Assessment Of Left Ventricular Systolic Function In Patients With Rheumatoid Arthritis Using Two-dimensional Ultrasonic Layer-specific Strain Imaging

Objective:Quantitative assessment of left ventricular(LV)systolic strain in patients with rheumatoid arthritis(RA)using ultrasonic layer-specific strain imaging,revealing myocardial function impairment in patients with rheumatoid arthritis.Methods:Forty-eight patients with RA who had not been diagnosed for the first time and had not taken synthetic disease modifying anti rheumatic drugs(DMARDs)within three months were included as the patient group.Thirty-five healthy adults of matched age and sex served as the control group.Register the patient's name,sex,age,height,weight,blood pressure,rheumatoid factor(RF),anti-cyclic citrullinated peptide(anti-CCP),erythrocyte sedimentation rate(ESR),and C-reactive protein are routinely(CRP).The two groups of observation subjects were subjected to conventional echocardiography,tissue Doppler imaging(TDI),and three consecutive cardiac cycle standard left ventricular short-axis mitral valve opening levels,papillary muscle level and apical level cut planes,apical four-chamber heart,two-chamber heart Two-dimensional grayscale dynamic image of a three-chambered heart section.Import the collected images into the workstation for two-dimensional parameter measurement and strain analysis to obtain the inner diameter of the heart chamber,the wall thickness of the observed object,and calculate the left ventricular mass index(LVMI),relative wall thickness(RWT),and diastole Early diastolic forward mitral flow velocity(MV-E),advanced diastolic velocity of mitral valve(MV-A),MV-E/A Ratio,Early diastolic velocity of mitral annulus(MV-e),early diastolic velocity of mitral septal annulus(S-e),average value e',E/e',Simpson biplane method to measure ejection fraction(EF),left ventricular short-axis endocardial global circumferential strain(Global Circumferential Strain ofendocardium,GCS-endo;Global Circumferential Strain of middle myocardium,GCS-mid;Global Circumferential Strain of epicardium,GCS-epi),Global Radial Strain(GRS),average of three short-axis level strains(?GCS-endo,?GCS-mid,?GCS-epi,?GRS),Global Longitudinal Strain of endocardium(GLS-endo),Global Longitudinal Strain of middle myocardium(GLS-mid)and Global Longitudinal Strain of epicardium(GLS-epi).The above parameters between the two groups were compared for significant difference,and a linear correlationship between biochemical indexes and LV layer-specific myocardial strain was analyzed respectively.Results:1.Cardiac structural parameters:Compared with the control group,the left ventricular mass index(LVMI)in the RA group increased(106.16(23.63)vs94.23±20.01,P=0.006).2.Cardiac diastolic function parameters and ejection fraction:There was no significant difference in the parameters of diastolic function between the two groups of subjects;The ejection fraction(EF)in the RA case group was lower than that in the control group within a normal range,and the difference was statistically significant(61.9 ±5.75 vs 66.77±5.49,P=0.000).3.Myocardial work parameters:The global work efficiency(GWE)in the left ventricular myocardial work index was reduced,and the difference was statistically significant(96(3.25)vs 97(2.25)%,P=0.046).4.Myocardial strain parameters:Circumferential strain:The circumferential strain of left ventricular mitral valve level myocardium(GCS-endo:-23.37± 6.03 vs-28.21±5.45,P=0.000;GCS-mid:-13.86± 4.42 vs-16.18 ± 3.98,P=0.019)and apical level myocardium(GCS-endo:-31.34±9.09 vs-35.87±10.21,P=0.033;GCS-mid:-19.84± 5.88 vs-23.06±6.67,P=0.019;GCS-epi:-12.74 ± 4.98 vs-15.16 ±5.29,P=0.033)in RA patients was reduced to different degrees.The mean value of the circumferential strain of the left ventricular in the RA group showed ?GCS-endo(-27.03±4.99 vs-31.28±5.72,P=0.001)and?GCS-mid(-16.42±3.28 vs-18.74±3.83,P=0.005)decreased.Radial strain:Radial strain of the LV myocardium at the level of the mitral valve decreases(37.95(26.7)vs 55.42±19.55,P=0.001).Longitudinal strain:The global longitudinal strain(GLS)of the left ventricle endocardial myocardium and middle myocardium was reduced(GLS-endo:-21.90±3.58 vs-23.73±3.09,P=0.017;GLS-mid:-19.11±3.05 vs-20.42±2.77,P=0.048).5.Correlation analysis:There was a mild positive correlation between different layer-specific myocardial longitudinal strains and C-reactive protein(CRP),Rheumatoid factor(RF)(CRP vs GLS-endo:r=0.387,P=0.024;GLS-mid:r=0.398,P=0.020;GLS-epi:r=0.357,P=0.038;RF vs GLS-endo:r=0.448,P=0.009;GLS-mid:r=0.449,P=0.009;GLS-epi:r=0.454,P=0.008).Conclusion:1.The circumferential and longitudinal strains of the left ventricle endocardial myocardium and middle myocardium in RA patients are more severe than that of the epicardial myocardium,indicating that cardiac damage in RA patients may be related to the decrease of myocardial coronary perfusion.2.The longitudinal strain damage of each layer of myocardium has a linear correlation with the increase of CRP and RF titers,which indicates that the increase of CRP and RF titers will increase the degree of myocardial damage,and the decrease of myocardial strain can provide a basis for diagnosis and treatment of clinical RA patients.3.The application of two-dimensional layer-specific strain imaging can evaluate the degree of myocardial damage in RA patients before the cardiac contractile function is significantly reduced.