| Objective:Rheumatoid arthritis is a systemic multi-system damage autoimmune disease, heart is an important organ of its likely involved, to assess left ventricular systolic myocardial mechanical at early stage with normal ejection fraction in patients suffered from rheumatoid arthritis(RA) using ultrasonic velocity vector imaging (velocity vector imaging, VVI) technology, and to provide a sentive and reliable quantitative evaluation for the clinical diagnosis and treatment of RA patients with heart disease, and to provide indicators for effect observation of treatment.Methods:According to 1987 American Rheumatism Society (ACR) diagnostic criteria for RA patients with normal ejection fraction, total of 84 selected cases were divided into three groups. Group A:RF<20IU/ml,51 cases; group B:RF20-60IU/ml,13 cases; group C:RF> 60IU/ml,21 cases; control group:combining with history, and physical examination, and exclusion of heart disease and other systemic diseases,35 normal healthy adults cases were selected with normal conventional echocardiographic heart structure and function. The dynamic gray scale images of left ventricle of 3 complete continuous cardiac cycles which were acquired in three standard short-axis views (including mitral, papillary muscle and apical views) and apical four-chamber view with long axis basale, middle and apical segments; The peak systolic radial strain (SRSmax), strain rate (SRSrmax), peak systolic circumferential strain (SCSrmax) and strain rate (SCSmax) were derived from mitral valve (basal segments), papillary muscles (middle segments) and apical segments (apical segment) via VVI workstation and the longitudinal peak systolic velocity (Vsmax), peak systolic longitudinal strain (Smax), strain rate (SRmax) and segmental ejection fraction were obtained at three levels of left ventricle in apical four-chamber view. The differences of myocardial mechanical parameters from each groups were compared and correlated.Results:(1) Radial strain and strain rate. GroupA:4 segments SRSmax and SRSrmax of left ventricular posterior wall and inferior wall (basal, middle segment) were significantly lower than the control group, was statistically significant (P<0.05).Group B:Comparison of basal segment only partially (anterior wall, a front wall, after an interval) segment, the middle segment (the front wall) were no significant differences (P>0.05). A total of 14 remaining segments SRSmax and SRSrmax were significantly lower than the control group. Group C:In addition to the front wall of the base section, apical segment before the interval, the remaining total of 16 segments SRSmax and SRSrmax were less than the control group. (2) Circumferential strain and strain rate. A: only the front wall of basal segment, and most segments in middle and apical segments,The SCSmax and SCSrmax were significantly lower than the control group, statistically significant difference(P<0.05).B:In addition to the basal segment (anterior interval), the remaining 16 segments of SCSmax were significantly lower than the control group (P<0.05). In addition to the basal segment and the front wall apical segment, more than 11 segments, the SCSrmax were significantly lower than the control (P<0.05).C:Only the front wall and basal segment, difference of SCSmax and SCSrmax was not statistically significant (P>0.05), the remaining segments were significantly lower than the control group. (3) Comparison of left ventricular longitudinal strain and strain rate.A:the difference of each segment was not statistically significant (p> 0.05).B:interventricular septum (basal segments), the left ventricular free wall (basal segment, middle segment),the difference of Smax was statistically significant (p<0.05).C:interventricular septum (basal segments), the left ventricular free wall (basal segment, middle segment) (p <0.05) (4) In part segments of the left ventricle, peak radial strain values were negatively correlated with RF (5) Left ventricular longitudinal strain values and the corresponding portion of the segment,EF were positively correlated.Conclusions:(1)The left ventricular segmental wall myocardial mechanical dysfunction is existing in RA patients.(2) Ejection fraction at normal levels, the patient has appeared impaired systolic function.(3) RA patients with myocardial mechanical function of the extent of the damage portion segments associated with RF value. (4)RA patients with left ventricular myocardial mechanical function part segment EF changes affect the value of the corresponding segment. |
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