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Preclinical impairment of myocardial function in rheumatoid arthritis patients

Detection of myocardial strain by speckle tracking echocardiography

Subklinische Störung der Myokardfunktion bei Patienten mit rheumatoider Arthritis

Erkennung der Myokarddeformation durch Speckle-Tracking-Echokardiographie

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Abstract

Objectives

The incidence of heart failure is higher in patients with rheumatoid arthritis (RA) than in the general population and contributes to elevated cardiovascular mortality and morbidity rates. Impaired myocardial function can be detected by a novel echocardiographic method, speckle tracking echocardiography (STE), when conventional methods have yielded normal findings. The aim of our study was to investigate the effect of disease duration on myocardial strain and strain rate parameters in patients with RA.

Methods

This cross-sectional study included 37 RA patients [n=16, female gender n=16, mean age, 45.7 ± 9 years in the early-stage disease (ESD); n= 21, female gender n=19, 45.7 ± 16.8 years in the advanced-stage disease (ASD) group] who were compared according to early disease duration and advanced-stage disease (2.8 ± 1.2 vs. 14.6 ± 6.8 years, respectively). Hypertension, diabetes mellitus, and other cardiovascular risk factors were excluded. Offline analysis of STE was performed and data between the two groups were compared.

Results

RS, RSR-E, and RSR-E/A values were statistically significantly lower in patients with ASD. Circumferential strain and strain rate were similar between the two groups. Except for LSR-E/A values, LS, LSR-S, LSR-E, and LSR-A values were decreased in patients with ASD.

Conclusion

RA patients without clinical evidence of cardiovascular disease and in the absence of traditional cardiovascular risk factors can be followed up with STE. In this way, early impairment of myocardial deformation can be detected before the appearance of any clinical evidence of cardiac involvement.

Zusammenfassung

Ziele

Die Inzidenz der Herzinsuffizienz ist bei Patienten mit rheumatoider Arthritis (RA) höher als bei Personen der Allgemeinbevölkerung und trägt zu einer erhöhten kardiovaskulären Mortalitäts- und Morbiditätsrate bei. Eine gestörte Myokardfunktion kann mit einem neuen Echokardiographieverfahren, der Speckle-Tracking-Echokardiographie (STE), erkannt werden, wenn herkömmliche Verfahren einen Normalbefund ergeben haben. Ziel der vorliegenden Studie war es, die Auswirkungen der Krankheitsdauer auf Parameter der Myokarddeformation und Deformationsrate („strain rate“) bei Patienten mit RA zu untersuchen.

Methoden

Es wurden 37 RA-Patienten (n=16, weiblich: n=16, Durchschnittsalter: 45,7 ± 9 Jahre in der Gruppe mit frühem Krankheitsstadium bzw. n=21, weiblich: n=19; 45,7 ± 16,8 Jahre in der Gruppe mit fortgeschrittenem Krankheitsstadium) in diese Querschnittsstudie eingeschlossen und in Bezug auf frühes bzw. fortgeschrittenes Krankheitsstadium verglichen (2,8 ± 1,2 Jahre vs. 14,6 ± 6,8 Jahre). Hypertonie, Diabetes mellitus und andere kardiovaskuläre Risikofaktoren wurden ausgeschlossen. Die Auswertung der STE erfolgte offline, und die Daten wurden zwischen den beiden Gruppen verglichen.

Ergebnisse

Die Werte für RS, RSR-E und RSR-E/A waren bei Patienten im fortgeschrittenen Krankheitsstadium statistisch signifikant niedriger als bei denen im frühen Stadium. Zirkumferenzielle Deformation und Deformationsrate waren in beiden Gruppen ähnlich. Mit Ausnahme der Werte für LSR-E/A waren die Werte für LS, LSR-S, LSR-E, LSR-A bei Patienten im fortgeschrittenen Krankheitsstadium vermindert.

Schlussfolgerung

Bei RA-Patienten ohne klinischen Hinweis auf kardiovaskuläre Erkrankungen und ohne herkömmliche kardiovaskuläre Risikofaktoren könnte der Verlauf mittels STE kontrolliert und eine beginnende Störung der Myokarddeformation erkannt werden, bevor es zu klinischen Zeichen einer Herzbeteiligung kommt.

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Compliance with ethical guidelines

Conflict of interest. A.O. Baktir, B. Sarli, M.A. Cebicci, H. Saglam, Y. Dogan, M. Demirbaş, S.T. Sutbeyaz, and H. Arinc state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Kayseri Education and Research Hospital, Sanayi Mah. Atatürk Bulvarı Hastane Cad. No:78, 38010, Kocasinan/Kayseri, Turkey

    A.O. Baktir MD, B. Sarli, H. Saglam, Y. Dogan & H. Arinc

  2. Department of Physical Medicine & Rehabilitation, Kayseri Education and Research Hospital, Kayseri, Turkey

    M.A. Cebicci, M. Demirbaş & S.T. Sutbeyaz

Authors
  1. A.O. Baktir MD
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  2. B. Sarli
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  3. M.A. Cebicci
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  4. H. Saglam
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  5. Y. Dogan
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  6. M. Demirbaş
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  8. H. Arinc
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Correspondence to A.O. Baktir MD.

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Baktir, A., Sarli, B., Cebicci, M. et al. Preclinical impairment of myocardial function in rheumatoid arthritis patients. Herz 40, 669–674 (2015). https://doi.org/10.1007/s00059-014-4068-3

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  • DOI: https://doi.org/10.1007/s00059-014-4068-3

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