Photo Credit: Ivan-balvan

The following is a summary of “Subclinical left ventricular dysfunction in rheumatoid arthritis: findings from the prospective Porto-RA cohort,” published in the September 2024 issue of Cardiology by Alexandre et al.  

Patients with rheumatoid arthritis (RA) often have subclinical left ventricular systolic dysfunction (LVSD) despite preserved ejection fraction (EF), making early detection challenging, echocardiographic strain analysis may be a valuable tool. 

Researchers conducted a retrospective study to assess the prognostic role of strain analysis in RA. 

They involved 277 patients with RA who had no known heart disease and preserved EF. The patients were categorized based on left ventricular global longitudinal strain (GLS), average GLS (≤ −18%) vs.subclinical LVSD (> −18%). 

The results showed that the primary outcome was a composite of myocardial infarction, heart failure (HF) hospitalization, stroke, or cardiovascular death (MACE). The mean age was 57 years, with 79% female. Although the mean GLS was average at −20 ± 3%, subclinical LVSD occurred in 24% of patients (n = 67). The condition correlated with older age (OR 1.54 per 10 years; P<0.001) and comorbidities like dyslipidemia (OR 2.27; P=0.004), obesity (OR 2.29; P=0.015), and chronic kidney disease (OR 8.39; P=0.012). Subclinical LVSD was associated with a 3.9-fold higher risk of MACE (P=0.003) and a 3.4-fold greater risk of HF hospitalization/cardiovascular death (P=0.041). A GLS threshold of > −18.5% provided optimal sensitivity (78%) and specificity (74%) for elevated MACE risk (area under the curve [AUC] = 0.78; P<0.001). 

They concluded that subclinical LVSD, identified by reduced GLS, was strongly associated with adverse cardiovascular events in RA, with potential therapeutic implications requiring further clinical investigation. 

Source: link.springer.com/article/10.1007/s00392-024-02548-6