类风湿关节炎中的心肌功能障碍：一项对照组织多普勒超声心动图研究。

Myocardial dysfunction in rheumatoid arthritis: a controlled tissue-Doppler echocardiography study.

作者信息

Meune Christophe, Wahbi Karim, Assous Noémie, Weber Simon, Kahan André, Allanore Yannick

机构信息

Department of Cardiology, Paris Descartes University, Medical School, Cochin Hospital, Paris, France.

出版信息

J Rheumatol. 2007 Oct;34(10):2005-9. Epub 2007 Sep 1.

PMID:17787044

Abstract

OBJECTIVE

To determine the sensitivity and accuracy of tissue-Doppler echocardiography (TDE) to assess myocardial contractility. Heart failure is one of the determinants of the excess in mortality in patients with rheumatoid arthritis (RA).

METHODS

Consecutive RA patients with normal clinical cardiac examination were prospectively included and compared to 27 controls. All underwent conventional echocardiography, and systolic and diastolic strain rate (SR) were determined by TDE.

RESULTS

Twenty-seven patients with RA were included (mean age 50 +/- 10 yrs, disease duration 8 +/-6 yrs). Mean disease activity score was 4.3 +/- 1.6, C-reactive protein 23 +/- 32 mg/l. When compared to controls (50 +/- 9 yrs), patients with RA had increased left ventricular mass (99 +/- 24 vs 80 +/- 25 g/m2, p = 0.009), and there was a trend for left atrial enlargement (31 +/- 3 vs 29 +/- 6 mm, p = 0.06). Fractional shortening and systolic SR did not differ between groups. Diastolic function, as estimated by the E/A Doppler velocity ratio was similar in both groups (p = 0.18). However, diastolic SR was strikingly reduced in patients with RA versus controls (3.7 +/- 1.3 vs 5.5 +/- 1.1s-1, p < 0.001) with 18/27 patients with RA having marked reduced diastolic SR (SR < 4s-1). None of the RA characteristics was associated with significant differences in TDE measurements.

CONCLUSION

TDE identifies impaired diastolic function in patients with RA that may not be detected by conventional measurements.

摘要

目的

确定组织多普勒超声心动图（TDE）评估心肌收缩力的敏感性和准确性。心力衰竭是类风湿关节炎（RA）患者死亡率过高的决定因素之一。

方法

前瞻性纳入临床心脏检查正常的连续RA患者，并与27名对照者进行比较。所有人均接受了常规超声心动图检查，并通过TDE测定收缩期和舒张期应变率（SR）。

结果

纳入27例RA患者（平均年龄50±10岁，病程8±6年）。平均疾病活动评分为4.3±1.6，C反应蛋白为23±32mg/l。与对照组（50±9岁）相比，RA患者左心室质量增加（99±24 vs 80±25g/m2，p = 0.009），并且有左心房扩大的趋势（31±3 vs 29±6mm，p = 0.06）。两组间缩短分数和收缩期SR无差异。通过E/A多普勒速度比估计的舒张功能在两组中相似（p = 0.18）。然而，与对照组相比，RA患者的舒张期SR显著降低（3.7±1.3 vs 5.5±1.1s-1，p < 0.001），27例RA患者中有18例舒张期SR明显降低（SR < 4s-1）。RA的特征均与TDE测量的显著差异无关。