title: Evaluation of ascending aorta wall in rheumatoid arthritis by tissue and strain Doppler imaging during anti-tumor necrosis factor-α therapy.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) are at increased risk of vascular events. Data on the effects of tumor necrosis factor-α (TNF-α) blocking agents on aortic vascular function are still debated.
  
  
  OBJECTIVE
  To evaluate the effects of anti-TNF-α treatment on elastic properties of the ascending aorta (distensibility, stiffness, and tissue Doppler imaging [TDI] strain) in RA patients.
  
  
  METHODS
  We prospectively followed 13 patients affected by RA without cardiovascular risk factors for 1 year during anti-TNF-α treatment. Every subject received an echocardiographic examination before starting anti-TNF-α drugs and after 1 year. Aortic elastic properties were calculated from the echocardiographically derived thoracic aortic diameters, and TDI strain was measured on the wall of the ascending aorta 3 cm above the aortic valve.
  
  
  RESULTS
  We found lower distensibility (12.9 ± 3.5 vs 21.5 ± 7.5 mm Hg(-1); P <0.001) and a higher stiffness index (21.3 ± 3.6 vs 11.7 ± 1.4; P <0.001) in RA cases at baseline compared with values after 1 year of treatment. Peak systolic (S') and diastolic (E' and A') waves of the aortic wall TDI were similar at baseline and at 1 year follow-up (S' wave: 5.6 ± 2.2 cm/s vs 6.5 ± 2.6 cm/s, E' wave: -4.6 ± 2.9 vs -5.0 ± 1.2 cm/s, A' wave: -5.6 ± 0.19 vs -5.9 ± 2.05 cm/s), whereas TDI strain of the aortic wall was improved after anti-TNF-α treatment (-23.7 ± 1.4% vs -31.6 ± 2.8%, P < 0.001).
  
  
  CONCLUSIONS
  Anti-TNF-α treatment after 12 months significantly modifies the elastic properties of the aorta. This may reflect the favorable changes in its elastic tissue after anti-TNF-α treatment in RA patients without cardiovascular risk factors. This suggests a potential cardiovascular risk benefit.
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavazzana
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Franco
authors.initials: F
authors.lastname: Franceschini
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging* / Q000187:drug effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D014409:Tumor Necrosis Factor-alpha