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Habib SA, Hasan AA, Abd Elaziz OH, Ibrahim AH, Ali TA, Kotb FM, Khalaf H, Omar MA, Said IF, Shokr AM, Elkhouly AA, Faheem AA, Abbas AM, Dabash TA, Hefzy MM, Aboomar AA. Comparing Left Ventricular Structure and Functions in End-Stage Renal Disease Using Conventional Echocardiography and 2D Speckle Tracking Echocardiography. Cureus 2024; 16:e62926. [PMID: 39040724 PMCID: PMC11262811 DOI: 10.7759/cureus.62926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Patients on hemodialysis (HD) are prone to various cardiovascular complications. Two-dimensional speckle tracking echocardiography (2D STE) is an innovative technique for early myocardial dysfunction detection, even with normal ejection fraction (EF). OBJECTIVE We aim to detect left ventricle (LV) dysfunction in regular hemodialysis patients using 2D STE compared to traditional echocardiography. METHODS The study comprised 30 patients with end-stage renal disease (ESRD), subdivided according to left ventricular mass index (LVMI) into group 1 with left ventricular hypertrophy (LVH) (n=19) and group 2 without LVH (n=11). Another 30 healthy control subjects were recruited as group 3. The EF, average systolic velocity (Sa), and 2D LV strain were taken as measures of LV systolic function. The indicators for diastolic function included the E/A ratio and E velocity/peak early diastolic velocity. RESULTS Regarding the parameters of LV systolic and diastolic functions assessed by traditional echocardiography, we found no significant difference between groups 1 and 2. However, using 2D STE, we observed significant differences in the average Sa velocity (p=0.025), average LV strain (p=0.03), 2D global longitudinal strain (GLS) (p=0.03), E/Ea (p=0.003), and LV myocardial performance index (MPI) (p=0.006). Also, a significant positive correlation was found between LVMI and left ventricular end-diastolic diameter (LVEDD) (p<0.01, r=0.63), EF measured by 2D (p=0.034, r=0.39), mitral E/A ratio (p=0.03, r=0.49), and mitral E/Ea (p<0.01, r=0.72). There was a significantly strong negative correlation between LVMI and 2D average LV strain (p=0.034, r=-0.39). CONCLUSION We concluded that 2D STE is more sensitive than a conventional echo in detecting early LV systolic and diastolic dysfunction even in patients with normal EF.
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Affiliation(s)
- Shimaa A Habib
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Asmaa A Hasan
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | | | - Amal H Ibrahim
- Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Tamer A Ali
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Fatma M Kotb
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Hani Khalaf
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Mohamad A Omar
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Damietta, EGY
| | - Ibrahim F Said
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Attia M Shokr
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Abdelaal A Elkhouly
- Department of Cardiology, Islamic Cardiac Center, Al-Azhar University, Cairo, EGY
| | - Ahmed A Faheem
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Ahmed Mohamed Abbas
- Department of Urology and Nephrology, National Institute of Nephrology, Cairo, EGY
| | - Tarek A Dabash
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Damietta, EGY
| | | | - Ahmed A Aboomar
- Department of Internal Medicine, Nephrology Unit, Faculty Medicine, Tanta University, Tanta, EGY
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Ebik M, Taştekin N, Gürdoğan M, Ebik M, Birtane M, Emmungil H, Yılmazer B, Süt N. The importance of speckle tracking echocardiography in the evaluation of cardiac functions in patients with rheumatoid arthritis. Arch Rheumatol 2024; 39:303-311. [PMID: 38933726 PMCID: PMC11196223 DOI: 10.46497/archrheumatol.2024.10274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/13/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives In this study, we aimed to analyze the layer-specific strain values obtained by speckle tracking echocardiography (STE) method in the determination of subclinical cardiac dysfunction in rheumatoid arthritis (RA) patients. Patients and methods Between February 2019 and October 2019, a total of 63 female RA patients (mean age: 51.82±6.07 years; range, 40 and 65 years) who had a confirmed diagnosis were included. Thirty-one age-matched female healthy individuals (mean age: 50.71±5.37 years; range, 40 and 65 years) were selected as the control group. The patients were divided into three groups according to the duration of disease as <5 years, 5-10 years and >10 years. The Disease Activity Score in 28 joint - C-reactive protein (CRP) was used to determine disease activation. The standard assessment included complete serum CRP, anti-cyclic citrullinated peptide, rheumatoid factor, N-terminal pro B-type natriuretic peptide (NT-proBNP), and homocysteine. Global longitudinal strain (GLS) analysis was performed with STE. Results The NT-proBNP values were found to be higher in RA patients compared to the control group (p=0.044). In terms of conventional echocardiographic parameters, a significant difference between E/A and E/E' ratios was observed (p<0.001 and p=0.015). Endocardium, transmural, and epicardium GLS values obtained by STE were found to be lower in RA patients (p<0.05). The left ventricular (LV) GLS values worsened, as the duration of disease increased (p<0.05). There was a significant correlation between RA disease activity and LV GLS values, showing that increasing levels of disease activity was associated with worse LV GLS (r=0.583, p<0.01 and r=0.681, p<0.01 and r=0.689, p<0.01 for endocardium, transmural and epicardium, respectively). Conclusion Our study results suggest that the layer-specific GLS values obtained by STE decrease in RA patients.
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Affiliation(s)
- Müşerref Ebik
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Nurettin Taştekin
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Muhammet Gürdoğan
- Department of Cardiology, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Mustafa Ebik
- Department of Cardiology, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Murat Birtane
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Hakan Emmungil
- Department of Internal Medicine, Division of Rheumatology, Division of Rheumatology, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Barış Yılmazer
- Department of Internal Medicine, Division of Rheumatology, Division of Rheumatology, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Necdet Süt
- Department of Biostatistics, Trakya University Faculty of Medicine, Edirne, Türkiye
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Brahem M, Amor HIH, Sarraj R, Touil I, Kraiem S, Rouabhia R, Hmaier E, Mbarek GH, Ben Salem A, Mlouki I, Mhamdi S, Hachfi H, Younes M. Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis. Curr Rheumatol Rev 2024; 20:72-81. [PMID: 37518997 DOI: 10.2174/1573397119666230727111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA). METHODS We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique. RESULTS Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01). CONCLUSION Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.
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Affiliation(s)
- Mouna Brahem
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | | | - Rihab Sarraj
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Touil
- Department of Pneumology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Kraiem
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ramzi Rouabhia
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ella Hmaier
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ghassen Haj Mbarek
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ameni Ben Salem
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Mlouki
- Department of Preventive Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Sana Mhamdi
- Department of Preventive Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Haifa Hachfi
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Mohamed Younes
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
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Detection of myocardial dysfunction using global longitudinal strain with speckle-tracking echocardiography in patients with vs without rheumatoid arthritis: a systematic review and meta-analysis. J Echocardiogr 2023; 21:23-32. [PMID: 35987937 DOI: 10.1007/s12574-022-00583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a systemic autoimmune disorder primarily involving the peripheral joints. Systemic involvement can occur, including myocardial dysfunction. Speckle tracking echocardiography (STE) is a novel diagnostic study which is recently being used to detect subclinical cardiac dysfunction. Global longitudinal strain (GLS) by STE is more sensitive than standard echocardiographic parameters to detect occult cardiac dysfunction. METHODS A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the STE parameters between RA and non-RA patients. RESULTS Left ventricular (LV) GLS was significantly lower in patients with RA compared to non-RA patients with a standard mean difference (SMD) of -1.09 (-1.48--0.70, P < 0.001). LV Global Circumferential Strain (GCS) was reported in five studies, and it was found to be lower in RA patients with an SMD of -1.25 (-2.59--0.10; P < 0.0010). Meta regression analysis studies failed to show any significant impact of disease duration, activity, age, sex and BMI on LV GLS and RV GLS. CONCLUSIONS RA patients have lower LV GLS and LV GCS compared to controls suggesting impaired myocardial dysfunction. Further studies need to be done to delineate the importance of lower GLS in asymptomatic rheumatoid patients to guide disease management and risk factor modification in this selected population.
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Kirillova IG, Gorbunova YN, Popkova TV, Diatroptov ME, Nasonov EL. Subclinical left ventricular dysfunction and N-terminal pro-brain natriuretic peptide in patients with rheumatoid arthritis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-560-565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim – to determine the frequency of myocardial dysfunction using echocardiography with speckle tracking (STE) method, the relationship between a low global longitudinal strain (GLS) with the level of NT-proBNP, clinical and laboratory manifestations of rheumatoid arthritis. Material and methods. The study included 43 patients with RA (ACR/EULAR criteria, 2010): 79% women, age – 53.0 [38.0; 63.0] years, disease duration – 60.0 [36; 180] months; DAS28 – 5.9 [5.2; 6.4], positive for ACCP (74%), RF IgM (81%), without prior biological therapy and CVD. Methotrexate was received by 44%, leflunomide – 35%, sulfasalazine – 9.3%, hydroxychloroquine – 7%, glucocorticoids – 67.4%, non-steroidal anti-inflammatory drugs – 74% of patients with RA. All RA patients underwent echocardiography – tissue Doppler and STE. The level of NT-proBNP was determined in the blood serum The normal range for NT-proBNP was less than 125 pg/ml.Results. Low GLS was observed in 26 (61%) patients with RA. RA patients had a decrease GLS, E LV, E’ LV, E/A LV compared with the control group. Left ventricular diastolic dysfunction (LVDD) was higher in RA patients (13 (31%) vs 0%). Patients with RA had significantly higher levels of NT-proBNP (114.8 [45.1; 277.5] and 52 [40.5; 69.1] pg/ml) compared with the control group. There were correlations between a low GLS and DAS28 (r=0.9), the number of painful joints (r=0.6), radiological stage (r=0.6) and the presence of systemic manifestations (r=0.5), age (r=–0.9), E LV velocity (r=–0.5) (p<0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p><0.05 in all cases).>< 0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p< 0.05 in all cases).Conclusions. In RA patients with a high frequency the low GLS LV was detected, which is associated with a high activity of the inflammatory process. STE helps to detect myocardial dysfunction in patients with RA at earlier stages than tissue Doppler. The use of STE, the determination of the level of NT-proBNP make it possible to diagnosing preclinical disorders of systolic and diastolic functions of the LV, which can contribute to the early initiation of therapy and improve the prognosis in this category of patients.
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Affiliation(s)
| | | | | | | | - E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
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Iskander J, Kelada P, Rashad L, Massoud D, Afdal P, Abdelmassih AF. Advanced Echocardiography Techniques: The Future Stethoscope of Systemic Diseases. Curr Probl Cardiol 2022; 47:100847. [PMID: 33992429 PMCID: PMC9046647 DOI: 10.1016/j.cpcardiol.2021.100847] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease (CVD) has been showing patterns of extensive rise in prevalence in the contemporary era, affecting the quality of life of millions of people and leading the causes of death worldwide. It has been a provocative challenge for modern medicine to diagnose CVD in its crib, owing to its etiological factors being attributed to a large array of systemic diseases, as well as its non-binary hideous nature that gradually leads to functional disability. Novel echocardiography techniques have enabled the cardiac ultrasound to provide a comprehensive analysis of the heart in an objective, feasible, time- and cost-effective manner. Speckle tracking echocardiography, contrast echocardiography, and 3D echocardiography have shown the highest potential for widespread use. The uses of novel modalities have been elaborately demonstrated in this study as a proof of concept that echocardiography has a place in routine general practice with supportive evidence being as recent as its role in the concurrent COVID-19 pandemic. Despite such evidence, many uses remain off-label and unexploited in practice. Generalization of echocardiography at the point of care can become a much-needed turning point in the clinical approach to case management. To actualize such aspirations, we recommend further prospective and interventional studies to examine the effect of implementing advanced techniques at the point of care on the decision-making process and evaluate their effectiveness in prevention of cardiovascular morbidities and mortalities.
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Affiliation(s)
- John Iskander
- Faculty of Medicine, Cairo University, Cairo, Egypt,Corresponding author: John Iskander, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Kelada
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lara Rashad
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Massoud
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Afdal
- Residency program, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Antoine Fakhry Abdelmassih
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, Egypt,Consultant of Pediatric Cardiology, Children Cancer Hospital of Egypt (57357 Hospital), Cairo, Egypt
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Cardiovascular Magnetic Resonance Detects Inflammatory Cardiomyopathy in Symptomatic Patients with Inflammatory Joint Diseases and a Normal Routine Workup. J Clin Med 2022; 11:jcm11051428. [PMID: 35268519 PMCID: PMC8911388 DOI: 10.3390/jcm11051428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Background. Patients with inflammatory joint diseases (IJD) are more likely to develop cardiovascular disease compared with the general population. We hypothesized that cardiovascular magnetic resonance (CMR) could identify cardiac abnormalities in patients with IJD and atypical symptoms unexplained by routine clinical evaluation. Patients-Methods. A total of 51 consecutive patients with IJD (32 with rheumatoid arthritis, 10 with ankylosing spondylitis, and 9 with psoriatic arthritis) and normal clinical, electrocardiographic and echocardiographic workups, were referred for CMR evaluation due to atypical chest pain, shortness of breath, and/or palpitations. Their CMR findings were compared with those of 40 non-IJD controls who were referred for the same reason. All participants were examined using either a 1.5 T or 3.0 T CMR system. For T1/T2 mapping, comparisons were performed separately for each field strength. Results. Biventricular systolic function was similar between groups. In total, 25 (49%) patients with IJD vs. 0 (0%) controls had replacement-type myocardial fibrosis (p < 0.001). The T2 signal ratio, early/late gadolinium enhancement, and extracellular volume fraction were significantly higher in the IJD group. Native T1 mapping was significantly higher in patients with IJD independent of the MRI field strength (p < 0.001 for both). T2 mapping was significantly higher in patients with IJD compared with controls only in those examined using a 1.5 T MR system—52.0 (50.0, 55.0) vs. 37.0 (33.5, 39.5), p < 0.001. Conclusions. In patients with IJD and a mismatch between cardiac symptoms and routine non-invasive evaluation, CMR uniquely identified a significant proportion of patients with myocardial inflammation. A CMR examination should be considered in patients with IJD in similar clinical settings.
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Tański W, Gać P, Chachaj A, Sobieszczańska M, Poręba R, Szuba A. Selected clinical parameters and changes in cardiac morphology and function assessed by magnetic resonance imaging in patients with rheumatoid arthritis and ankylosing spondylitis without clinically apparent heart disease. Clin Rheumatol 2021; 40:4701-4711. [PMID: 34173901 PMCID: PMC8519900 DOI: 10.1007/s10067-021-05777-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of the study was to assess the relationship between the occurrence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and the cardiac magnetic resonance (CMR) changes in people without clinically overt heart disease. METHODS The study group consisted of 74 people (48.81 ± 11.35 years): 29 patients with RA, 23 patients with AS and 22 people from control group. Blood samples were taken to assess laboratory parameters, disease activity was determined using activity scales, and CMR was performed. RESULTS It was shown that the factors independently related to higher left ventricular mass index are AS occurrence, human B27 leukocyte antigen occurrence, higher neutrophil gelatinase-associated lipocalin concentration (NGAL) and higher body mass index (BMI). The lower right ventricular ejection fraction is result of an independent effect of RA, AS and higher NGAL. RA presence, methotrexate use, higher rheumatoid factor titer, higher NGAL, older age and higher BMI should be considered independent risk factors for greater left ventricular myocardium water content. RA occurrence, AS occurrence, type 2 diabetes occurrence and a higher C-reactive protein concentration can be independently associated with a higher probability of non-ischemic left ventricular myocardium injury. Larger pericardial fluid volume is result of an independent effect of higher NGAL, higher anti-cyclic citrullinated peptide antibodies titer and higher DAS28 disease activity index. Use of steroids is protective factor against larger volume of pericardial fluid. CONCLUSIONS RA and AS in people without clinically apparent heart disease are associated with the occurrence of adverse changes in CMR. Key Points •RA and AS in people without clinically apparent heart disease are associated with the occurrence of adverse changes in CMR.. •The independent risk factors for higher LVEF are AS occurrence, human B27 leukocyte antigen occurrence, higher NGAL concentration and higher BMI.. •RA presence, methotrexate use, higher RF, higher NGAL, older age and higher BMI are independent risk factors for higher LV T2 ratio.. •RA occurrence, AS occurrence, type 2 diabetes occurrence and a higher CRP are independently associated with a higher risk of non-ischemic LV myocardium injury..
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Affiliation(s)
- Wojciech Tański
- Department of Internal Medicine, 4th Military Hospital, Weigla 5, PL 50-981, Wroclaw, Poland
| | - Paweł Gać
- Centre for Diagnostic Imaging, 4th Military Hospital, Weigla 5, PL 50-981, Wroclaw, Poland. .,Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368, Wrocław, Poland.
| | - Angelika Chachaj
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, PL 50-556, Wrocław, Poland
| | - Małgorzata Sobieszczańska
- Department of Geriatrics, Wroclaw Medical University, Curie-Skłodowskiej 66, PL 50-369, Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, PL 50-556, Wrocław, Poland
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, PL 50-556, Wrocław, Poland
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Left ventricular myocardial strain assessed by cardiac magnetic resonance feature tracking in patients with rheumatoid arthritis. Insights Imaging 2021; 12:5. [PMID: 33410952 PMCID: PMC7790980 DOI: 10.1186/s13244-020-00948-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of the study was to assess a relationship between the occurrence of rheumatoid arthritis (RA) and its selected clinical parameters, and left ventricular myocardial strain. Material and methods Fifty-six subjects were qualified for the study: 30 RA patients and 26 subjects without rheumatoid diseases. The study design included taking medical history, assessment of the disease activity using selected scales of activity, collecting samples of venous blood to assess selected laboratory parameters and the assessment of cardiac magnetic resonance (CMR). Using the feature tracking method, the following parameters of the left ventricular myocardial strain were assessed: longitudinal strain (LS), radial strain (RS) and circumferential strain (CS). Results Regarding global values, peak LS and peak CS were statistically significantly lower in RA patients than in the control group. In the whole study group, the factors independently related to low global LS peaks were as follows: occurrence of RA, occurrence of arterial hypertension, increased activity of antibodies against cyclic citrullinated peptide and increased concentration of neutrophil gelatinase-associated lipocalin. The occurrence of RA, occurrence of diabetes, tobacco smoking, higher activity of antibodies against cyclic citrullinated peptide and current use of methotrexate are the risk factors for low peak of global CS. The current use of steroids constitutes a protecting factor against low global CS peaks. Conclusion In subjects with no clinically manifested cardiac damage, RA is associated with a deteriorated left ventricular systolic function assessed by left ventricular myocardial strain measured by CMR feature tracking.
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Hiebert JB, Vacek J, Shah Z, Rahman F, Pierce JD. Use of speckle tracking to assess heart failure with preserved ejection fraction. J Cardiol 2019; 74:397-402. [PMID: 31303358 PMCID: PMC6764910 DOI: 10.1016/j.jjcc.2019.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) currently represents approximately 50% of heart failure (HF) cases in the USA and is increasingly recognized as a leading cause of morbidity and mortality. Recent data suggest that the prevalence of HFpEF relative to HF with reduced ejection fraction (HFrEF) is increasing at a rate of 1% per year. With an aging population and increasing risk factors such as hypertension, obesity, and diabetes mellitus, HFpEF will soon be the most prevalent HF phenotype. Two-dimensional speckle-tracking echocardiography (STE) has been used to diagnose HFpEF specifically by focusing on the longitudinal systolic function of the left ventricle (LV). Yet there are many patients with HFpEF in whom there are no differences in LV global longitudinal systolic strain, but there are changes in left atrial function and structure. There are several proposed pathophysiological mechanisms for HFpEF such as endothelial dysfunction, interactions among proteins, signaling pathways, and myocardial bioenergetics. Yet only one specific therapy, mineralocorticoid receptor antagonist, spironolactone, is recommended as a treatment for patients with HFpEF. However, spironolactone does not address many of the pathophysiologic changes that occur in HFpEF, thus new novel therapeutic agents are needed. With the limited available therapies, clinicians should use STE to assess for the presence of this syndrome in their patients to provide effective diagnosis and management.
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Affiliation(s)
- John B Hiebert
- University of Kansas, School of Nursing, Kansas City, KS, USA
| | - James Vacek
- Clinical Cardiology and Cardiovascular Research, Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, KS, USA
| | - Zubair Shah
- The University of Kansas Health System, Kansas City, KS, USA
| | - Faith Rahman
- University of Kansas, School of Nursing, Kansas City, KS, USA.
| | - Janet D Pierce
- Department of Molecular and Integrative Physiology, University of Kansas, School of Nursing, Kansas City, KS, USA
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