SAT0139 Subclinical impairment of myocardial functionality during the very early stage of inflammatory joint diseases. (12th June 2018)

• Record Type: Journal Article
• Authors: Lo Gullo, A.; Rodríguez-Carrio, J.; Savarino, F.; Aragona, C. O.; Dattilo, G.; Zito, C.; Suárez, A.; Loddo, S.; Atteritano, M.; Saitta, A.; Mandraffino, G.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 931
• Page End: 932
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.2430
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: cardiovascular (CV) disease morbidity is increased in inflammatory joint diseases (IJD), as rheumatoid (RA) and psoriatic arthritis (PsA). Whereas accelerated subclinical atherosclerosis and endothelial dysfunction have been widely studied, less attention has been paid to myocardial function. RA patients with established disease who develop heart failure often have impaired left ventricular (LV) diastolic functionality with preserved LV ejection fraction (EF) and present fewer signs than non-RA patients. Then, additional and more sensitive screening tools as myocardial strain imaging are needed. In this sense, speckle-tracking echocardiography (STE) has been demonstrated to be suitable for detecting impaired systolic function. Although CV risk is increased at disease onset, whether abnormal myocardial functionality could be found already in the early phase of IJD remains unknown. Objectives: to evaluate the myocardial functionality by STE in recent onset RA and PsA patients and its associations with clinical features. Methods: STE was used to assess the myocardial functionality in patients with very early RA (n=41) (2010 EULAR/ACR criteria) and PsA (n=35) (CASPAR criteria) without traditional CV risk factors, and 58 matched healthy controls (HC). Global longitudinal and circumferential strain (GLS and GCS) were estimated. Results: RA patients exhibited impaired GLS (-18.13±1.36%) and GCS (-20.15±1.34%) compared to HC (-23.25±1.80%, p<0.001 and -24.50±0.70%, p<0.001; respectively), GLS being also altered in PsA (-21.57±2.59%, p=0.020 vs HC). No differences in LV mass index, posterior wall thickness, LV DD, E/A index or EF were found among groups (all p>0.050). DAS28 was correlated to GLS (r=0.908, p<0.001) and GCS (r=0.868, p<0.001) in RA. These findings were further confirmed by multivariate regression analyses adjusted for age, gender, BMI, CRP, ESR, SBP, DBP and duration of the symptoms, DAS28 being the only independent predictor of GLS (p<0.001) and GCS (p=0.002). Principal Component Analyses retrieved equivalent results. Although GCS was not significantly different in PsA compared to HC, a positive correlation with DAS28 (r=0.438, p=0.008) was observed. Consequently, GLS and GCS were impaired in PsA patients with high disease activity (DAS28>2.9) compared to HC (GLS: p=0.066 and GCS: p=0.007). Conclusions: a subclinical myocardial dysfunction can be observed in IJD patients with preserved LV function and without traditional CV risk factors. The subclinical impairment of the myocardial function was found to be a very early event in IJD. Disease activity was the main predictor of myocardial strain impairment. Strain imaging by STE may detect early myocardial dysfunction in IJD. Disclosure of Interest: None declared