title: Right ventricular diastolic abnormalities in rheumatoid arthritis and its relationship with left ventricular and pulmonary involvement. A tissue Doppler echocardiographic study.
abstract: OBJECTIVE
  To investigate right ventricular diastolic function in rheumatoid arthritis (RA) and its relationship with left ventricular and pulmonary involvement.
  
  
  METHODS
  Thirty-five RA patients and 30 healthy subjects were submitted to conventional Doppler (CE) and tissue Doppler echocardiography (TDE) to assess left and right systolic and diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). To detect pulmonary involvement, pulmonary function tests and high-resolution computed tomography (HRCT) scans were performed in all RA patients.
  
  
  RESULTS
  An abnormal RV filling, as expressed byan inverted tricuspid (Tr.) E/A ratio, was detected in 12 (34%) of the 35 RA patients and in 2 (7%) of the 30 controls (P<0.004). If compared to CE findings, prevalence of RV diastolic abnormalities were found higher in patients with RA by TDE (RV annulus Em/Am ratio <1 (in 31 (89%) of 35 patients) (P = 0.002). Twenty-two (63%) of 35 patients had abnormal HRCT findings. Pulmonary involvement with pulmonary hypertension (PHT) (36+/-5 mmHg) was detected in 10 (29%) of 35 RA. In this group, increase of RV annulus and basal Am wave, decrease of Tr. E/A ratio and RV annulus Em/Am ratio were statistically significant compared to RA (12 (34%) of 35) patients with pulmonary involvement who had normal PAP (19+/-5 mmHg), (P = 0.014, P = 0.006, P = 0.015, P = 0.049, respectively).
  
  
  CONCLUSIONS
  This study points out an impaired RV filling in a significant part of RA patients without overt heart failure. Impairment of RV diastolic function may be a predictor of subclinic myocardial and pulmonary involvement in patients with RA.
authors.affiliation: Department of Cardiology, School of Medicine, Mustafa Kemal University, 31100, Hatay, Turkey. eseyfeli@hotmail.com
authors.forename: Ergun
authors.initials: E
authors.lastname: Seyfeli
authors.forename: Hayal
authors.initials: H
authors.lastname: Guler
authors.forename: Sebahat
authors.initials: S
authors.lastname: Akoglu
authors.forename: Sinem
authors.initials: S
authors.lastname: Karazincir
authors.forename: Ferit
authors.initials: F
authors.lastname: Akgul
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Saglam
authors.forename: Tunzale
authors.initials: T
authors.lastname: Seydaliyeva
authors.forename: Fatih
authors.initials: F
authors.lastname: Yalcin
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications*; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology*