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Myocardial Dysfunction in Rheumatoid Arthritis: A Controlled Tissue-Doppler Echocardiography Study

CHRISTOPHE MEUNE, KARIM WAHBI, NOÉMIE ASSOUS, SIMON WEBER, ANDRÉ KAHAN, and YANNICK ALLANORE

ABSTRACT.

Objective. To determine the sensitivity and accuracy of tissue-Doppler echocardiography (TDE) to assess myocardial contractility. Heart failure is one of the determinants of the excess in mortality in patients with rheumatoid arthritis (RA).

Methods. Consecutive RA patients with normal clinical cardiac examination were prospectively included and compared to 27 controls. All underwent conventional echocardiography, and systolic and diastolic strain rate (SR) were determined by TDE.

Results. Twenty-seven patients with RA were included (mean age 50 ± 10 yrs, disease duration 8 ± 6 yrs). Mean disease activity score was 4.3 ± 1.6, C-reactive protein 23 ± 32 mg/l. When compared to controls (50 ± 9 yrs), patients with RA had increased left ventricular mass (99 ± 24 vs 80 ± 25 g/m², p = 0.009), and there was a trend for left atrial enlargement (31 ± 3 vs 29 ± 6 mm, p = 0.06). Fractional shortening and systolic SR did not differ between groups. Diastolic function, as estimated by the E/A Doppler velocity ratio was similar in both groups (p = 0.18). However, diastolic SR was strikingly reduced in patients with RA versus controls (3.7 ± 1.3 vs 5.5 ± 1.1s^-1, p < 0.001) with 18/27 patients with RA having marked reduced diastolic SR (SR < 4s^-1). None of the RA characteristics was associated with significant differences in TDE measurements.

Conclusion. TDE identifies impaired diastolic function in patients with RA that may not be detected by conventional measurements. (First Release Sept 1 2007; J Rheumatol 2007;34:2005-9)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
MYOCARDIAL DIASTOLIC FUNCTION
TISSUE-DOPPLER ECHOCARDIOGRAPHY

From Cardiology and Rheumatology A Departments, Paris Descartes University, Medical School, Cochin Hospital, Paris, France.

C. Meune, MD, PhD; K. Wahbi, MD; S. Weber, MD, Cardiology; N. Assous, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD, Rheumatology A, Paris Descartes University, Medical School, Cochin Hospital.

Address reprint requests to Dr. Y. Allanore, Hôpital Cochin, Service de rhumatologie A, 27 rue du faubourg Saint Jacques, 75014 Paris, France. E-mail: yannick.allanore@cch.aphp.fr

Accepted for publication June 21, 2007.