunction. Global longitudinal strain (GLS) by STE is more sensitive than standard echocardiographic parameters to detect occult cardiac dysfunction.

Methods

A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the STE parameters between RA and non-RA patients.

Results

Left ventricular (LV) GLS was significantly lower in patients with RA compared to non-RA patients with a standard mean difference (SMD) of −1.09 (−1.48–−0.70, P < 0.001). LV Global Circumferential Strain (GCS) was reported in five studies, and it was found to be lower in RA patients with an SMD of −1.25 (−2.59–−0.10; P < 0.0010). Meta regression analysis studies failed to show any significant impact of disease duration, activity, age, sex and BMI on LV GLS and RV GLS.

Conclusions

RA patients have lower LV GLS and LV GCS compared to controls suggesting impaired myocardial dysfunction. Further studies need to be done to delineate the importance of lower GLS in asymptomatic rheumatoid patients to guide disease management and risk factor modification in this selected population.

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Abbreviations

LVEF:

Left ventricular ejection fraction

STE:

Speckle tracking echocardiography

GLS:

Global longitudinal strain

GCS:

Global circumferential strain

SMD:

Standard mean difference

References

  1. Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising?: results from olmsted county, minnesota, 1955–2007. Arthritis Rheum. 2010;62:1576–82.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hunter TM, Boytsov NN, Zhang X, Schroeder K, Michaud K, Araujo AB. Prevalence of rheumatoid arthritis in the united states adult population in healthcare claims databases, 2004–2014. Rheumatol Int. 2017;37:1551–7.

    Article  PubMed  Google Scholar 

  3. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum. 2002;46:862–73.

    Article  PubMed  Google Scholar 

  4. Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2005;52:402–11.

    Article  PubMed  Google Scholar 

  5. Crowson CS, Nicola PJ, Kremers HM, O’Fallon WM, Therneau TM, Jacobsen SJ, et al. How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease? Arthritis Rheum. 2005;52:3039–44.

    Article  PubMed  Google Scholar 

  6. Nicola PJ, Maradit-Kremers H, Roger VL, Jacobsen SJ, Crowson CS, Ballman KV, et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum. 2005;52:412–20.

    Article  PubMed  Google Scholar 

  7. Solomon DH, Reed GW, Kremer JM, Curtis JR, Farkouh ME, Harrold LR, et al. Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheumatol. 2015;67:1449–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Imbalzano E, Zito C, Carerj S, Oreto G, Mandraffino G, Cusmà-Piccione M, et al. Left ventricular function in hypertension: new insight by speckle tracking echocardiography. Echocardiography. 2011;28:649–57.

    Article  PubMed  Google Scholar 

  9. Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging. 2016;9:e003754.

    Article  PubMed  Google Scholar 

  10. Donal E, Lund LH, Oger E, Hage C, Persson H, Reynaud A, et al. New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: a subanalysis of the ka (karolinska) ren (rennes) study. Eur J Heart Fail. 2015;17:680–8.

    Article  CAS  PubMed  Google Scholar 

  11. Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, Liu L, et al. Prognostic importance of impaired systolic function in heart failure with preserved ejection fraction and the impact of spironolactone. Circulation. 2015;132:402–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Park JJ, Park J, Park J, Cho G. Global longitudinal strain to predict mortality in patients with acute heart failure. J Am Coll Cardiol. 2018;71:1947–57.

    Article  PubMed  Google Scholar 

  13. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015. https://doi.org/10.1136/bmj.g7647.

    Article  PubMed  Google Scholar 

  15. Ikonomidis I, Tzortzis S, Lekakis J, Paraskevaidis I, Andreadou I, Nikolaou M, et al. Lowering interleukin-1 activity with anakinra improves myocardial deformation in rheumatoid arthritis. Heart. 2009;95:1502–7.

    Article  CAS  PubMed  Google Scholar 

  16. Fine NM, Crowson CS, Lin G, Oh JK, Villarraga HR, Gabriel SE. Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography. Ann Rheum Dis. 2014;73:1833–9.

    Article  PubMed  Google Scholar 

  17. Ikonomidis I, Tzortzis S, Andreadou I, Paraskevaidis I, Katseli C, Katsimbri P, et al. Increased benefit of interleukin-1 inhibition on vascular function, myocardial deformation, and twisting in patients with coronary artery disease and coexisting rheumatoid arthritis. Circ Cardiovasc Imaging. 2014;7:619–28.

    Article  PubMed  Google Scholar 

  18. Ayyildiz YO, Vural MG, Efe TH, Ertem AG, Koseoglu C, Ayturk M, et al. Effect of long-term TNF-α inhibition with infliximab on left ventricular torsion in patients with rheumatoid arthritis. Hellenic J Cardiol. 2015;56:406–13.

    PubMed  Google Scholar 

  19. Magda SL, Mincu RI, Florescu M, Ciobanu AO, Udrea GF, Cinteza M, et al. The assessment of subclinical cardiovascular dysfunction in treated rheumatoid arthritis. Maedica. 2016;11:267.

    PubMed  PubMed Central  Google Scholar 

  20. Midtbø H, Semb AG, Matre K, Kvien TK, Gerdts E. Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis. Ann Rheum Dis. 2017;76:371–6.

    Article  PubMed  Google Scholar 

  21. Mohamed LA, Maghraby HM, Saleh AM. Early detection of left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis using global longitudinal strain assessment.

  22. Tarek El-Zawawy H, Helal A, Zaki T, Galal H, Mohamed Allam M, Hussein Elzawawy T, et al. CardioAlex 2017 conference proceedings abstracts. Eur Heart J Suppl. 2017;19:G1-8.

    Article  Google Scholar 

  23. Cioffi G, Ognibeni F, Dalbeni A, Giollo A, Orsolini G, Gatti D, et al. High prevalence of occult heart disease in normotensive patients with rheumatoid arthritis. Clin Cardiol. 2018;41:736–43.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gullo AL, Rodríguez-Carrio J, Aragona CO, Dattilo G, Zito C, Suárez A, et al. Subclinical impairment of myocardial and endothelial functionality in very early psoriatic and rheumatoid arthritis patients: association with vitamin D and inflammation. Atherosclerosis. 2018;271:214–22.

    Article  PubMed  Google Scholar 

  25. 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;31:41–9.

    Article  PubMed  Google Scholar 

  26. Hanvivadhanakul P, Buakhamsri A. Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease. Adv Rheumatol. 2019;59:56.

    Article  PubMed  Google Scholar 

  27. Nikdoust F, Safiarian S, Mostafavi A, Gharibdoust F, Tabatabaei SAH. Assessment of global longitudinal strain via speckle-tracking echocardiography in patients with rheumatoid arthritis. Iranian Heart J. 2020;21:103–9.

    Google Scholar 

  28. Marchant DJ, Boyd JH, Lin DC, Granville DJ, Garmaroudi FS, McManus BM. Inflammation in myocardial diseases. Circ Res. 2012;110:126–44.

    Article  CAS  PubMed  Google Scholar 

  29. Lim SL, Lam CS, Segers VF, Brutsaert DL, De Keulenaer GW. Cardiac endothelium–myocyte interaction: clinical opportunities for new heart failure therapies regardless of ejection fraction. Eur Heart J. 2015;36:2050–60.

    Article  CAS  PubMed  Google Scholar 

  30. Holmström M, Koivuniemi R, Korpi K, Kaasalainen T, Laine M, Kuuliala A, et al. Cardiac magnetic resonance imaging reveals frequent myocardial involvement and dysfunction in active rheumatoid arthritis. Clin Exp Rheumatol. 2016;34:416–23.

    PubMed  Google Scholar 

  31. Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK. Twist mechanics of the left ventricle: principles and application. JACC Cardiovasc Imaging. 2008;1(3):366–76. https://doi.org/10.1016/j.jcmg.2008.02.006.

    Article  PubMed  Google Scholar 

  32. Benameur N, Arous Y, Ben Abdallah N, Kraiem T. Comparison between 3D echocardiography and cardiac magnetic resonance imaging (CMRI) in the measurement of left ventricular volumes and ejection fraction. Curr Med Imaging. 2019;15:654–60.

    Article  Google Scholar 

  33. Neisius U, Myerson L, Fahmy AS, Nakamori S, El-Rewaidy H, Joshi G, et al. Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy. PLoS ONE. 2019;14:e0221061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Morbach C, Walter BN, Breunig M, Liu D, Tiffe T, Wagner M, et al. Speckle tracking derived reference values of myocardial deformation and impact of cardiovascular risk factors—results from the population-based STAAB cohort study. PLoS ONE. 2019;14:e0221888.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Mantel Ä, Holmqvist M, Andersson DC, Lund LH, Askling J. Association between rheumatoid arthritis and risk of ischemic and nonischemic heart failure. J Am Coll Cardiol. 2017;69:1275–85.

    Article  PubMed  Google Scholar 

  36. 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:FSO396.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Liu JH, Chen Y, Yuen M, et al. Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2016;15:22–5. https://doi.org/10.1186/s12933-016-0333-5.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Oh JK, Park JH. Role of strain echocardiography in patients with hypertension. Clin Hypertens. 2022;28(1):6. https://doi.org/10.1186/s40885-021-00186-y.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Park SJ, Park J, Lee HS, Kim MS, Park YK, Park Y, et al. Impaired RV global longitudinal strain is associated with poor long-term clinical outcomes in patients with acute inferior STEMI. JACC: Cardiovasc imaging. 2015;8:161–9.

    PubMed  Google Scholar 

  40. Zornoff LA, Skali H, Pfeffer MA, John Sutton SM, Rouleau JL, Lamas GA, et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol. 2002;39:1450–5.

    Article  PubMed  Google Scholar 

  41. Holman WL, Kormos RL, Naftel DC, Miller MA, Pagani FD, Blume E, et al. Predictors of death and transplant in patients with a mechanical circulatory support device: a multi-institutional study. J Heart Lung Transplant. 2009;28:44–50.

    Article  PubMed  Google Scholar 

  42. Hinojar Baydes R, De Angelis V, Garcia-Martin A, Gonzalez-Gomez A, Sanroman M, Pascual M, et al. Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation. Eur Heart J. 2020;41(ehaa946):1912.

    Google Scholar 

  43. Morris DA, Krisper M, Nakatani S, Köhncke C, Otsuji Y, Belyavskiy E, et al. Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: a multicentre study. Eur Heart J Cardiovasc Imaging. 2017;18:212–23.

    Article  PubMed  Google Scholar 

  44. Thavendiranathan P, Negishi T, Somerset E, Negishi K, Penicka M, Lemieux J, et al. Strain-guided management of potentially cardiotoxic cancer therapy. J Am Coll Cardiol. 2021;77:392–401.

    Article  CAS  PubMed  Google Scholar 

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Medicine, Creighton University School of Medicine, 7710 Mercy Road Suite 202, Omaha, NE, 68124, USA

    Vinay K. Thallapally, Raahat Bansal, Sonia Gupta & Sarah Aurit

  2. Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA

    Abhishek Thandra, Venkat S. Pajjuru, Dixitha Anugula & Aboeata Ahmed

  3. Division of Rheumatology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA

    Joseph Nahas

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [RB] [SG] [VP] [DA] and [SA]. The first draft of the manuscript was written by [VKT] [AT] [AA] [JN] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Vinay K. Thallapally.

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Thallapally, V.K., Bansal, R., Thandra, A. et al. Detection of myocardial dysfunction using global longitudinal strain with speckle-tracking echocardiography in patients with vs without rheumatoid arthritis: a systematic review and meta-analysis. J Echocardiogr 21, 23–32 (2023). https://doi.org/10.1007/s12574-022-00583-8

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  • DOI: https://doi.org/10.1007/s12574-022-00583-8

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