Title:Echocardiography Coupled with Strain Method in the Screening for
Cardiac Involvement in Rheumatoid Arthritis
Volume: 20
Issue: 1
Author(s): Mouna Brahem, Hassen Ibn Hadj Amor, Rihab Sarraj*, Imen Touil, Salma Kraiem, Ramzi Rouabhia, Ella Hmaier, Ghassen Haj Mbarek, Ameni Ben Salem, Imen Mlouki, Sana Mhamdi, Haifa Hachfi and Mohamed Younes
Affiliation:
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
Keywords:
Rheumatoid arthritis, cardiac involvement, cardiac ultrasound, strain, echocardiography, screening.
Abstract:
Objective: In this study, the usefulness of transthoracic echocardiography (TTE) in
systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid
arthritis (RA).
Methods: We performed a comparative cross-sectional study from July 2020 to February 2021.
Each patient underwent a TTE coupled with the strain technique.
Results: Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE
were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in
65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference
(p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group
(36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical
left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method
was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients
was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy
was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion
and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found
a significant relationship between echocardiographic damage and disease activity (p < 0.01), number
of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the
use and dose of Corticosteroids (p = 0.02; p = 0.01).
Conclusion: Echocardiographic damage in RA is frequent and often asymptomatic, hence there has
been an increased interest in systematic screening in order to improve the quality of life and vital
prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.
