| Part 1:Evaluation of left ventricular function in patients with rheumatoid arthritis by non-invasive pressure strain loop techniquePurpose:To evaluate the left ventricular function changes of patients with rheumatoid arthritis(RA)by pressure strain loop(PSL)technique.Methods:64 patients and 32 healthy volunteers diagnosed with RA in the Affiliated Hospital of Yangzhou University from April 2021 to December 2022 were prospectively selected as subjects.According to the duration of disease,RA patients were divided into Group A(n=32,duration<5 years)and Group B(n=32,duration≥ years).Clinical data were collected.Brachial arterial blood pressure was measured in all subjects and routine echocardiography and myocardial work(MW)analysis were performed.Conventional echocardiographic parameters,left ventricular global longitudinal strain(GLS),peak strain dispersion(PSD)and myocardial work index(MWI),namely left ventricular global work index(LVGWI),left ventricular global constructive work(LVGCW),left ventricular global wasted work(LVGWW)and left ventricular global work efficiency(LVGWE),were investigated in the three groups,for comparative analysis.Receiver operating characteristic curve(ROC)was used to evaluate MWI,and the optimal cut-off values of each parameter were calculated.Pearson correlation coefficient was used to analyze the correlation between MWI and other left ventricular systolic function parameters.Results:1.There were no significant differences in gender,age,systolic blood pressure and diastolic blood pressure between the three groups and the control group(P>0.05).The RF,CRP and ESR of group A and B were higher than those of control group,and there were obvious differences in statistics(H=5.672、4.445、5.668,in group A,H=6.790、4.584、6.343,in group B;all P<0.05).2.the comparison of routine echocardiography parameters between Groups A,B,and the control group.There were no statistically significant differences in IVSD,LVDd,LVDs,EDV,ESV,LVEF,LVSV,or LVFS between any of the groups(P>0.05).3.The absolute values of GLS,LVGWI,LVGCW,and LVGWE in Group A and Group B were lower than those in the control group,with statistically significant differences(H=3.896,6.659,2.518,4.926,in group A,H=-5.534,9.512,5.310,7.099,in group B,all P<0.05);The LVGWW and PSD of Group B were higher than those of the control group,with statistically significant differences(H=4.898,-2.316,in group A,H=6.452,-6.738,in group B;both P<0.05).The LVGWI,LVGCW,and LVGWE in Group B were significantly lower than those in Group A(H=2.612,2.792,2.174;P<0.05);The LVGWW and PSD of Group B were higher than those of Group A,with statistically significant differences(H=2.552,-4.442;P<0.05),other parameters were not statistically significant.4.Pearson correlation analysis showed that GLS value(Negative value)was negatively correlated with LVGWI,LVGCW and LVGWE(r=-0.824,-0.659,-0.817,all P<0.001),and positively correlated with LVGWW and PSD(r=0.823,0.841,P<0.001).LVEF was positively correlated with LVGWI,LVGCW and LVGWE(r=0.811,0.266,0.242,all P<0.001),and negatively correlated with LVGWW and PSD(r=-0.336,-0.326,P<0.001).PSD was significantly negatively and positively correlated with LVGWI,LVGCW and LVGWE(r=-0.712,-0.615,-0.731,all P<0.001),and significantly and positively correlated with LVGWW(r=0.717,all P<0.001).5.Receiver operating characteristic curve analysis showed that the area under the curve of LVGWE,LVGWW,LVGWI,PSD,GLS was(0.941,0.925,0.912,0.839,0.866),and the sensitivity was(89.5%,87.2%,85.5%,75.1%,79.3%),the specificity was(98.6%,97.8%,95.0%,92.8%,93.8%),respectively.The area under curve,sensitivity and specificity of LVGWE,LVGWW and LVGWI were higher than those of PSD and GLS.Conclusion:Noninvasive PSL is a new technology with broad prospects for development.Its MW index is more sensitive than two-dimensional speck-tracking GLS,and earlier than conventional echocardiography LVEF provides a new technical method for quantitative assessment of left ventricular systolic function in patients with RA.Part 2:Evaluation of myocardial work before and after treatment of rheumatoid arthritis by non-invasive pressure strain loopObjective:To evaluate the changes of left ventricular myocardial work in patients with rheumatoid arthritis(RA)before and after treatment by non-invasive press-strain loop(PSL).Methods:Prospectively,A total of 43 patients with RA diagnosed in the Affiliated Hospital of Yangzhou University from April 2021 to December 2022 were prospectively selected as subjects.35 healthy volunteers were recruited as the control group in the same period.The clinical data,conventional echocardiographic parameters,left ventricular global longitudinal strain(GLS),left ventricular global work index(LVGWI),left ventricular global constructive work(LVGCW),left ventricular global wasted work(LVGWW),left ventricular global work efficiency(LVGWE),and peak strain dispersion(PSD)were compared and analyzed.Results:1.Before treatment,GLS absolute value,LVGWI,LVGCW and LVGWE in the treatment group were significantly lower than those in the control group(t=-5.339,5.595,5.761,7.728,P<0.05);The LVGWW and PSD before treatment were significantly higher than those in the control group(t=-8.703,-6.432,P<0.05).2.Compared with the control group,GLS absolute value,LVGWI,LVGCW,LVGWE were significantly decreased after treatment(t=-4.016,4.244,2.510,3.853,P<0.05);LVGWW and PSD were significantly higher than those in the control group(t=-4.498,4.146,P<0.05).3.LVGWI,LVGCW,LVGWE after treatment were higher than those before treatment(Z=-2.439、-4.075.-4.622,P<0.05);LVGWW and PSD decreased(Z=4.682、4.463,P<0.05),and the differences were statistically significant.The rest had no statistical significance(P>0.05).Conclusion:The myocardial work parameters obtained by PSL technology are highly reproducible,which can sensitively detect the changes of left ventricular Myocardial work in RA patients before and after treatment,and can more quickly and sensitively monitor the changes of myocardial work after drug treatment in clinical practice. |
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