title: Myocardial dysfunction in rheumatoid arthritis: a controlled tissue-Doppler echocardiography study.
abstract: 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.
authors.affiliation: Department of Cardiology, Paris Descartes University, Medical School, Cochin Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Karim
authors.initials: K
authors.lastname: Wahbi
authors.forename: Noémie
authors.initials: N
authors.lastname: Assous
authors.forename: Simon
authors.initials: S
authors.lastname: Weber
authors.forename: André
authors.initials: A
authors.lastname: Kahan
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
mesh_terms: 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