ABSTRACT
Cardiac involvement is common in patients with rheumatoid arthritis [RA] and cardiovascular disease represent the most common cause of death in those patients. Data about left ventricular diastolic function abnormalities in patients with RA are scarce. The aim of this study was to evaluate left ventricular filling abnormalities as early predictor of asymptomatic cardiac involvement in patients with RA and 10 to study the correlation between diastolic function abnormalities with disease duration and severity. This study enrolled 31 patients affected by RA according to ACRA criteria who had no evidence of cardiac disease, and compared with 10 age and gender matched control group. All patients were subjected to clinical evaluation and Iaboratory testing which included sedimentation rate [ESR], rheumatoid factor [RF] and blood picture. All patients and I'onirol group were subjected to echo-Doppler study for assessment of the mitral flow and measurements of maximal [early diastolic flow velocity [Peak E] [m/sec], maximal late diastolic flow velocity [Peak A] [m /sec], E/A ratio, the area under the the atria I filling velocity curve [Time velocity integral of the velocity waveform representing left atrial contraction, TVI of A [m/sec]. The total area under the mitral flow velocity curve [Time velocity integral of the velocity Wave form representig diastolic filling, TVI of DF [m/sec] and ratio of A/TVI of DF. There was a statistically significant impairment in left ventricular filling pattern in patients with rheumatoid arthritis compared to the control group as evidenced by taeased E/A ratio [0.96 +/- 0.29 in RA patients versus 1.38 +/- 0.19 in ihe control group, p=0.0017]. Also, there was a statistically significant difference in the TVI of A/TVI ofDF [0.46 +/- 0.16 in the patients group versus 0.33 +/- 0.058 in the control group, p=0.017. There was a significant negative correlation between the E/A ratio and the age of the patients with RA [p=0.0181 4p-[1.4216]. Interestingly, in patients with subcutaneous nodules, we found a significant correlation between E/A ratio and the number of swollen joints [p=0.0341 and r=-3.162]. to; was a significant correlation between TVI of A/TVI of DF and disease duration in patients with RA [p=0.0028 and dl.4W5]. Also, There was a significant negative correlation between hemoglobin level and TVI of A/TVI of DF ratio [p=0.034 and r=-0.65]. The prevalence of diastolic dysfunction is high in patients with rheumatoid arthritis. This raises the importance of performing echocardiography in these patients particularly those with long disease duration, patients with seropositive sera especially when they have a combination of subcutaneous nodules and increased number of swollen joints.