Noninvasive imaging methods for evaluating cardiovascular involvement in patients with rheumatoid arthritis before and after anti-TNF drug treatment

Aim: To use 2D speckle-tracking echocardiography, and conventional and tissue Doppler echocardiography to detect subclinical left ventricular myocardial dysfunction in patients with rheumatoid arthritis (RA). Methods: Thirty RA outpatients were assessed before and after 18 months of treatment with antiTNF drugs, along with 30 healthy controls. Cardiovascular risk was assessed by means of ultrasound carotid assessment and comprehensive echocardiographic evaluation (conventional and speckle-tracking calculation). Results: The speckle-tracking analyses were significantly different between the two groups, with global longitudinal strain deformation in the apical four-chamber view being significantly lower in the RA patients (median: 18.78%, interquartile range [IQR]: 15.80-20.82% vs 20.16%, IQR: 19.03-21.89%; [p <0.05]). After 18 months of biological treatment, global longitudinal strain showed a significant improvement (18.78%, IQR: 15.80-20.82 vs 19.24%, IQR: 18.23-19.98; [p < 0.01]), such as for DAS28 (4.80, IQR: 4.65-5.22 vs 2.78; IQR: 2.52-2.99; [p < 0.01]). Conclusion: Speckle-tracking echocardiography showed that left ventricular myocardial longitudinal strain was impaired in the RA patients. Lay abstract: The different structures of the heart may be affected by rheumatoid arthritis (RA)-related inflammation, with the most frequent lesion being conduction defects, followed by pericarditis, cardiomyopathy and valve disease. We demonstrated, in a study involving 30 RA patients and using speckle-tracking echocardiography, that left ventricular myocardial longitudinal strain was impaired in the RA patients, in the absence of any clinical or other echocardiographic evidence of cardiovascular disease. The results suggest that inflammation is associated with myocardial alteration, as it returns to healthy controls levels upon therapy with anti-TNF drugs.