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Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease

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Abstract

Objective

The aim of this study was to evaluate left ventricular diastolic function in patients with active rheumatoid arthritis (RA), analyzing conventional Doppler and tissue Doppler echocardiographic imaging (TDI) which is a new echocardiographic application, with special regard to disease duration.

Methods

Fifty-two patients with active RA and 47 healthy persons were included in this study. Duration of disease ranged from 3 to 324 months (mean 76±85 months). All patients and the control group were evaluated by M-mod, two-dimensional, conventional Doppler echocardiography and TDI.

Results

Among conventional Doppler transvalvular mitral flow parameters, late diastolic flow velocity (A) and deceleration time (DT) values were higher in patients with RA than that in the control group (p<0.001). E (early diastolic flow velocity)/A ratio was found to be lower in patients with RA than that in the control group (p<0.001). Mitral annular early diastolic velocity (E m), among TDI parameters, was found to be lower in patients with RA than that in the control group (p<0.001). E m/A m (mitral annular late diastolic velocity) ratio was found to be lower in RA patients compared with that in the control group (p<0.001). The relation was found between A (r=0.43, p=0.001), DT (r=0.30, p=0.03), E/A ratio (r=0.40, p=0.004), E m (r=0.32, p=0.02), E m/A m ratio (r=0.30, p=0.03), and E/E m (r=0.32, p=0.02), with disease duration in patients with RA.

Conclusion

At present, it is concluded that active RA patients, in the absence of clinical evidence of heart disease, show diastolic dysfunction characterized by impaired E/A ratio, E m/A m ratio, and DT. The relation between diastolic dysfunction and disease duration suggests a subclinical myocardial involvement.

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References

  1. Harris ED (1990) Rheumatoid arthritis. Pathophysiology and implications for therapy. N Engl J Med 322:1277–1289

    Article  PubMed  Google Scholar 

  2. Pincus T, Callahan LF (1986) Taking mortality in rheumatoid arthritis seriously—predictive markers, socioeconomic status and comorbidity. J Rheumatol 13:841–845

    PubMed  CAS  Google Scholar 

  3. Mutru O, Laakso M, Isomaki H, Koota K (1989) Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology 76:71–77

    PubMed  CAS  Google Scholar 

  4. Wallberg-Jonsson S, Ohman ML, Dahlqvist SR (1997) Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J Rheumatol 24:445–451

    PubMed  CAS  Google Scholar 

  5. Lebowits WB (1963) The heart in rheumatoid arthritis. A clinical and pathological study of 62 cases. Ann Intern Med 58:102–123

    PubMed  Google Scholar 

  6. Apstein CS, Eberli FR (1998) Diastolic function and dysfunction with exercise, hypertrophy, ischemia, and heart failure. Cardiologia 43:1269–1279

    PubMed  CAS  Google Scholar 

  7. Mandinov L, Eberli FR, Seiler C, Hess OM (2000) Diastolic heart failure. Cardiovasc Res 45:813–825

    Article  PubMed  CAS  Google Scholar 

  8. Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. J Am Coll Cardiol 30:8–18

    Article  PubMed  CAS  Google Scholar 

  9. Choong CY, Herrmann HC, Weyman AE, Fifer MA (1987) Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol 10:800–808

    Article  PubMed  CAS  Google Scholar 

  10. Garcia MJ, Thomas JD, Klein AL (1998) New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 32:865–875

    Article  PubMed  CAS  Google Scholar 

  11. Lindstrom L, Wranne B (1999) Pulsed tissue Doppler evaluation of mitral annulus motion: a new window to assessment of diastolic function. Clin Physiol 19:1–10

    Article  PubMed  CAS  Google Scholar 

  12. Bruch C, Marin D, Kuntz S, Schmermund A, Bartel T, Schaar J, Erbel R (1999) Analysis of mitral annulus excursion with tissue Doppler echocardiography (tissue Doppler echocardiography=TDE). Noninvasive assessment of left ventricular, diastolic dysfunction. Z Kardiol 88:353–362

    Article  PubMed  CAS  Google Scholar 

  13. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH et al (1997) Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 30:474–480

    Article  PubMed  CAS  Google Scholar 

  14. Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quinones MA, Zoghbi WA (1998) Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue Doppler imaging. Circulation 20:1644–1650

    Google Scholar 

  15. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  16. Montecucco C, Gobbi G, Perlini S, Rossi S, Grandi AM, Caporali R, Finardi G (1999) Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 17:407–412

    PubMed  CAS  Google Scholar 

  17. Schiller NB, Shah PM, Crawford M et al (1989) Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 2:358–367

    PubMed  CAS  Google Scholar 

  18. Vaziri SM, Larson MG, Benjamin EJ, Levy D (1994) Echocardiographic predictors of nonrheumatic atrial fibrillation: the Framingham Heart study. Circulation 89:724–730

    PubMed  CAS  Google Scholar 

  19. Benjamin EJ, D'Agostino RB, Belanger AJ, Wolf PA, Levy D (1995) Left atrial size and the risk of stroke and death: the Framingham Heart study. Circulation 92:835–941

    PubMed  CAS  Google Scholar 

  20. Alpaslan M, Onrat E, Evcik D (2003) Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis. Clin Rheumatol 22:84–88

    Article  PubMed  CAS  Google Scholar 

  21. Di Franco M, Paradiso M, Mammarella A et al (2000) Diastolic function abnormalities in rheumatoid arthritis. Evaluation By echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease. Ann Rheum Dis 59:227–229

    Article  PubMed  Google Scholar 

  22. Maione S, Valentini G, Giunta A et al (1993) Cardiac involvement in rheumatoid arthritis: an echocardiographic study. Cardiology 83:234–239

    Article  PubMed  CAS  Google Scholar 

  23. Levendoglu F, Temizhan A, Ugurlu H, Ozdemir A, Yazici M (2003) Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatol Int 24:141–146

    Article  PubMed  Google Scholar 

  24. Ommen SR, Nishimura RA, Appleton CP et al (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures. Circulation 102:1788–1794

    PubMed  CAS  Google Scholar 

  25. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533

    Article  PubMed  CAS  Google Scholar 

  26. Lengyel M, Nagy A, Zarondi A (2002) Tissue Doppler echocardiography: a new technique to assess diastolic function. Orv Hetil 17:333–339

    Google Scholar 

  27. Mikuls TR, Saag KG (2001) Rheumatoid arthritis: comorbidity in rheumatoid arthritis. Rheum Dis Clin North Am 27:283–303

    Article  PubMed  CAS  Google Scholar 

  28. Page J, Henry D (2000) Consumption of NSAIDs and the development of congestive heart failure in elderly patients. Arch Intern Med 160:777–784

    Article  PubMed  CAS  Google Scholar 

  29. Nashel D (1986) Is atherosclerosis a complication of long-term corticosteroid treatment? Am J Med 80:925–929

    Article  PubMed  CAS  Google Scholar 

  30. Landewe R, van den Borne B, Breedveld F et al (2000) Methotrexate effects in patients with rheumatoid arthritis with cardiovascular comorbidity. Lancet 355:1616–1617

    Article  PubMed  CAS  Google Scholar 

  31. Haagsma C, Blom H, van Riel PL et al (1999) Influence of sulfasalazine, methotrexate and combination of both on plasma homocysteine concentrations in patients with rheumatoid arthritis. Ann Rheum Dis 58:79–84

    PubMed  CAS  Google Scholar 

  32. Iglesias Cubero G, Rodriguez Reguero JJ, Rojo Ortega JM (1993) Restrictive cardiomyopathy caused by chloroquine. Br Heart J 69:451–452

    Article  PubMed  CAS  Google Scholar 

  33. Ratliff NB, Estes ML, Myles JL, Shirey EK, McMahon JT (1987) Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. N Engl J Med 316:191–193

    Article  PubMed  CAS  Google Scholar 

  34. Qasim FJ, Thiru S, Gillespie K (1997) Gold and d-penicillamine induce vasculitis and up-regulate m RBA for IL-4 in the Brown Norway rat: support for a role of Th2 cell activity. Clin Exp Immunol 108:438–445

    Article  PubMed  CAS  Google Scholar 

  35. Sagie A, Benjamin EJ, Galderisi M et al (1993) Reference values for Doppler indexes of left ventricular diastolic filling in the elderly. J Am Soc Echocardiogr 6:570–576

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiology Department, Faculty of Medicine, Atatürk University, Erzurum, Turkey

    Şakir Arslan, Engin Bozkurt & Mustafa Kemal Erol

  2. Department of Immunology and Rheumatology, Faculty of Medicine, Atatürk University, Erzurum, Turkey

    Refik Ali Sari

Authors
  1. Şakir Arslan
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  2. Engin Bozkurt
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  3. Refik Ali Sari
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  4. Mustafa Kemal Erol
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Corresponding author

Correspondence to Şakir Arslan.

Additional information

This study has been accepted as a poster presentation at the Annual European Congress of Rheumatology “EULAR 2004” (Berlin, Germany, 9–12 June 2004

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Arslan, Ş., Bozkurt, E., Ali Sari, R. et al. Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease. Clin Rheumatol 25, 294–299 (2006). https://doi.org/10.1007/s10067-005-0014-3

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  • DOI: https://doi.org/10.1007/s10067-005-0014-3

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