Speckle tracking can detect subclinical myocardial dysfunction in rheumatoid arthritis patients

Patients with rheumatoid arthritis (RA) have shorter life expectancy and their risk of cardiovascular death is more than 50 % higher than the rest of the population. Early myocardial dysfunction in RA patients may be detectable sooner using speckle‑tracking echocardiography.

Cross-sectional study enrolled 55 patients with RA (mean age 44.1 years) without known cardiovascular disease and 31 healthy controls. All subjects underwent a standard echocardiographic examination: indexed left ventricular mass, left ventricle ejection fraction, isovolumic contraction and relaxation times (IVCT and IVRT), mitral valve inflow curve (E/A), septal mitral annular motion (e'), and E/e' ratio as well as the speckle tracking assessment of left ventricle longitudinal, radial and circular strain and strain rate.

In standard echocardiographic examination RA patients exhibited higher indexed left ventricle mass (96.36±20.90 g/m2 vs 95.84±21.86 %, p=0.013), lower ejection fraction (64.84±3.87 % vs 67.10±3.87 %, p=0.011) and prolonged IVCT (61.51±9.30 ms vs 53.71±8.95 ms, p=0.001). Diastolic dysfunction was demonstrated by prolonged IVRT (81.62±9.56 ms vs 74.58±12.02 ms, p=0.007) as well as by higher E/e' ratio (8.21±1.76 vs 7.21±1.52, p=0.009). Speckle‑tracking method detected lower global longitudinal epicardial strain (-19.51 % vs -21.46 %, p=0.049). Radial, circular, and transversal strains and strain rates were same in both groups. Global longitudinal epicardial strain correlated with IVCT and IVRT, disease duration, and markers of myocardial damage NTproBNP.

Standard echocardiographic assessment of myocardial function is examiner- and angle-dependent method with considerable limitations for evaluation of minimal subclinical changes. Speckle-tracking echocardiography significantly revealed incipient myocardial dysfunction in RA patients without overt cardiovascular diseases. This correlates with clinical RA characteristics and markers of cardiac damage (Tab. 4, Ref. 48).