Use of tissue Doppler and its comparison with other pulse Doppler echocardiography in the evaluation of diastolic functions in patients with active juvenile idiopathic arthritis

Assessment of left atrial mechanical functions and atrial electromechanical delay in Juvenile idiopathic arthritis by tissue Doppler echocardiography

BACKGROUND

Juvenile idiopathic arthritis (JIA) is a systemic chronic inflammatory disease. Studies using tissue Doppler imaging (TDI) for the evaluation of cardiac functions of children with JIA are limited. Thus, this study was conducted to evaluate Left ventricular function, left atrial mechanical functions and atrial electromechanical delay in JIA.

METHODS

This study was carried out as a across sectional study. A total of 34 patients with active JIA and 34 controls were included. Atrial electromechanical delay and left atrial (LA) mechanical functions in addition to systolic and diastolic left ventricular (LV) functions were measured by using conventional echocardiography and TDI. Assessment of disease activity was done using Juvenile arthritis disease activity score (JADAS-27).

RESULTS

JIA patients had abnormal atrial electromechanical coupling as established from prolonged lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), inter-atrial and intra-atrial electromechanical delays compared with healthy controls. Left ventricular filling abnormalities were found characterized by a reduced E/A ratio (1.07 ± 0.56 vs. 1.48 ± 0.16, p = 0.01). E/Em was significantly higher in patients with JIA (7.58 ± 1.79 vs. 4.74 ± 1.45, p = 0.003) denoting impaired diastolic function. Left atrial mechanical functions assessment showed significantly decreased LA passive emptying fraction, increased LA active emptying fraction and LA total emptying volume in JIA patients (p = 0.01, p = 0.01, p = 0.03 respectively).

CONCLUSION

Atrial electromechanical coupling intervals, and LA mechanical functions were impaired which can be considered as an early form of subclinical cardiac involvement in JIA patients. Significant diastolic functional abnormalities exist in JIA.

Cardiac involvement in juvenile idiopathic arthritis

An insidious progression of cardiovascular (CV) involvement is generally associated with rheumatologic diseases and finally regarded as a major source of morbidity and mortality in Juvenile idiopathic arthritis (JIA) patients. JIA could involve all of the cardiac structures, including pericardium, myocardium, endocardium; coronary vessels; valves and conduction system. Development of pericarditis, myocarditis, endocarditis and ventricular dysfunction are not unexpected issues in the progress of JIA. It is essential to ensure a comprehensive follow-up with advanced and up-to-date diagnostic and therapeutic modalities for prevention of CV complications in JIA patients. Since these are all associated with an unfavorable prognosis, it is necessary to detect subclinical cardiac involvement in CV asymptomatic patients, in order to start adequate management and treatment. Furthermore, controlling chronic inflammatory state of JIA by new treatment modalities will also significantly reduce the overall morbidity and mortality related to CV diseases. In this review, we aimed to investigate CV involvement patterns in patients with JIA.

Cardiac Function in Adult Patients with Juvenile Idiopathic Arthritis

Objective.

To compare cardiac function in adults with longterm juvenile idiopathic arthritis (JIA) with that of healthy controls, and to investigate the influence of inflammation, disease severity, and use of antirheumatic medication on cardiac function.

Methods.

Eighty-five patients with JIA (median age 38.6 yrs) with active disease for at least 15 years were reexamined at a median of 29 years after disease onset and compared with 46 matched controls. Echocardiography, including tissue Doppler imaging and longitudinal peak-systolic global strain, was used to assess diastolic and systolic myocardial function, and 12-channel electrocardiography was performed.

Results.

The interventricular septum was thicker in patients than controls (mean ± SD 0.8 ± 0.2 cm vs 0.7 ± 0.1 cm, p = 0.036). Diastolic function in patients was altered compared with controls characterized by lower mitral E wave deceleration time (165 ± 36 ms vs 180 ± 40 ms, p = 0.029), higher surrogate marker of left ventricular (LV) filling pressure (median lateral E/e’ 5.3, interquartile range 4.6–6.3 vs 4.8, 3.9–5.7, p = 0.036), and larger left atrial area (16.4 ± 2.9 cm2vs 15.1 ± 2.8 cm2, p = 0.015). Systolic and diastolic blood pressures were higher in patients (120 ± 15 mmHg vs 114 ± 9 mmHg, p = 0.021 and 76 ± 10 mmHg vs 71 ± 8 mmHg, p = 0.009, respectively). QT corrected interval was similar in patients and controls. High high-sensitivity C-reactive protein (CRP), polyarticular disease course, and extended joint affection at 29-year followup, as well as duration of active disease, cumulative erythrocyte sedimentation rate, and CRP, and prednisolone use were associated with higher lateral E/e’.

Conclusion.

Adult patients with JIA did not differ from controls in LV systolic function, but had mildly thicker interventricular septum and indications for higher LV filling pressure, and most in patients with a higher disease burden.