title: Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study.
abstract: Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment.
  
  
  
  13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases).
  
  
  
  Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively).
  
  
  
  Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.
authors.affiliation: University of Brescia. enrico.vizzardi@tin.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavazzana
authors.forename: Franco
authors.initials: F
authors.lastname: Franceschini
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Lombardi
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D018487:Ventricular Dysfunction, Left; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
chemical_list: D014409:Tumor Necrosis Factor-alpha