Echocardiographic evaluation of diastolic dysfunction in rheumatoid arthritis – a case–control study

Abstract

Objectives. To assess left ventricular diastolic dysfunction (LVDD) and its predictors in rheumatoid arthritis (RA).

Methods. This cross-sectional case–control study assessed 100 RA patients and 100 healthy controls for LVDD by M-mode, two-dimensional, colour Doppler echocardiography.

Results. RA patients had higher prevalence of LVDD than controls (43% vs. 14%; p < 0.001). LVDD had significant association with duration (p = 0.033), severity of disease activity (p < 0.0001), Steinbrocker stage and functional class (p < 0.0001 each) and non-adherence to treatment (p = 0.047). Peak of late diastolic (A) mitral flow velocity and isovolumic relaxation time (IVRT) were higher (p < 0.05 each), whereas left ventricular ejection fraction, peak of early diastolic (E) mitral flow velocity and E/A ratio were lower (p < 0.05 each) in RA patients than in controls. Deceleration time (DT) was not significantly different in the two groups (p = 0.623). E/A ratio had significant correlation with anti-cyclic citrullinated peptide antibody (ACPA) (r = 0.233, p = 0.019) and age (r = 0.203, p = 0.042). IVRT had significant negative correlation with ACPA (r = −0.196, p = 0.044), while DT had significant correlation with Disease Activity Score with 28-joint (DAS28) counts (r = 0.244, p = 0.014). ACPA was an independent predictor of E/A ratio (p = 0.031). DAS28 was the only independent predictor of LVDD (odds ratio [OR] = 6.01; p = 0.007).

Conclusions. LVDD occurred commonly in RA patients and depended on severity of disease activity.

Keywords:

• Left ventricular diastolic dysfunction
• Echocardiographic evaluation
• Rheumatoid arthritis
• India

Acknowledgements

We are grateful to the Himalayan Institute Hospital Trust, Dehradun, India for funding this project. We thank Hem Chandra Sati, Swami Rama Himalayan University, Dehradun, India for his help in statistical work.

Authors’ contributions: RKau and RKak conceived the study. AS, RKau, RMK and RKak carried out the clinical assessment. All authors analysed and interpreted the data. AS prepared the initial manuscript. RKau, RMK and RKak revised the manuscript critically for intellectual content. RMK prepared the revised manuscript. All authors read and approved the final version. RKau and RKak are guarantors of the paper.

Conflict of interest

None.