Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease

There are limited studies on the prevalence of diastolic dysfunction in rheumatoid arthritis (RA) from the Indian subcontinent. The aim of this study was to evaluate left ventricular filling abnormalities in patients with RA without clinically-evident cardiovascular manifestations, and to correlate it with disease duration.

45 patients affected with RA according to the American Rheumatism Association criteria, were selected without evidence of cardiac disease, and compared with age- and sex-matched control subjects. All patients and the control group were submitted to M-mode, two-dimensional and Doppler echocardiography. The following diastolic parameters were evaluated: peak of early diastolic (E) and late diastolic (A) mitral flow velocity, E/A ratio, isovolumic relaxation time (IVRT), ejection fraction and fractional shortening.

In RA patients, left ventricular filling abnormalities were found characterised by a reduced E/A ratio (mean [SD] 0.98 [0.22] versus controls 1.09 [0.11]; p-value equals 0.004), prolonged IVRT (75.77 [8.12] ms versus 70.43 [2.94] ms; p-value equals 0.001) and increased late diastole flow velocity (76.91 [11.61] cm/s versus 70.11 [5.32] cm/s; p-value equals 0.001). In the group of patients, a negative correlation was found between E/A ratio and disease duration (Pearson correlation, r equals -0.56, p-value equals 0.001), indicating diastolic dysfunction with increasing disease duration. A strong correlation was also found between IVRT and disease duration (r equals 0.66, p-value equals 0.01) and also between late diastolic flow velocity and disease duration (r equals 0.61, p-value equals 0.001).

The present study confirms a high frequency of left ventricular diastolic dysfunction characterised by impaired E/A ratio, prolonged IVRT and increased late diastole flow velocity in patients with RA without evident cardiovascular disease. The correlation between transmitral flow alteration and disease duration suggests a subclinical myocardial involvement with disease progression. This may be relevant to the high incidence of cardiovascular deaths observed in patients with RA.