Evaluation of Subclinical Cardiac Dysfunction in Rheumatoid Arthritis and Ankylosing Spondylitis Using Tissue Doppler Imaging: Impact of TNF-α Inhibitor Therapy

Abstract

Objectives: This study aimed to evaluate left ventricular diastolic function in patients with rheumatoid arthritis and ankylosing spondylitis using the myocardial performance index derived from tissue Doppler imaging. A secondary objective was to assess whether tumor necrosis factor-alpha inhibitor therapy was associated with changes in cardiac performance.

Methods: Patients diagnosed with rheumatoid arthritis or ankylosing spondylitis and age- and sex-matched healthy controls underwent comprehensive transthoracic echocardiography, including tissue Doppler imaging. The myocardial performance index was calculated using isovolumetric contraction time, isovolumetric relaxation time, and ejection time. Clinical disease activity and functional status were assessed. Subgroup analyses were conducted based on the use of tumor necrosis factor-alpha inhibitors.

Results: Patients with rheumatoid arthritis exhibited significantly reduced early/atrial transmitral flow ratios in the lateral, anterior, and inferior walls of the left ventricle (P<0.05), as well as elevated pulmonary artery pressure (P=0.003), consistent with early diastolic dysfunction. Myocardial performance index values were regionally impaired. In contrast, patients with ankylosing spondylitis demonstrated preserved diastolic function with only a mild increase in pulmonary artery pressure (P=0.009). The use of tumor necrosis factor-alpha inhibitors was not significantly associated with differences in echocardiographic parameters.

Conclusions: Subclinical diastolic dysfunction may be present in patients with rheumatoid arthritis even in the absence of overt cardiovascular disease. Diastolic indices appear preserved in ankylosing spondylitis. No significant echocardiographic differences were observed based on tumor necrosis factor-alpha inhibitor use, though further studies are warranted to clarify treatment-related effects.

Keywords

• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Echocardiography
• Diastolic Dysfunction
• Tumor Necrosis Factor Inhibitors

References

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