Assessment of Global Longitudinal Strain via Speckle-Tracking Echocardiography in Patients With Rheumatoid Arthritis

Document Type : Original Article

Authors

1 Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

2 Department of Rheumatology, Faculty of medicine, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: The inflammatory nature of rheumatoid arthritis presents a hypothesis on the increase in the likelihood of cardiovascular diseases in patients with rheumatoid arthritis. Recently, the use of speckle-tracking echocardiography to evaluate ventricular strain, especially the global longitudinal strain (GLS), has provided more comprehensive information on ventricular dysfunction in these patients. In the present study, we evaluated changes in the GLS index along with other left and right ventricular parameters in patients with rheumatoid arthritis compared with healthy controls.
Methods: The study population was comprised of a case group (patients with rheumatoid arthritis in the active phase during the first 5 years of diagnosis referred to Shariati Hospital without a history of any other diseases) and a control group (individuals without a history of rheumatoid arthritis or cardiac abnormalities referred for clinical check-ups). In both groups, 2D and 3D echocardiographic examinations were performed by a single cardiologist to assess cardiac functional parameters.
Results: Comparisons of the echocardiographic indices between the 2 groups showed significantly lower LA (Left Atrium), AO (Aorta), interventricular septal end-diastole (IVSD), Posterior wall diastolic diameter (PWD), and RVsm (Right Ventricular systolic celocity) in the group suffering from rheumatoid arthritis than in the control group. The GLS parameter was significantly lower in the rheumatoid arthritis group than in the healthy group (-19.5 ± 2.34 vs -20.42 ± 3.07; P = 0.042); however, there was no difference in the global circumferential strain parameter between the 2 groups (-19.69 ± 3.55 vs -20.49 ± 1.79; P = 0.566). In contrast, the mean right ventricular GLS was -18.77 ± 5.34 in the case group versus -21.87 ± 13.99 in the control group, indicating a significant difference (P = 0.008).
Conclusions: In the echocardiographic assessment of patients with rheumatoid arthritis, a decrease in the ventricular function parameters, especially the GLS, is expected, which may be due to the effect of inflammatory factors on the cardiac ventricular strain.

Keywords


1. Solomon DH, Goodson NJ, Katz JN, et al.
Patterns of cardiovascular risk in rheumatoid
arthritis. Ann Rheum Dis. 2006;65:1608–
1612.
2. Maradit-Kremers H, Crowson CS, Nicola
PJ, et al. Increased unrecognized coronary
heart disease and sudden deaths in
rheumatoid arthritis: a population-based
cohort study. Arthritis Rheum. 2005;52:402–
411.
3. Peters MJ, van Halm VP, Voskuyl AE, et al.
Does rheumatoid arthritis equal diabetes
mellitus as an independent risk factor for
cardiovascular disease? A prospective
study. Arthritis Rheum. 2009;61:1571–
1579.
4. Peters MJ, Symmons DP, McCarey D, et al.
EULAR evidence-based recommendations
for cardiovascular risk management in
patients with rheumatoid arthritis and other
forms of inflammatory arthritis. Ann Rheum
Dis. 2010;69:325–331.
5. Nicola PJ, Maradit-Kremers H, Roger VL, et
al. The risk of congestive heart failure in rheumatoid arthritis: A population-based
study over 46 years. Arthritis
Rheum. 2005;52:412–420.
6. Davis JM, 3rd, Roger VL, Crowson CS,
Kremers HM, Therneau TM, Gabriel SE.
The presentation and outcome of heart
failure in patients with rheumatoid arthritis
differs from that in the general
population. Arthritis Rheum. 2008;58:2603–
2611.
7. Francis ML, Varghese JJ, Mathew JM,
Koneru S, Scaife SL, Zahnd WE. Outcomes
in patients with rheumatoid arthritis and
myocardial infarction. Am J
Med. 2010;123:922–928.
8. Wislowska M, Sypuła S, Kowalik I.
Echocardiographic findings, 24-hour
electrocardiographic Holter monitoring in
patients with rheumatoid arthritis according
to Steinbrocker’s criteria, functional index,
value of Waaler-Rose titre and duration of
disease. Clin Rheumatol 1998;17:369-377.
9. Wislowska M, Sypuła S, Kowalik I.
Echocardiographic findings and 24-h
electrocardiographic Holter monitoring in
patients with nodular and non-nodular
rheumatoid arthritis. Rheumatol Int 1999;
18: 163-169.
10. Amundsen BH, Helle-Valle T, Edvardsen T,
et al. Noninvasive myocardial strain
measurement by speckle tracking
echocardiography: validation against
sonomicrometry and tagged magnetic
resonance imaging. J Am Coll
Card. 2006;47:789–793.
11. Leitman M, Lysyansky P, Sidenko S, et al.
Two-dimensional strain-a novel software for
real-time quantitative echocardiographic
assessment of myocardial function. J Am
Soc Echocardiogr. 2004;17:1021–1029.
12. Reisner SA, Lysyansky P, Agmon Y, et al.
Global longitudinal strain: a novel index of
left ventricular systolic function. J Am Soc
Echocardiogr. 2004;17:630–633.
13. Langeland S, D'Hooge J, Wouters PF, et al.
Experimental validation of a new ultrasound
method for the simultaneous assessment of
radial and longitudinal myocardial
deformation independent of insonation
angle. Circulation. 2005;112:2157–2162.
14. Marwick TH. Measurement of strain and
strain rate by echocardiography: ready for
prime time? J Am Coll Card. 2006;47:1313–
1327.
15. Bellavia D, Pellikka PA, Abraham TP, et al.
Evidence of impaired left ventricular
systolic function by Doppler myocardial
imaging in patients with systemic
amyloidosis and no evidence of cardiac
involvement by standard two-dimensional
and Doppler echocardiography. Am J
Card. 2008;101:1039–1045.
16. Yang H, Sun JP, Lever HM, et al. Use of
strain imaging in detecting segmental
dysfunction in patients with hypertrophic
cardiomyopathy. J Am Soc
Echocardiogr. 2003;16:233–239.
17. Liu YW, Tsai WC, Su CT, et al. Evidence of
left ventricular systolic dysfunction detected
by automated function imaging in patients
with heart failure and preserved left
ventricular ejection fraction. J Card
Fail. 2009;15:782–789.
18. Sitia S, Tomasoni L, Cicala S, et al.
Detection of preclinical impairment of
myocardial function in rheumatoid arthritis
patients with short disease duration by
speckle tracking echocardiography. Int J
Cardiol. 2012;160:8–14.
19. Wu, K. C. and Lima, J. A. (2003)
Noninvasive imaging of myocardial
viability: current techniques and future
developments. Circ. Res. 93, 1146–1158
20. Sutherland, G. R., Di, S. G., Claus, P.,
D’hooge, J. and Bijnens, B. (2004) Strain
and strain rate imaging: a new clinical
approach to quantifying regional myocardial
function. J. Am. Soc. Echocardiogr. 17,
788–802
21. Garot, J., Lima, J. A., Gerber, B. L. et al.
(2004) Spatially resolved imaging of
myocardial function with strain-encoded MR: comparison with delayed contrastenhanced MR imaging after myocardial
infarction. Radiology 233, 596–602
22. Naseem M1, Samir S1, Ibrahim IK1, Khedr
L1, Shahba AAE2. 2-D speckle-tracking
assessment of left and right ventricular
function in rheumatoid arthritis patients with
and without disease activity. J Saudi Heart
Assoc. 2019 Jan;31(1):41-49.
23. Cioffi G1, Viapiana O2, Ognibeni
F2, Dalbeni A2, Giollo A2, Gatti D2, Idolazzi
L2, Faganello G3, Di Lenarda A3, Rossini
M2. Prognostic Role of Subclinical Left
Ventricular Systolic Dysfunction Evaluated
by Speckle-Tracking Echocardiography
in Rheumatoid Arthritis. J Am Soc
Echocardiogr. 2017 Jun;30(6):602-611.
24. Benacka O, Benacka J, Blazicek P, Belansky
M, Payer J, Killinger Z, Lietava J. Speckle
tracking can detect subclinical myocardial
dysfunction in rheumatoid arthritis patients.
Bratisl Lek Listy. 2017;118(1):28-33.
25. Midtbø H1,2, Semb AG3, Matre K2, Kvien
TK3, Gerdts E2. Disease activity is
associated with reduced left ventricular
systolic myocardial function in patients with
rheumatoid arthritis. Ann Rheum Dis. 2017
Feb;76(2):371-376.
26. Fine NM1, Crowson CS2, Lin G1, Oh
JK1, Villarraga HR1, Gabriel SE2. Evaluation
of myocardial function in patients with
rheumatoid arthritis using strain imaging by
speckle-tracking echocardiography. Ann
Rheum Dis. 2014 Oct;73(10):1833-9.