Assessment of Global Longitudinal Strain via Speckle-Tracking Echocardiography in Patients With Rheumatoid Arthritis

Background: The inflammatory nature of rheumatoid arthritis presents a hypothesis on the increase in the likelihood of cardiovascular diseases in patients with rheumatoid arthritis. Recently, the use of speckle-tracking echocardiography to evaluate ventricular strain, especially the global longitudinal strain (GLS), has provided more comprehensive information on ventricular dysfunction in these patients. In the present study, we evaluated changes in the GLS index along with other left and right ventricular parameters in patients with rheumatoid arthritis compared with healthy controls. Methods: The study population was comprised of a case group (patients with rheumatoid arthritis in the active phase during the first 5 years of diagnosis referred to Shariati Hospital without a history of any other diseases) and a control group (individuals without a history of rheumatoid arthritis or cardiac abnormalities referred for clinical check-ups). In both groups, 2D and 3D echocardiographic examinations were performed by a single cardiologist to assess cardiac functional parameters. Results: Comparisons of the echocardiographic indices between the 2 groups showed significantly lower LA (Left Atrium), AO (Aorta), interventricular septal end-diastole (IVSD), Posterior wall diastolic diameter (PWD), and RVsm (Right Ventricular systolic celocity) in the group suffering from rheumatoid arthritis than in the control group. The GLS parameter was significantly lower in the rheumatoid arthritis group than in the healthy group (-19.5 ± 2.34 vs -20.42 ± 3.07; P = 0.042); however, there was no difference in the global circumferential strain parameter between the 2 groups (-19.69 ± 3.55 vs -20.49 ± 1.79; P = 0.566). In contrast, the mean right ventricular GLS was -18.77 ± 5.34 in the case group versus -21.87 ± 13.99 in the control group, indicating a significant difference (P = 0.008). Conclusions: In the echocardiographic assessment of patients with rheumatoid arthritis, a decrease in the ventricular function parameters, especially the GLS, is expected, which may be due to the effect of inflammatory factors on the cardiac ventricular strain.