Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography

Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Annals of the rheumatic diseases (Impact Factor: 9.27). 07/2013; 73(10). DOI: 10.1136/annrheumdis-2013-203314
Source: PubMed

ABSTRACT Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD), although strategies to detect subclinical CVD are poorly characterised. The purpose of this study was to assess myocardial function by speckle-tracking echocardiography strain imaging in patients with RA without known CVD.
Eighty-seven patients with RA selected from a population-based sample underwent echocardiography. Left ventricular (LV) and right ventricular (RV) longitudinal peak systolic strain were measured. A subset of 59 patients with RA was compared with 59 age-, gender- and race-matched subjects with normal echocardiography and no CVD or risk factors.
The mean ± SD age of the patients with RA and the normal patients was 55.7±12.1 and 54.5±12.2 years (p=0.42), respectively, with 45 (76%) women in each group. Global LV strain (-15.7±3.2% vs -18.1±2.4%, p<0.001) and RV strain (-17.9±4.7% vs -20.7±2.4%, p<0.001) was reduced in patients with RA compared with normal patients. Among all 87 patients with RA the mean disease duration and C-reactive protein at echocardiography were 10.0±6.1 years and 3.5±3.7 mg/L, and 74% were seropositive. Adjusted univariate regression analysis demonstrated a significant correlation between global LV strain and RA Health Assessment Questionnaire disability index (p=0.032), and borderline associations with prior use of oral corticosteroids (p=0.062) and methotrexate (p=0.054) after adjustment for age, gender, blood pressure, body mass index, heart rate and LV mass index.
Global longitudinal LV and RV strain is reduced in patients with RA compared with healthy patients. Strain abnormalities correlate with RA disease severity. Strain imaging by echocardiography may detect early myocardial dysfunction in RA.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Although ulcerative colitis (UC) shows obvious similarities with other autoimmune diseases, cardiac consequences have not adequately introduced. The aim of our study was to evaluate left ventricular (LV) function in UC patients by using novel echocardiographic parameters. Results Forty-five UC patients (mean age 37, 18 female) and 90 age-and sex-matched healthy volunteers (mean age 40, 38 female) included in the study. The mean disease activity score according to partial Mayo score was 2.16 +/- 2.13. Mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) measurements were significantly lower (-21.16 +/- 2.71 vs. -23.36 +/- 3.34; p < 0.001 and -1.33 +/- 0.24 vs. -1.43 +/- 0.24; p = 0.037, respectively), whereas global circumferential (-22.67 +/- 3.66 vs. -23.37 +/- 3.99; p = 0.140) and global radial strain (43.07 +/- 8.58 vs. 44.12 +/- 9.32; p = 0.545) measurements of the LV were similar in patients with UC compared with controls. The correlation coefficient (r) between GLS and partial Mayo score was -0.578 (p < 0.001). Conclusion Our study suggests that systolic cardiac deformation values are impaired in UC patients. Reduced GLS and GLSR might be an early indicator of cardiac involvement in this population.
    Digestive Diseases and Sciences 07/2014; 59(12). DOI:10.1007/s10620-014-3274-4 · 2.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with chronic inflammatory diseases are at increased risk of heart failure due to ischemic heart disease and other causes including heart failure with preserved ejection fraction. Using rheumatoid arthritis and treated HIV infection as two prototypical examples, we review the epidemiology of heart failure in these populations and potential therapies to prevent it. Particular focus is given to antiinflammatory therapies including statins and biologic disease-modifying drugs. There is also limited evidence for lifestyle changes and blockade of the renin-angiotensin-aldosterone system. We conclude by proposing how a strategy for heart failure prevention, such as the model tested in the Screening To Prevent Heart Failure (STOP-HF) trial, may be adapted to chronic inflammatory disease.
    Current Cardiovascular Risk Reports 08/2014; 8(8). DOI:10.1007/s12170-014-0392-7
  • [Show abstract] [Hide abstract]
    ABSTRACT: The care for patients with cancer has advanced greatly over the past decades. A combination of earlier cancer diagnosis and greater use of traditional and new systemic treatments has decreased cancer-related mortality. Effective cancer therapies, however, can result in short- and long-term comorbidities that can decrease the net clinical gain by affecting quality of life and survival. In particular, cardiovascular complications of cancer treatments can have a profound effect on the health of patients with cancer and are more common among those with recognized or unrecognized underlying cardiovascular diseases. A new discipline termed cardio-oncology has thus evolved to address the cardiovascular needs of patients with cancer and optimize their care in a multidisciplinary approach. This review provides a brief introduction and background on this emerging field and then focuses on its practical aspects including cardiovascular risk assessment and prevention before cancer treatment, cardiovascular surveillance and therapy during cancer treatment, and cardiovascular monitoring and management after cancer therapy. The content of this review is based on a literature search of PubMed between January 1, 1960, and February 1, 2014, using the search terms cancer, cardiomyopathy, cardiotoxicity, cardio-oncology, chemotherapy, heart failure, and radiation.
    Mayo Clinic Proceedings 09/2014; 89(9):1287–1306. DOI:10.1016/j.mayocp.2014.05.013 · 5.81 Impact Factor