Noninvasive Imaging Methods for Evaluating Cardiovascular Involvement in Patients With Rheumatoid Arthritis Before and After Anti-TNF Drug Treatment

Aim: To use 2D speckle-tracking echocardiography, and conventional and tissue Doppler echocardiography to detect subclinical left ventricular myocardial dysfunction in patients with rheumatoid arthritis (RA). Methods: Thirty RA outpatients were assessed before and after 18 months of treatment with anti-TNF drugs, along with 30 healthy controls. Cardiovascular risk was assessed by means of ultrasound carotid assessment and comprehensive echocardiographic evaluation (conventional and speckle-tracking calculation). Results: The speckle-tracking analyses were significantly different between the two groups, with global longitudinal strain deformation in the apical four-chamber view being significantly lower in the RA patients (median: 18.78%, interquartile range [IQR]: 15.80–20.82% vs 20.16%, IQR: 19.03–21.89%; [p < 0.05]). After 18 months of biological treatment, global longitudinal strain showed a significant improvement (18.78%, IQR: 15.80–20.82 vs 19.24%, IQR: 18.23–19.98; [p < 0.01]), such as for DAS28 (4.80, IQR: 4.65–5.22 vs 2.78; IQR: 2.52–2.99; [p < 0.01]). Conclusion: Speckle-tracking echocardiography showed that left ventricular myocardial longitudinal strain was impaired in the RA patients.