Diastolic function abnormalities in rheumatoid arthritis. Evaluation by echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease

Objective-The aim of this study was to evaluate left ventricular filling in patients with rheumatoid arthritis (RA), analysing transmitral flow and pu lmonary venous flow, with special regard to age and disease duration. Methods-32 patients affected by RA according to ARA criteria were selected, without evidence of cardiac disease, and compared with matched control sub jects. All patients and the control group were submitted to M-mode, two dim ensional, Doppler and colour Doppler (continuous and pulsed wave) echocardi ography. The following diastolic parameters were evaluated: transmitralic h ow (E/A ratio), pulmonary venous flow (S/D ratio), a-Pw, IVRT and DT. Results-In RA patients left ventricular filling abnormalities were found ch aracterised by a reduced E/A ratio (mean (SD) 1.16 (0.31) v controls 1.37 ( 0.32); p =0.02) and an increased S/D ratio (1.43 (0.40) v controls 1.22 (0. 29); p = 0.017). In the group of patients a relation was found between E/A ratio and disease duration (r= 0.40, p =0.01 Spearman rank correlation). Conclusions-At present, it is concluded that RA patients, in absence of cli nical evidence of heart disease, show diastolic dysfunction characterised b y impaired E/A and S/D ratio. The relation between transmitral flow alterat ion and disease duration suggests a sub-clinical myocardial involvement.