Seyfeli Ergun, Guler Hayal, Akoglu Sebahat, Karazincir Sinem, Akgul Ferit, Saglam Hayrettin, Seydaliyeva Tunzale, Yalcin Fatih
Department of Cardiology, School of Medicine, Mustafa Kemal University, 31100, Hatay, Turkey.
Int J Cardiovasc Imaging. 2006 Dec;22(6):745-54. doi: 10.1007/s10554-006-9096-5. Epub 2006 May 17.
To investigate right ventricular diastolic function in rheumatoid arthritis (RA) and its relationship with left ventricular and pulmonary involvement.
Thirty-five RA patients and 30 healthy subjects were submitted to conventional Doppler (CE) and tissue Doppler echocardiography (TDE) to assess left and right systolic and diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). To detect pulmonary involvement, pulmonary function tests and high-resolution computed tomography (HRCT) scans were performed in all RA patients.
An abnormal RV filling, as expressed byan inverted tricuspid (Tr.) E/A ratio, was detected in 12 (34%) of the 35 RA patients and in 2 (7%) of the 30 controls (P<0.004). If compared to CE findings, prevalence of RV diastolic abnormalities were found higher in patients with RA by TDE (RV annulus Em/Am ratio <1 (in 31 (89%) of 35 patients) (P = 0.002). Twenty-two (63%) of 35 patients had abnormal HRCT findings. Pulmonary involvement with pulmonary hypertension (PHT) (36+/-5 mmHg) was detected in 10 (29%) of 35 RA. In this group, increase of RV annulus and basal Am wave, decrease of Tr. E/A ratio and RV annulus Em/Am ratio were statistically significant compared to RA (12 (34%) of 35) patients with pulmonary involvement who had normal PAP (19+/-5 mmHg), (P = 0.014, P = 0.006, P = 0.015, P = 0.049, respectively).
This study points out an impaired RV filling in a significant part of RA patients without overt heart failure. Impairment of RV diastolic function may be a predictor of subclinic myocardial and pulmonary involvement in patients with RA.
研究类风湿关节炎（RA）患者的右心室舒张功能及其与左心室和肺部受累情况的关系。
对35例RA患者和30名健康受试者进行常规多普勒（CE）和组织多普勒超声心动图（TDE）检查，以评估左、右心室的收缩和舒张功能，并估算最大动脉收缩期肺动脉压（PAP）。对所有RA患者进行肺功能测试和高分辨率计算机断层扫描（HRCT），以检测肺部受累情况。
35例RA患者中有12例（34%）出现右心室充盈异常，表现为三尖瓣（Tr.）E/A比值倒置，30名对照组中有2例（7%）出现该情况（P<0.004）。与CE检查结果相比，TDE检查发现RA患者右心室舒张功能异常的患病率更高（右心室环Em/Am比值<1（35例患者中有31例（89%））（P = 0.002）。35例患者中有22例（63%）HRCT检查结果异常。35例RA患者中有10例（29%）检测到肺部受累并伴有肺动脉高压（PHT）（36±5 mmHg）。与肺部受累但PAP正常（19±5 mmHg）的RA患者（35例中有12例（34%））相比，该组患者右心室环和基底Am波增加、Tr. E/A比值和右心室环Em/Am比值降低具有统计学意义（分别为P = 0.014、P = 0.006、P = 0.015、P = 0.049）。
本研究指出，在相当一部分无明显心力衰竭的RA患者中存在右心室充盈受损。右心室舒张功能受损可能是RA患者亚临床心肌和肺部受累的预测指标。
