Ultrasonographic Evaluation Of The Effect Of Inflammatory Mechanisms On Pulmonary Artery Systolic Pressure And Left Ventricular Diastolic Function In Rheumatoid Arthritis

Part One The comparative study of the pulmonary arterial systolicpressure and disease activity in rheumatoid arthritisObjective: To evaluate pulmonary arterial systolic pressure (PASP)change using ultrasound, and analyze the relationship between PASP anddisease activity in rheumatoid arthritis (RA).Methods: From April2012to March2013,70consecutive inpatientswith active RA were enrolled from the Affiliated Hospital of North SichuanMedical College, aged from16to74years (Mean age52.05±11.82years).Prior history of coronary heart disease, hyperlipidemia, diabetes mellitus,smoking and drinking, or who declined to participate were excluded. Thecontrol group was recruited from a local health exhibition and consisted of60age-and sex-matched healthy subjects. PASP was be determined bymeasuring the peak systolic pressure gradient from the right ventricle to theright atrium using echocardiography and assessed the correlation of PASPwith the disease activity indexes.Results: There were no significant differences in pulmonary flow peakvelocity (PAVmax), acceleration velocity (PAACC), acceleration time (PAAT),Velocity-time integral (PAVTI) between patients with RA and controls (allP>0.05). Patients with RA had significantly higher right ventricular diastolicdiameter(RVEDd), Pulmonary diameter(PAD) and right ventricularmyocardial performance index(RVMPI)（P<0.05）. Furthermore, late diastolic tricuspid valve flow Peak velocity (TrA),the ration of the early diastolictricuspid valve flow Peak velocity(TrE) and TrA was lower and the PASP washigher as compared with controls（P<0.01）. Meanwhile, Among thosepatients with RA,20/70(29%) of them had pulmonary arterial hypertension（PAH）. The PASP were positively correlated with erythrocytesedimentation rate （ESR），C reactive protein (CRP),disease activityscores in twenty-eight-joint (DAS28), the antibody of anti-cycliccitrulline polypeptide (Anti-CCP), Whilst there was a slightly positivecorrelation between PASP and Anti-CCP (r=0.188，P<0.05）.Conclusions:1)The study demonstrate a close inter-relationshipbetween PASP and the inflammatory indicators, Immune makers (ESR、CRP、 DAS28、 Anti-CCP) in RA patients. PASP was significantlyincreased, suggesting that inflammatory activity and immunemechanisms play important role in PAH in RA patients.2) This studyalso points out that the decreasing of right ventricular function andincreasing of PASP result from the damaged myocardial cell andconduction system. Part Two The comparative study of left ventricular diastolic functionand disease activity in rheumatoid arthritisObjective: To evaluate the change of left ventricular diastolic functionand investigate the relation between left ventricular diastolic function anddisease activity in RA patients.Methods: From April2012to March2013,70consecutive inpatients with active RA were enrolled from the Affiliated Hospital of North SichuanMedical College, aged from16to74years (Mean age52.05±11.82years).Prior history of coronary heart disease, hyperlipidemia, diabetes mellitus,smoking and drinking, or who declined to participate were excluded. Thecontrol group was recruited from a local health exhibition and consisted of60age-and sex-matched healthy subjects. Cardiac related parameters weredetermined by echocardiography and evaluated the correlation of leftventricular diastolic function and the disease activity indexes (ESR, CRP,DAS28, antiCCP).Results: Patients with RA had lower early diastolic mitral annulusvelocity(Em) and mitral inflow E/A ration（P<0.01）, higher left atrialdiameter(LAD)，mitral inflow late diastolic A wave velocity(VA), E/Em rationand late diastolic mitral annulus maximum velocity(Am), longerisovolumetric relaxation time（IVRT）than control group （P<0.01）.Moreover, Patients with RA had higher pulmonary venous inflow latediastolic A wave velocity(PVAr)， pulmonary venous inflow A wavevelocity-time integral(ArVTI) and A wave duration (DAr)（P<0.05）.Moreover, the CRP were positively correlated with E/Em,Em,ArVTI,Dar（P<0.05），DAS28were positively correlated with E/Em、ArVTI、DAr（P<0.05）. Whilst theAnti-CCP level was also associated with Em and earlydiastolic pulmonary venous inflow peak velocity (PVD).Conclusions:1) The comparison revealed that left ventricular diastolicfunction impaired and left ventricular diastolic function parameterssignificantly decreased in RA patients.2) There was a correlation between leftventricular diastolic function parameters and the disease activity indexessuggesting that the decline of left ventricular diastolic function was associated with the inflammation activity in RA patients. The inflammation statusaggravate RA disease degree, the left ventricular diastolic function isobviously impaired.