Speckle Tracking Echocardiography for the Early Detection of Subclinical Left Ventricular Systolic Dysfunction in Rheumatoid Arthritis

Abstract

Background: Rheumatoid arthritis is a chronic systemic autoimmune disease in which cardiovascular complications account for much of the excess mortality reported in affected populations. Heart failure occurs more often than coronary disease alone would predict, and myocardial injury develops silently across years of sustained inflammatory activity. Conventional two-dimensional echocardiography, and the left ventricular ejection fraction in particular, stays within reference limits until damage is advanced, leaving a long interval during which cardiac involvement escapes detection. Two-dimensional speckle tracking echocardiography measures myocardial deformation directly by following acoustic markers within the myocardial wall through the cardiac cycle, and it is not limited by the angle between the ultrasound beam and the direction of fibre shortening. Global longitudinal strain obtained by this method falls in rheumatoid arthritis patients whose ejection fraction is still normal, and the degree of impairment follows disease duration, functional disability and cumulative inflammatory burden.