Correlation Between Rheumatoid Arthritis Disease Activity And Left Ventricular Systolic Function

Research background and purpose:Cardiovascular disease(CVD)is the most common cause of death in patients with Rheumatoid arthritis(RA).Severe and long-term disease activity and inflammation play an important role in atherosclerotic injury and cardiovascular disease in RA patients.Investigating the correlation between disease activity and left ventricular systolic function in patients with RA by using Two-dimensional speckle tracking imaging(2D-STI),to provide a basis for the early prevention of cardiac complications in RA patients.Materials and Methods:A total of 104 RA patients without known heart disease who visited the Department of Rheumatology and Immunology of the First Affiliated Hospital of Chengdu Medical College from December 2021 to November 2022 were collected as the RA patient group,and 90 volunteers matched with RA patients in age and gender were collected as the control group.The general data of RA patient group were collected,including tender joint counts,swollen joint counts,and the disease score of the patients in the last 7 days.Laboratory indicators of RA patients were collected,mainly including indicators related to disease activity: C-reactive protein(CRP),Erythrocyte sedimentation rate(ESR),Rheumatoid factor(RF)and Anti-cyclic citrullinated peptide antibody(ACPA).Disease activity score using 28 joint counts(DAS28)in RA patients was calculated,including DAS28-CRP and DAS28-ESR.Conventional echocardiography and 2D-STI echocardiography were performed in both groups,and the ultrasonic parameters were recorded,including: Left ventricular ejection fraction(LVEF),Global longitudinal strain(GLS)of left ventricular myocardium and longitudinal strain of three long-axis sections(AP4 L,AP3 L,AP2 L),Global circumferential strain(GCS)of left ventricular myocardium and circumferential strain of three short-axis sections(SAM BC,SAM MC,SAM AC).The ultrasonic parameters were compared between RA patients and controls.RA patients were further divided into disease activity DAS28-CRP≤3.2 group and disease activity DAS28-CRP>3.2 group,and disease activity DAS28-ESR≤3.2 group and disease activity DAS28-ESR>3.2 group.The differences of ultrasonic parameters among RA patients with different disease activity status were compared.Pearson or Spearman correlation analysis was used to analyze the correlation between 2D-STI echocardiographic parameters and disease activity in RA patients.Linear regression was used to observe the effect of disease activity on GLS and GCS in RA patients.Results:1.Comparison of conventional echocardiographic parameters between RA group and control group: the left ventricular systolic function parameter LVEF in RA group was slightly lower than that in control group within the normal range(P<0.001).2.Comparison of 2D-STI echocardiographic parameters between RA group and control group: the absolute value of strain in RA group was lower than that in control group,and the absolute value of GLS and GCS were lower than normal level(all P<0.001).3.Comparison of 2D-STI echocardiographic parameters between the disease activity DAS28-CRP≤3.2 group and the disease activity DAS28-CRP>3.2 group in RA patients: part of the absolute value of global and sectional strain in the disease activity DAS28-CRP>3.2 group was lower than that in the DAS28-CRP≤3.2 group(all P<0.05).4.Comparison of 2D-STI echocardiographic parameters between the disease activity DAS28-ESR≤3.2 group and the disease activity DAS28-ESR > 3.2 group in RA patients: part of the absolute value of global and sectional strain in the disease activity DAS28-ESR>3.2 group was lower than that in the DAS28-ESR≤3.2 group(all P<0.05).5.The correlation between 2D-STI echocardiographic parameters and disease activity in RA patients: the absolute value of GLS in RA patients was negatively correlated with disease activity related parameters DAS28-CRP,DAS28-ESR,tenderness joint counts,swollen joint counts,disease activity score in the last 7 days,CRP and ESR(all P<0.05).The absolute value of GCS in RA patients was negatively correlated with disease activity related parameters DAS28-CRP,DAS28-ESR,tenderness joint counts,swelling joint counts,disease activity score in the last 7 days,CRP,ESR and RF(+)(all P<0.05).6.Linear regression analysis of the effect of disease activity on GLS and GCS in RA patients: After adjusting for gender,age,body mass index,duration of disease,white blood cell,lymphocyte,RF(+),ACPA(+),the absolute value of GLS or GSC decreased with the increase of DAS28-CRP or DAS28-ESR in RA patients(all P<0.05).Conclusions:1.2D-STI technology can detect abnormal left ventricular systolic function in RA patients earlier than conventional echocardiography.2.Disease activity is negatively correlated with left ventricular systolic function in RA patients.The higher the disease activity,the lower the left ventricular systolic function.3.More attention to disease activity and early use of 2D-STI technology can help to prevent cardiac complications in RA patients and improve the comprehensive management of RA patients.