Myocardial dysfunction in patients with rheumatoid arthritis in the speckle-tracking echocardiography and its relationship with the clinical characteristics of the disease

Kateryna Uzun; Valeriy  Batushkin; Аndriy Gnylorybov; Dmytro Uzun; Alina Krivosheya; Yuriy  Potapov

doi:10.32345/USMYJ.1(144).2024.44-54

Kateryna Uzun Kyiv Medical University, Kyiv, Ukraine https://orcid.org/0000-0001-6179-4324
Valeriy Batushkin Kyiv Medical University, Kyiv, Ukraine https://orcid.org/0000-0002-4793-7445
Аndriy Gnylorybov M. Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-5989-5548
Dmytro Uzun Regional Center of Cardio- and X-Ray Endovascular Surgery, Kramatorsk, Ukraine https://orcid.org/0000-0002-9167-6430
Alina Krivosheya Regional Center of Cardio- and X-Ray Endovascular Surgery, Kramatorsk, Ukraine https://orcid.org/0009-0000-0175-7767
Yuriy Potapov National Medical University, Lyman, Ukraine https://orcid.org/0000-0003-1519-8374

DOI: https://doi.org/10.32345/USMYJ.1(144).2024.44-54

Keywords: Rheumatoid Arthritis, Ventricular Dysfunction, Echocardiography, Global Longitudinal Strain, Speckle Tracking Echocardiography, DAS28

Abstract

patients with RA have an approximately 50% increased risk of cardiovascular events and cardiovascular death. Cardiovascular diseases lead to a decrease in life expectancy, and the determination of the mechanisms of myocardial damage in patients with RA is of great importance for the development of methods for the early prevention of heart failure. The aim of our study was to study myocardial dysfunction using speckle tracking echocardiography (STE) in patients with RA and to find out possible correlations with the course of the disease and risk factors for cardiovascular diseases. Materials and methods. 29 RA patients were examined (5 in remission, 17.2%). Rheumatoid factor (RF), the level of antibodies to cyclic citrullinated peptides (a-CRP), quantitative C-reactive protein (CRP) was determined in the blood of all patients, and echocardiography and speckle-tracking echocardiography were performed to determine indicators of longitudinal deformation of the left ventricle. Disease activity was determined using the DAS28 index (CRP) and other functional and laboratory indicators. The results. The study of STE indicators is much better than "classical" echocardiography, revealing latent preclinical heart lesions. We established a significant decrease in Global Longitudinal Strain in the basal anterior and basal antero-septal segments (-17.24±3.01% and 15.94±9.37%, respectively) and preservation of local strain in the apical and middle segments (respectively -26.95+4.95% and -21.69+3.05%). In general, 41.2% of patients with RA had lesions of the basal segments. When analyzing the correlation between disease activity and deformation in STE, an inverse relationship between the DAS28 index and apical deformation (API Strain) was established (r=-0.50, р=0.06). The highest correlations were found between STE and functional status of disease: HAQ-DI score (r=-0.51, p=0.05) and VAS activity (r=-0.64, p=0.01). Conclusions. Functional activity according to the HAQ-DI score and VAS had a significantly greater relationship with preclinical manifestations of heart damage (detected by STE) than standard cardio-vascular risk factors. It is necessary to continue the search for other important factors that can lead to the formation of heart lesions and are related to both the activity of the disease and the functional status of patients. It is expedient to conduct comparative studies of STE in RA and coronary artery disease to clarify the differences in the processes of formation of myocardial damage.

References

Myasoedova, E., Crowson, C. S., Kremers, H. M., Therneau, T. M., & Gabriel, S. E. (2010). Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Arthritis and rheumatism, 62(6), 1576–1582. https://doi.org/10.1002/art.27425

Hunter, T. M., Boytsov, N. N., Zhang, X., Schroeder, K., Michaud, K., & Araujo, A. B. (2017). Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014. Rheumatology international, 37(9), 1551–1557. https://doi.org/10.1007/s00296-017-3726-1

Van Doornum, S., McColl, G., & Wicks, I. P. (2002). Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis?. Arthritis and rheumatism, 46(4), 862–873. https://doi.org/10.1002/art.10089

Узун К.С., Батушкін В.В., Гнилорибов А.М. та ін. Ішемічні та неішемічні ураження серця у хворих на ревматоїдний артрит. I. Клінічні і субклінічні зміни у міокарді, поширеність та тяжкість атеросклерозу, особливості впливу традиційних факторів ризику, роль системного запалення. Український Ревматологічний Журнал. 2021; 4 (86):46-51. https:// doi.org/10.32471/rheumatology.2707-6970.86.16483

Maradit-Kremers, H., Crowson, C. S., Nicola, P. J., Ballman, K. V., Roger, V. L., Jacobsen, S. J., & Gabriel, S. E. (2005). Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis and rheumatism, 52(2), 402–411. https://doi.org/10.1002/art.20853

Crowson, C. S., Nicola, P. J., Kremers, H. M., O'Fallon, W. M., Therneau, T. M., Jacobsen, S. J., Roger, V. L., Ballman, K. V., & Gabriel, S. E. (2005). How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?. Arthritis and rheumatism, 52(10), 3039–3044. https://doi.org/10.1002/art.21349

Nicola, P. J., Maradit-Kremers, H., Roger, V. L., Jacobsen, S. J., Crowson, C. S., Ballman, K. V., & Gabriel, S. E. (2005). The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis and rheumatism, 52(2), 412–420. https://doi.org/10.1002/art.20855

Solomon, D. H., Reed, G. W., Kremer, J. M., Curtis, J. R., Farkouh, M. E., Harrold, L. R., Hochberg, M. C., Tsao, P., & Greenberg, J. D. (2015). Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis & rheumatology (Hoboken, N.J.), 67(6), 1449–1455. https://doi.org/10.1002/art.39098

Imbalzano, E., Zito, C., Carerj, S., Oreto, G., Mandraffino, G., Cusmà-Piccione, M., Di Bella, G., Saitta, C., & Saitta, A. (2011). Left ventricular function in hypertension: new insight by speckle tracking echocardiography. Echocardiography (Mount Kisco, N.Y.), 28(6), 649–657. https://doi.org/10.1111/j.1540-8175.2011.01410.x

Freed, B. H., Daruwalla, V., Cheng, J. Y., Aguilar, F. G., Beussink, L., Choi, A., Klein, D. A., Dixon, D., Baldridge, A., Rasmussen-Torvik, L. J., Maganti, K., & Shah, S. J. (2016). Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain. Circulation. Cardiovascular imaging, 9(3), 10.1161/CIRCIMAGING.115.003754 e003754. https://doi.org/10.1161/CIRCIMAGING.115.003754

Donal, E., Lund, L. H., Oger, E., Hage, C., Persson, H., Reynaud, A., Ennezat, P. V., Bauer, F., Drouet, E., Linde, C., Daubert, C., & KaRen investigators (2015). New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: a subanalysis of the Ka (Karolinska) Ren (Rennes) Study. European journal of heart failure, 17(7), 680–688. https://doi.org/10.1002/ejhf.291

Shah, A. M., Claggett, B., Sweitzer, N. K., Shah, S. J., Anand, I. S., Liu, L., Pitt, B., Pfeffer, M. A., & Solomon, S. D. (2015). Prognostic Importance of Impaired Systolic Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circulation, 132(5), 402–414. https://doi.org/10.1161/CIRCULATIONAHA.115.015884

Park, J. J., Park, J. B., Park, J. H., & Cho, G. Y. (2018). Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure. Journal of the American College of Cardiology, 71(18), 1947–1957. https://doi.org/10.1016/j.jacc.2018.02.064

Thallapally, V. K., Bansal, R., Thandra, A., Gupta, S., Aurit, S., Pajjuru, V. S., Anugula, D., Ahmed, A., & Nahas, J. (2023). Detection of myocardial dysfunction using global longitudinal strain with speckle-tracking echocardiography in patients with vs without rheumatoid arthritis: a systematic review and meta-analysis. Journal of echocardiography, 21(1), 23–32. https://doi.org/10.1007/s12574-022-00583-8

Redfield, M. M., Jacobsen, S. J., Burnett, J. C., Jr, Mahoney, D. W., Bailey, K. R., & Rodeheffer, R. J. (2003). Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA, 289(2), 194–202. https://doi.org/10.1001/jama.289.2.194

Lo Gullo, A., Rodríguez-Carrio, J., Gallizzi, R., Imbalzano, E., Squadrito, G., & Mandraffino, G. (2020). Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Progress in cardiovascular diseases, 63(3), 327–340. https://doi.org/10.1016/j.pcad.2020.03.005