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Echocardiographic evaluation of pulmonary hypertension, right ventricular function, and right ventricular-pulmonary arterial coupling in patients with rheumatoid arthritis

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Abstract

Introduction

Rheumatoid arthritis (RA) patients are at increased risk for developing cardiovascular disease, including right heart failure. The evaluation of right ventricle (RV) using the relationship between tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic pressure (RVSP) is of clinical prognostic relevance. Mild echocardiographic pulmonary hypertension (ePH) has been associated with worse RV function. The aim of this study was to evaluate RV function as measured by TAPSE to RVSP ratio in rheumatoid arthritis patients compared to matched healthy controls.

Method

A case-control study with 67 RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and 45 matching controls was included. A transthoracic echocardiogram was performed to all patients. TAPSE was measured as the distance traveled from end-diastole to end-systole. RVSP was calculated using the modified Bernoulli equation. Comparisons were done using Chi-square and Mann-Whitney’s U test or Student’s t test.

Results

Patients with RA had significantly reduced ventricular function (TAPSE 23 [21-25] vs 25 [23-26], p = 0.033) and TAPSE/RVSP ratio was significantly lower in RA-patients than controls (TAPSE to RVSP ratio 0.809 [0.67-1.01] vs 0.933 [0.79-1.11], p = 0.009). RA-patients with mild ePH had similar RV function, evaluated by TAPSE, in comparison to RA-patients with normal RVSP.

Conclusion

RA-patients had worse RV function measured by TAPSE and worse TAPSE/RVSP ratio than controls. Also, RA-patients with mild ePH had reduced right ventricular-pulmonary arterial coupling in comparison with patients with RA and normal RVSP. These echocardiographic findings could justify aggressive treatment for these patients and assess their evolution.

Key Points

• Right ventricular (RV) function and RV coupling with the pulmonary artery (RV-PA coupling) were worse in patients with RA in comparison to healthy controls.

• Values of right ventricular systolic pressure (RVSP) were similar between RA-patients and non-RA controls.

• Prevalence of normal RVSP, mild echocardiographic pulmonary hypertension (ePH), and pulmonary hypertension was similar between RA-patients and non-RA matched controls

•Patients with RA and mild ePH had reduced RV-PA coupling in comparison with RA-patients with normal RVSP.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials

References

  1. Nicola PJ, Maradit-Kremers H, Roger VL, Jacobsen SJ, Crowson CS, Ballman KV, Gabriel SE (2005) The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum 52(2):412–420. https://doi.org/10.1002/art.20855

    Article  PubMed  Google Scholar 

  2. McLaughlin VV, Shillington A, Rich S (2002) Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation 106(12):1477–1482. https://doi.org/10.1161/01.cir.0000029100.82385.58

    Article  CAS  PubMed  Google Scholar 

  3. Dawson JK, Goodson NG, Graham DR, Lynch MP (2000) Raised pulmonary artery pressures measured with Doppler echocardiography in rheumatoid arthritis patients. Rheumatology (Oxford) 39(12):1320–1325. https://doi.org/10.1093/rheumatology/39.12.1320

    Article  CAS  Google Scholar 

  4. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J, Harrington RA, Anderson JL, Bates ER, Bridges CR, Eisenberg MJ, Ferrari VA, Grines CL, Hlatky MA, Jacobs AK, Kaul S, Lichtenberg RC, Lindner JR, Moliterno DJ, Mukherjee D, Pohost GM, Rosenson RS, Schofield RS, Shubrooks SJ, Stein JH, Tracy CM, Weitz HH, Wesley DJ, Accf/Aha (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119(16):2250–2294. https://doi.org/10.1161/CIRCULATIONAHA.109.192230

    Article  PubMed  Google Scholar 

  5. Huston JH, Maron BA, French J, Huang S, Thayer T, Farber-Eger EH, Wells QS, Choudhary G, Hemnes AR, Brittain EL (2019) Association of mild echocardiographic pulmonary hypertension with mortality and right ventricular function. JAMA Cardiol 4(11):1112–1121. https://doi.org/10.1001/jamacardio.2019.3345

    Article  PubMed  PubMed Central  Google Scholar 

  6. Iaccarino L, Gatto M, Bettio S, Caso F, Rampudda M, Zen M, Ghirardello A, Punzi L, Doria A (2013) Overlap connective tissue disease syndromes. Autoimmun Rev 12(3):363–373. https://doi.org/10.1016/j.autrev.2012.06.004

    Article  CAS  PubMed  Google Scholar 

  7. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ (2019) Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 32(1):1–64. https://doi.org/10.1016/j.echo.2018.06.004

    Article  PubMed  Google Scholar 

  8. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014

    Article  PubMed  Google Scholar 

  9. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713; quiz 786-688. https://doi.org/10.1016/j.echo.2010.05.010

    Article  PubMed  Google Scholar 

  10. Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, Temporelli PL, Arena R (2013) Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol 305(9):H1373–H1381. https://doi.org/10.1152/ajpheart.00157.2013

    Article  CAS  PubMed  Google Scholar 

  11. Nikdoust F, Zangeneh R, Tabatabaei SA (2016) Cardiac involvement and echocardiographic characteristics in rheumatoid arthritis. Iranian Heart Journal 17(2):18–24

  12. Modin D, Mogelvang R, Andersen DM, Biering-Sorensen T (2019) Right ventricular function evaluated by tricuspid annular plane systolic excursion predicts cardiovascular death in the general population. J Am Heart Assoc 8(10):e012197. https://doi.org/10.1161/JAHA.119.012197

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kjaergaard J, Akkan D, Iversen KK, Kober L, Torp-Pedersen C, Hassager C (2007) Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail 9(6-7):610–616. https://doi.org/10.1016/j.ejheart.2007.03.001

    Article  PubMed  Google Scholar 

  14. Gajanana D, Seetha Rammohan H, Alli O, Romero-Corral A, Purushottam B, Ponamgi S, Figueredo VM, Pressman GS (2015) Tricuspid annular plane systolic excursion and its association with mortality in critically Ill patients. Echocardiography 32(8):1222–1227. https://doi.org/10.1111/echo.12926

    Article  PubMed  Google Scholar 

  15. Saeed S, Smith J, Grigoryan K, Lysne V, Rajani R, Chambers JB (2020) The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure index: association with all-cause mortality in patients with moderate or severe tricuspid regurgitation. Int J Cardiol 317:176–180. https://doi.org/10.1016/j.ijcard.2020.05.093

    Article  PubMed  Google Scholar 

  16. Guo X, Lai J, Wang H, Tian Z, Wang Q, Zhao J, Li M, Fang Q, Fang L, Liu Y, Zeng X (2019) Predictive value of non-invasive right ventricle to pulmonary circulation coupling in systemic lupus erythematosus patients with pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jez311

  17. Peacock AJ, Crawley S, McLure L, Blyth KG, Vizza CD, Poscia R, Francone M, Iacucci I, Olschewski H, Kovacs G, Noordegraaf A, Marcus JT, Veerdonk MC, Oosterveer FPT (2014) Changes in right ventricular function measured by cardiac magnetic resonance imaging in patients receiving pulmonary arterial hypertension–targeted therapy. Circ Cardiovasc Imaging 7(1):107–114. https://doi.org/10.1161/CIRCIMAGING.113.000629

    Article  PubMed  Google Scholar 

  18. Wilkins MR, Paul GA, Strange JW, Tunariu N, Gin-Sing W, Banya WA, Westwood MA, Stefanidis A, Ng LL, Pennell DJ, Mohiaddin RH, Nihoyannopoulos P, Gibbs JS (2005) Sildenafil versus endothelin receptor antagonist for pulmonary hypertension (SERAPH) study. Am J Respir Crit Care Med 171(11):1292–1297. https://doi.org/10.1164/rccm.200410-1411OC

    Article  PubMed  Google Scholar 

  19. Wang G-F, Guan L-H, Zhou D-X, Chen D-D, Zhang X-C, Ge J-BO (2020) Serum high-density lipoprotein cholesterol is significantly associated with the presence and severity of pulmonary arterial hypertension: a retrospective cross-sectional study. Adv Ther 37(5):2199–2209. https://doi.org/10.1007/s12325-020-01304-2

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank the team of the Preventive Cardiology-Rheumatology Clinic for their help with the collection of the data.

Author information

Authors and Affiliations

  1. Division of Cardiology, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico

    Jose R. Azpiri-Lopez & Raymundo Vera-Pineda

  2. Division of Rheumatology, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico

    Dionicio A. Galarza-Delgado, Iris J. Colunga-Pedraza, Jesus A. Cardenas-de la Garza, Carolina M. Martinez-Flores, Alejandra B. Rodriguez-Romero & Natalia Guajardo-Jauregui

  3. Internal Medicine Department, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico

    Rosa I. Arvizu-Rivera & Jose A. Davila-Jimenez

Authors
  1. Jose R. Azpiri-Lopez
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  2. Dionicio A. Galarza-Delgado
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  8. Carolina M. Martinez-Flores
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Contributions

All authors had access to the data and a role in writing the manuscript. Jose R. Azpiri-Lopez, Dionicio A. Galarza-Delgado, and Iris J. Colunga-Pedraza contributed to the study conception and design. Data collected by Carolina M. Martinez-Flores and Jose A. Davila-Jimenez. Statistical analysis was performed by Jesus A. Cardenas-de la Garza and Rosa I. Arvizu-Rivera. Analysis and interpretations were performed by Jose R. Azpiri-Lopez and Raymundo Vera-Pineda. Writing of the first draft was performed by Jesus A.Cardenas-de la Garza, Rosa I. Arvizu-Rivera, Alejandra B. Rodriguez-Romero, and Natalia Guajardo-Jauregui. All authors commented on posterior versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dionicio A. Galarza-Delgado.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Registration number of MI14-006. All patients gave written informed consent before the procedure.

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All the data retrieved were anonymized. Written informed consent was obtained before the procedure.

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Azpiri-Lopez, J.R., Galarza-Delgado, D.A., Colunga-Pedraza, I.J. et al. Echocardiographic evaluation of pulmonary hypertension, right ventricular function, and right ventricular-pulmonary arterial coupling in patients with rheumatoid arthritis. Clin Rheumatol 40, 2651–2656 (2021). https://doi.org/10.1007/s10067-020-05544-z

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