A recent study found that nearly one-third of patients with rheumatoid arthritis who had normal heart function on standard tests exhibited hidden heart strain when evaluated with advanced imaging.
Researchers used speckle tracking echocardiography (STE) to detect early signs of left ventricular systolic dysfunction (LVSD) in 36 patients with rheumatoid arthritis (RA) and 36 matched healthy controls. All of the participants had normal left ventricular ejection fraction (LVEF) on conventional echocardiography.
STE provided a more detailed view of heart muscle function by measuring global longitudinal strain (GLS). A GLS value of ≤ –18% indicated subclinical dysfunction. In this study, 33% of the patients with RA had reduced GLS vs 0% of the healthy controls.
Anemia was the most reliable predictor of subclinical LVSD. Anemic patients with RA were over 11 times more likely to have reduced GLS compared with those without anemia.
“Hemoglobin levels appeared as the most reliable predictor of subclinical LVSD, as indicated by [Receive Operating Characteristic] curve analysis ([Area Under the Curve] = 0.752, 95% confidence interval [CI] = 0.577–0.927, P = .02), surpassing both age and the E/A ratio,” said lead study author Rim Dhahri, of the Rheumatology Department at the Military Hospital of Tunis, and colleagues.
Diabetes and age were also associated with impaired GLS in univariate analysis, but neither remained significant in multivariate models. Disease activity scores, inflammation markers, and autoantibodies (such as rheumatoid factor and anti-CCP) were not significantly correlated with GLS.
The RA group had a mean age of 51.7 years, and 75% were female. Comorbidities were common: 25% had diabetes, 17% had hypertension, and 36% had anemia. Despite these conditions, all of the patients with RA had normal LVEF, highlighting the limitations of conventional imaging in detecting early cardiac involvement.
Standard echocardiography didn't show statistically significant differences between the RA and control groups in heart size or function. The study emphasized the added value of STE in identifying early myocardial changes that may go unnoticed on routine examinations.
The researchers didn't assess how specific RA treatments may influence myocardial strain, nor did they evaluate coronary microvascular function. Future studies may clarify whether disease-modifying antirheumatic drugs or biologics impact subclinical cardiac outcomes.
The findings suggested that advanced imaging may help identify at-risk patients with RA—especially those with anemia—prior to symptom development. Early detection may allow for targeted monitoring and intervention to prevent progression to overt heart disease.
No conflicts of interest were reported by the study authors.
Source: Frontiers in Medicine
