¹Sura Salih, Ruqaya Mustafa, Noura Esam, Reem Ali, Nuha Yassir

¹Dubai Medical College

Background(s): Atherosclerotic and non-atherosclerotic cardiovascular complications are frequent among rheumatoid arthritis  (RA). Cardiac involvement includes pericardial, myocardial,  vascular (ischemic heart disease), coronary microcirculation dysfunction, structural and functional abnormalities of the heart valves, and elevated pulmonary artery pressures. Even though cardiac abnormalities occur even in asymptomatic patients, very little is known about the cardiac involvement among RA patients in the Middle East Region.  This study is the first descriptive study for echocardiographic parameters in RA patients from the United Arab Emirates (UAE)

Method(s): This is a cross-sectional study to investigate the echocardiographic features in a total of 53 adult (>18 years) RA patients who met the  ACR/EULAR- 2010 classification criteria for RA. Patients with medical comorbidity, concomitant of other autoimmune disease, and pregnant women had been excluded. A standard trans-thoracic echocardiography examination was performed by a specialist cardio-sonographer. The echocardiography parameters studied included wall geometry, ejection fraction, left ventricular (LV) dimensions, right ventricular size and function, systolic and diastolic parameters, valve structure and function, aortic root dimensions, pulmonary pressures, and pericardium.

Summary statistical analysis was presented as mean (standard deviation) for continuous variables and as percentages for categorical data.  for the comparison of differences between RA patients and the control participants, the unpaired t-test for the continuous variables, and the Chi-square test for the categorical variables. A p-value of <0.05 was considered significant.

Result(s): The mean age of the patients was 49±15 (min 24, max 87) years, 47 (89%) females, and 6 (11%) males.

Interventricular septal thickness in diastole 9.33±2.03 mm (min 6, max13.50), LV post wall in diastole 9.38± 2.12 mm (min 6, max16), LV end-diastolic diameter 43.49± 6.63 mm (min 28, max 57), LV end-systolic diameter 27.14± 5.39 mm (min14, max 39), LV mass 136.27±57.07 g (min 62, max 338), LV mass index 2.21± 1.41 g/m2 (min 1, max  4), ejection fraction (EF)  67.06±7.85 % (min 49.6, max 89), Deceleration time  (ms) 182 ± 47 (min 102, max 347), early diastolic mitral inflow velocity (E; cm/s) 77±18 (min 36, max 113), ratio of early to late diastolic flow velocity (E/A) 1.29 ± 0.46 (min  0.6, max 2.7), Early Diastolic Mitral Annular Velocity, e’, by PW mitral inflow measurement 11.44± 3.56 cm/s (min 5.5, max 20), ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’ ratio) 7.15± 2.09 (min 3.5, max 12.8), Grade of diastolic dysfunction (DD) 0.57±0.75 (min 0, max 2), Right Ventricle function measured by Tricuspid Annular Plane Systolic Excursion (TAPSE) 21 ± 3 mm (min 15, max 30), Aortic root 26±3.62 mm (min 19, max 38), peak pulmonary artery systolic pressure 9±8 mmHg (min 5, max 35).

The most common valvular dysfunction among RA patients was aortic regurgitation (AR) in 9 (17%), followed by tricuspid regurgitation (TR) 4(8%), mitral regurgitation (MR) 2 (4%), aortic stenosis in 1 (2%), MS 1(2%), mitral valve prolapses (MVP) in 2 (4%), Mitral annulus calcification (MAC), pulmonary valve (PV) abnormality 0 (0%). Figure 1. There were no pericardium abnormalities 0 (0%).

Conclusion(s): Early management of RA and systematic echocardiographic screening in RA, can unveil cardiac involvement in RA, and improve the quality of life.