Three-dimensional Echocardiography for the Early Detection of Cardiac Dysfunction in Patients with Rheumatoid Arthritis

ABSTRACT
Background: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease. Left atrial (LA) dysfunction is strongly linked to cardiovascular diseases, and the early detection of LA function in patients with RA is vital. Real-time three-dimensional echocardiography (RT- 3DE) offers a noninvasive method to assess the structure and function of the LA. Aim of the study: To assess LA volumes and phasic function in patients with RA using 3D transthoracic echocardiography. Materials and Methods: This prospective case-control study included 162 subjects classified into two groups: Group 1 included 82 patients with RA, subdivided into an active RA group (n = 40) and an inactive RA group (n = 42), and Group 2 included 80 healthy  matched controls. All study participants were examined using 2D and 3D transthoracic echocardiography. Results: Diastolic dysfunction was significantly greater in patients with moderate and severe disease activity than in patients with mild disease activity. RT-3DE analysis of RA groups showed significantly higher maxium, minimum, and pre-atrial LA volumes compared to controls (p <0.01), and these volumes were significantly higher in the active RA group than in the inactive RA group (p <0.01). We also found significantly lower LA passive ejection fraction (EF) and active EF in both RA groups than the control group (p <0.01), and significantly lower total EF in the active RA group than the inactive RA group (p <0.01). Conclusion: Patients with RA had increased 3D LA volumes and impaired mechanical function, especially in active RA. RT-3DE provides an accurate measurement of LA volumes and function, being a feasible and reproducible method in clinical applications.