Prevalensi Disfungsi Diastolik dan Gagal Jantung dengan Fraksi Ejeksi Normal serta Hubungannya dengan Penurunan Global Longitudinal Strain Ventrikel Kiri Menggunakan Metode Speckle-Tracking pada Rheumatoid Arthritis

Abstract

Background and Objective: Patients with rheumatoid arthritis (RA) are at increased risk of heart failure, which is more likely to occur with a preserved ejection fraction. Although changes in heart structure due to fibrosis was postulated as the underlying mechanism causing diastolic dysfunction in RA, not much is known about the prevalence of diastolic dysfunction and heart failure in these patients. Therefore we examined RA patients for diastolic dysfunction and heart failure using echocardiography, including speckle-tracking, and measurement of NT-pro-BNP level. Methods: In this study we consecutively examined 143 patients with RA diagnosed according to the 2010 American College of Rheumatology/European League against rheumatism (ACR/EULAR)-criteria in the outpatient clinic. Echocardiography, both conventional and speckle-tracking, and blood sampling for NT-pro-BNP were done. Dia~tqlic function was analyzed based on E/A-ratio, deceleration time, and E/E' according to the EAE/ASE recommendations. Diastolic heart failure is diagnosed if symptom of heart failure is present and (1) average E/E'-ratio ~ 13 or, (2) NT-pro-BNP higher than 220 pg/ml with average E/E' -ratio> 8 or atrial fibrillation. Results: Sixty-nine percent of the patients (N= 99/143) were female. Mean age was 59,99 ± 12,9 years. Mean blood pressure was 131,43 / 78,74 (± 18,6 / 8,3, respectively) mmHg. 57% of the cohort has hypertension. Mean L V ejection fraction was 68,03 ± 6,5. Diastolic function abnormalities were found in 32,1% (14% diastolic dysfunction and 18, 1 % diastolic heart failure) according to the above mentioned criteria. Mean GLS was -19,64 ± 2,6%. Using a GLS value of -19,35% as a cut off, cohort with diastolic dysfunction and heart failure showed a significant reduction in GLS in comparison to those with normal diastolic function (p = 0,02, OR 2,273 (95% CI: 1,085-4,764). On the multivariate analysis, NT-pro-BNP (p=0,028; OR 2,737; 95% CI: 1,113-6,732), age (p=0,019; OR 2,688; 95% CI: 1,174-6,154), septal hypertrophy (p=0,036; OR 2,260; 95% CI 1,055-4,840) associate with GLS reduction. Conclusion: Diastolic function abnormalities were found in 32, 1 % in our RA cohort with preserved ejection fraction. As much as 18, 1 % presented with symptoms of heart failure. In strain imaging, a significant reduction in GLS was seen in those with diastolic function abnormalities. The endocardium is most susceptible to the deleterious effects of interstitial fibrosis that could be found in RA. GLS could detect abnormal longitudinal function of the subendocard at an earlier stage. Evaluation of global longitudinal strain could reveal more information about the cardiovascular manifestation in RA and should be integrated with the conventional echocardiographic measurement of diastolic function.