Benacka O, Benacka J, Blazicek P, Belansky M, Payer J, Killinger Z, Lietava J
Bratisl Lek Listy. 2017;118(1):28-33. doi: 10.4149/BLL_2017_006.
Patients with rheumatoid arthritis (RA) have shorter life expectancy and their risk of cardiovascular death is more than 50 % higher than the rest of the population. Early myocardial dysfunction in RA patients may be detectable sooner using speckle‑tracking echocardiography.
Cross-sectional study enrolled 55 patients with RA (mean age 44.1 years) without known cardiovascular disease and 31 healthy controls. All subjects underwent a standard echocardiographic examination: indexed left ventricular mass, left ventricle ejection fraction, isovolumic contraction and relaxation times (IVCT and IVRT), mitral valve inflow curve (E/A), septal mitral annular motion (e'), and E/e' ratio as well as the speckle tracking assessment of left ventricle longitudinal, radial and circular strain and strain rate.
In standard echocardiographic examination RA patients exhibited higher indexed left ventricle mass (96.36±20.90 g/m2 vs 95.84±21.86 %, p=0.013), lower ejection fraction (64.84±3.87 % vs 67.10±3.87 %, p=0.011) and prolonged IVCT (61.51±9.30 ms vs 53.71±8.95 ms, p=0.001). Diastolic dysfunction was demonstrated by prolonged IVRT (81.62±9.56 ms vs 74.58±12.02 ms, p=0.007) as well as by higher E/e' ratio (8.21±1.76 vs 7.21±1.52, p=0.009). Speckle‑tracking method detected lower global longitudinal epicardial strain (-19.51 % vs -21.46 %, p=0.049). Radial, circular, and transversal strains and strain rates were same in both groups. Global longitudinal epicardial strain correlated with IVCT and IVRT, disease duration, and markers of myocardial damage NTproBNP.
Standard echocardiographic assessment of myocardial function is examiner- and angle-dependent method with considerable limitations for evaluation of minimal subclinical changes. Speckle-tracking echocardiography significantly revealed incipient myocardial dysfunction in RA patients without overt cardiovascular diseases. This correlates with clinical RA characteristics and markers of cardiac damage (Tab. 4, Ref. 48).
类风湿关节炎（RA）患者的预期寿命较短，其心血管死亡风险比其他人群高50%以上。使用斑点追踪超声心动图可能更早检测到RA患者早期心肌功能障碍。
横断面研究纳入了55例无已知心血管疾病的RA患者（平均年龄44.1岁）和31名健康对照者。所有受试者均接受标准超声心动图检查：左心室质量指数、左心室射血分数、等容收缩和舒张时间（IVCT和IVRT）、二尖瓣流入曲线（E/A）、室间隔二尖瓣环运动（e'）、E/e'比值以及左心室纵向、径向和圆周应变及应变率的斑点追踪评估。
在标准超声心动图检查中，RA患者表现出较高的左心室质量指数（96.36±20.90g/m²对95.84±21.86%，p=0.013）、较低的射血分数（64.84±3.87%对67.10±3.87%，p=0.011）和延长的IVCT（61.51±9.30ms对53.71±8.95ms，p=0.001）。舒张功能障碍表现为IVRT延长（81.62±9.56ms对74.58±12.02ms，p=0.007）以及较高的E/e'比值（8.21±1.76对7.21±1.52，p=0.009）。斑点追踪法检测到较低的整体纵向心外膜应变（-19.51%对-21.46%，p=0.049）。两组的径向、圆周和横向应变及应变率相同。整体纵向心外膜应变与IVCT、IVRT、病程及心肌损伤标志物NTproBNP相关。
心肌功能的标准超声心动图评估是一种依赖检查者和角度的方法，在评估微小亚临床变化方面有很大局限性。斑点追踪超声心动图显著揭示了无明显心血管疾病的RA患者早期心肌功能障碍。这与临床RA特征及心脏损伤标志物相关（表4，参考文献48）。
