Role of Tissue Doppler Echocardiography in the Diagnosis of Early Left Ventricular Dysfunction in Rheumatoid Arthritis
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Objective: Rheumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alterations. The purpose of our study is the usefulness of Tissue Doppler echocardiography to detect the nature and extent of cardiac involvement in RA patients with no symptoms of cardiac disease, in comparison with a control sample.
Methods: We selected 21 patients affected by rheumatoid arthritis. No patient had any symptoms of cardiac disease. As a control group we studied 21 volunteers, randomly selected among a larger group of subjects who had come for routine check-up. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographic examination was carried out on each subject.
Results: out of 21 RA patients, 16 females 5 males with an average age of 38±9 years. Both the study group and control were matched with respect to age and sex. In RA patients we found a higher prevalence of several tissue Doppler parameters abnormalities. Patients with RA showed significantly higher tricuspid annular plane systolic ejection (TAPSE) 2.49±0.19 vs. 2.36±0.22 (p= 0.04), isovolumetric contraction time (IVCT) 48.8±11.7 vs. 41.2±7.7 msec, (p=0.02), isovolumetric velocity (IVV) 12.26±2.23 vs. 15.71±1.89 m/sec ( p = 0.00) acceleration time (AT) 0.43±0.05 vs. 0.35+0.05 msec (p = 0.00) lower isovolumetric acceleration (IVA) 28.68±6.57 vs. 45.8±10.1 m/sec2 (p = 0.00) early diastolic velocity (E)′ 10.48±1.99 vs. 13.02±1.54 cm/sec (p = 0.00). No significant difference was noted with IVRT (isovolumetric relaxation time) and A′ (late diastolic velocity). Duration of RA did not affect the significance of these parameters.
Conclusion: There was subclinical LV systolic and diastolic dysfunction with normal EF, detected by tissue Doppler imaging in Rheumatoid arthritis patients.