Color and Tissue Doppler Echocardiographical Findings in Patients with Rheumatoid Arthritis

Year 2018, Volume: 10 Issue: 2, 41 - 52, 07.12.2018

Mehmet Caglayan Ali Fuat Kara Mehmet Zihni Bilik Mehmet Ata Akıl Figen Ceylan Çevik Remzi Çevik

Abstract

Aim: Cardiac involvement associated with rheumatoid arthritis (RA) is one of the common inflammatory diseases of silent nature. In this study, presence of cardiac involvement was investigated by echocardiographic evaluation in RA patients.
Material and Methods: Fourty-eight patients with RA and 22 age-matched healthy controls were included in this study. All individuals were evaluated in terms of clinical and laboratory parameters. Conventional and tissue Doppler echocardiography was performed.
Results: According to the conventional and tissue Doppler evaluation, RVD (Right ventricular diastolic diameter), RAD (Right atrium diastolic diameter), Mit-E (Early diastolic wave of mitral valve), Tleft-Em (Left ventricular lateral wall tissue Doppler late diastolic wave), Tright-Em (Right ventricular free wall tissue Doppler early diastolic wave), Mit-E/Mit-A, Tleft-Em/Tleft-Am (Left ventricular lateral wall tissue Doppler late diastolic wave/ Left ventricular lateral wall tissue Doppler late diastolic wave), Tright-Em/Tright-Am were found to be significantly lower in the RA group. Mit-A (Late diastolic motion of mitral valve), DT (Mitral deceleration time), Tleft-Am, Tright-Am (Right ventricular free wall tissue Doppler late diastolic wave), IVRT (isovolumic relaxation time), LV-MPI (Left ventricular myocardial performance index), RV-MPI (Right ventricular myocardial perfusion index) were found to be significantly higher in the RA group.
Conclusion: Conventional and tissue Doppler measurements demonstrated the presence of diastolic dysfunction in RA patients. Conventional and tissue Doppler electrocardiographic evaluation offers necessary, non-invasive, and practical methods in the planning of the required treatment regimen for cardiac involvement within the context of the follow-up of the RA patients.

Keywords

diastolic dysfunction, doppler echocardiography

References

• 1. Pincus T, Kavanaugh A, Sokka T. Benefit/risk of therapies for rheumatoid arthritis: underestimation of the "side effects" or risks of RA leads to underestimation of the benefit/risk of therapies. Clin Exp Rheumatol 2004; 22(35): 2-11.
• 2. Book C, Saxne T, Jacobsson LT. Prediction of mortality in rheumatoid arthritis based on disease activity markers. J Rheumatol 2005; (32): 430–4.
• 3. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis. An extraarticular feature of rheumatoid arthritis? Arthritis Rheum 2002; 46: 862-73. 4. Renjith AS, Marwaha V, Aggarwal N, Koshy V, Singal VK, Kumar KVSH. Prevalence of left ventricular dysfunction in rheumatoid arthritis. J Family Med Prim Care 2017; 6(3): 622-6.
• 5. Giles JT , Fernandes V , Lima JA , Bathon JM . Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis. Arthritis Res Ther 2005; 7(5):195–207.
• 6. Fukuta H , Little WC . Diagnosis of diastolic heart failure. Curr Cardiol Rep 2007; 9(3): 224–8.
• 7. Abdul Muizz AM, Mohd Shahrir MS, Sazliyana S, Oteh M, Shamsul AS, Hussein H. A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity. Int J Rheum Dis. 2011; 14(1):18–30.
• 8. Ciftci O, Yilmaz S, Topcu S, Caliskan M, Gullu H, Erdogan D, et al. Impaired coronary microvascular function and increased intima- media thickness in rheumatoid arthritis. J atherosclerosis. 2008; 198 (2) : 332-7.
• 9. Arslan S, Bozkurt E, Sari RA, Erol MK. Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease. Clinical Rheumatology 2006; 25 (3): 294-9.
• 10. Birdane A, Korkmaz C, Ata N, Cavusoglu Y, Kasifoglu T, Dogan SM et al. Tissue Doppler imaging in the evaluation of the left and right ventricular diastolic functions in rheumatoid arthritis. J compilation 2007; 24 (5): 485-93.
• 11. Sharma A, Kaushik R, Kaushik RM, Kakkar R. Echocardiographic evaluation of diastolicdysfunction in rheumatoid arthritis – a case–control study. Mod Rheumatol 2015; 25(4): 552-7. 12. Seyfeli E, Guler H, Akoglu S, Karazincir S, Akgul F, Saglam H. et al. Right ventricular diastolic abnormalities in rheumatoid arthritis and its relationship with left ventricular and pulmonary involvement. Tissue Doppler echocardiographic study. Int J cardiovasc imaging 2007; 22 (6): 745-54.
• 13. Alpaslan M, Onrat E, Evcik D Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis. Clin Rheumatol 2003; 22 (2): 84– 8.
• 14. Levendoglu F, Temizhan A, Ugurlu H, Ozdemir A, Yazici M Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatol Int 2003; 24:141–46.
• 15. Vizzardi E, Cavazzana I, Bazzani C, Pezzali N, Ceribelli A, Bonadei I, et al. Echocardiographic evaluation of asymptomatic patients affected by rheumatoid arthritis. J Investig Med 2012; 60(8): 1204-8.
• 16. Di Franco M, Paradiso M, Mammarella A, Paoletti V, Labbadia G, Coppotelli L. et al Diastolic function abnormalities in rheumatoid arthritis. Evaluation By echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease. Ann Rheum Dis 2000; 59(3): 227–9.
• 17. Montecucco C, Gobbi G, Perlini S, Rossi S, Grandi AM, Caporali R. et al. Impaired diastolic function inactive rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 1999; 17(4): 407–12.
• 18. Yazıcı D, Tokay S, Aydin S, Toprak A, Inanc N, Khan SR et al. Echocardiographic evaluation of cardiac diastolic function in patients with rheumatoid arthritis: 5 years of follow-up. Clinical Rheumatology 2008; 27(5): 647-50.
• 19. Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ. et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996; 9(6): 838– 47