Myocardial dysfunction in rheumatoid arthritis: a controlled tissue-Doppler echocardiography study.
OBJECTIVE
To determine the sensitivity and accuracy of tissue-Doppler echocardiography (TDE) to assess myocardial contractility. Heart failure is one of the determinants of the excess in mortality in patients with rheumatoid arthritis (RA).


METHODS
Consecutive RA patients with normal clinical cardiac examination were prospectively included and compared to 27 controls. All underwent conventional echocardiography, and systolic and diastolic strain rate (SR) were determined by TDE.


RESULTS
Twenty-seven patients with RA were included (mean age 50 +/- 10 yrs, disease duration 8 +/-6 yrs). Mean disease activity score was 4.3 +/- 1.6, C-reactive protein 23 +/- 32 mg/l. When compared to controls (50 +/- 9 yrs), patients with RA had increased left ventricular mass (99 +/- 24 vs 80 +/- 25 g/m2, p = 0.009), and there was a trend for left atrial enlargement (31 +/- 3 vs 29 +/- 6 mm, p = 0.06). Fractional shortening and systolic SR did not differ between groups. Diastolic function, as estimated by the E/A Doppler velocity ratio was similar in both groups (p = 0.18). However, diastolic SR was strikingly reduced in patients with RA versus controls (3.7 +/- 1.3 vs 5.5 +/- 1.1s-1, p < 0.001) with 18/27 patients with RA having marked reduced diastolic SR (SR < 4s-1). None of the RA characteristics was associated with significant differences in TDE measurements.


CONCLUSIONS
TDE identifies impaired diastolic function in patients with RA that may not be detected by conventional measurements.
Meune
Christophe
C
Department of Cardiology, Paris Descartes University, Medical School, Cochin Hospital, Paris, France.
Wahbi
Karim
K
Assous
Noémie
N
Weber
Simon
S
Kahan
André
A
Allanore
Yannick
Y
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000401:mortality / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology