Utility Of Ultrafast Ultrasound Imaging For Assessing Atherosclerosis In Patients With Rheumatoid Arthritis

Background and purposeRheumatoid arthritis(RA)is a multi-systemic chronic autoimmune disease with a significantly higher mortality rate than the normal population.Cardiovascular events account for about 35%-50% of the total.Traditional cardiovascular risk factors are not yet available completely explained.Carotid atherosclerosis is an independent predictor of cardiovascular events,therefore,early diagnosis of RA patients with abnormal arterial structure and function,guiding clinical timely intervention are of great significance.Currently intima-media thickness(IMT)was for the evaluation of arterial structure changes in clinical,however,could not found the functional changes.Ultrafast ultrasound imaging is rapidly developing in recent years,a new technology that can accurately detect carotid PWV,early assessment of atherosclerosis.In this study,ultrafast ultrasound imaging was used to evaluate the structure and function of carotid artery in RA patients and healthy volunteers.The purpose of this study is to investigate the utility of ultrafast ultrasound imaging in measuring carotid PWV in patients with RA.Materials and MethodsAccording to the RA classification criteria proposed by ACR/EULAR in 2010,66 RA patients admitted to the Department of Rheumatology and Immunology from January 2016 to January 2017 were recruited,based on the patient's X-ray stage,the patients were divided into non-bone erosive group and bone erosive group.20 healthy volunteers were enrolled as the normal control group.Collected general data of all subjects such as age,sex,blood pressure and body mass index(BMI)and underwent carotid ultrasonography to measure the common carotid artery IMT,and started the speed imaging system to measure the early and late contractions of carotid artery pulse wave velocity(BS and ES).In addition,RA patients underwent laboratory examination and digital radiography,such as anti cyclic citrulline antibody(anti-CCP),anti sudden change citrullinated vimentin antibody(anti-MCV),rheumatoid factor(RF),disease activity(DAS28)and so on.We aimed to evaluate the utility of carotid atherosclerosis in RA patients with different X-ray stages and the influencing factors of BS and ES.Results1.Comparison of general data among groups: There was no significant difference in the age,sex and blood pressure between the normal control group,non-bone erosion and bone erosion group(P > 0.05).2.The anti cyclic citrullinated peptide antibody(anti-CCP)in the non bone erosion group was reduced by(357.19 + 352.09)RU/ml vs(690.12 + 654.44)RU/ml compared with the bone erosion group,and the difference was statistically significant(P <0.05).There was no significant difference in anti-MCV,rheumatoid factor(RF),duration of disease and disease activity(DAS28)between the two groups(P > 0.05).3.Groups of BS and ES were statistically significant,(6.39±0.81)m/s vs.(6.93±1.05)m/s vs.(5.28±0.67)m/s,(8.52±1.52)m/s vs.(9.33 ±1.26)m/s vs.(6.81±2.17)m/s(P<0.01)(P < 0.01);IMT of the RA group was obviously thicker than that of the control group,and the difference was statistically significant(P < 0.01),and IMT of the two group had no significant difference(P > 0.05),(0.70±0.13)mm vs.(0.76±0.13)mm vs.(0.60± 0.11)mm respectively.The overall carotid artery BS was significantly lower than that of ES,(6.34±1.08)m/s vs.(8.48 ±1.52)m/s,and was statistically significant(P < 0.01).4.The repeatability and consistency of carotid artery BS and ES were good detected by ultrafast ultrasound imaging.5.The BS and ES were positively correlated with IMT,and the correlation coefficients were 0.36 and 0.25,respectively.BS was positively correlated with age,BMI and anti-CCP,and ES was positively correlated with age,systolic pressure(SBP)and pulse pressure(PP).After multiple linear regression,the age was the independent risk factor of BS;The age and PP were independent risk factors of ES.Conclusion1.Ultrafast ultrasound imaging is an effective method for evaluating atherosclerosis,which is not invasive and convenient.2.The arterial elasticity decreased with the progression of disease in RA patients.3.The BS and ES measured by the ultrafast ultrasound imaging had good consistency and repeatability,and both were positively correlated with IMT.These indicated that carotid artery BS and ES were reliable indexes for evaluating the arterial elasticity function of RA patients.