CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
AFRICA
171
Table 4 shows LA echocardiographic and ECG parameters
between RA patients and controls: LAVI
max
and LAVI
preA
revealed
a significant increase in comparison with the control group (
p
<
0.05). As assessed by two-dimensional (2D) STE, the global
left atrial strain showed a significant impairment in the RA
patients (
p
<
0.05). Electrocardiographically we evaluated the
P-wave durations, P
max
, P
min
, and Pd. In the RA patients, P
max
was
significantly higher compared to the control group (
p
<
0.05).
There were no differences in P
max
values between the groups
before and after the treatment period.
Tables 5 and 6 illustrate the effects of infliximab therapy on LA
and LV echocardiographic and electrocardiographic parameters
versus the prednisolone-treated patients. Baseline conventional
and 2D STE parameters were similar between the two treatments
groups. Only E/E
′
ratio and LA global late diastolic strain rate
showed some significant differences (
p
<
0.05). There was a
significant improvement in E/E
′
, LAVI
max
, LAVI
preA
and LA global
strain values in the infliximab-treated patients (
p
<
0.05).
Discussion
In this prospective, preliminary study, we showed
echocardiographic LA abnormalities in RA patients in
comparison to the control group. Furthermore, there was an
improvement in LA abnormalities in the RA patients who were
treated with infliximab in comparison to the prednisolone-
treated group.
There is substantial evidence that RA is associated
with increased cardiovascular morbidity and mortality.
18
Cardiovascular manifestations of RA include atherosclerosis,
myocardial infarction, heart failure and cerebrovascular
disease.
19
It is becoming increasingly apparent that inflammation
mediators are strongly linked to this excess risk of cardiovascular
disease and mortality.
20
The impairment of coronary microcirculation may
compromise myocardial perfusion and cause LV systolic and
diastolic dysfunction.
21,22
Additionally, interstitial fibrosis caused
by cytokine-induced fibroblast activity, and collagen deposition
in the heart muscle are present in RA.
23
Previous studies
24,25
also
Table 2. Conventional echocardiographic characteristics of the study population
Controls
(
n
=
30)
RA patients
(
n
=
38)
Infliximab-treated
patients (
n
=
20)
Prednisolone-treated
patients (
n
=
18)
p
-value*
p
-value
#
LV EDV (ml)
80.1
±
10.1
83.2
±
6.1
85.7
±
6.6
83.9
±
4.7
0.74
0.2
LV ESV (ml)
29.3
±
5.6
28.8
±
6.2
28.3
±
4.2
29.2
±
5.3
0.49
0.51
LV EF (%)
64.6
±
4.1
64.2
±
3.0
63.8
±
4.0
64.1
±
3.3
0.35
0.7
IVS (mm)
9.5
±
0.6
9.7
±
0.5
9.7
±
1.7
9.5
±
2.5
0.39
0.06
PW (mm)
8.5
±
0.6
8.5
±
0.4
8.6
±
0.6
8.5
±
0.8
0.91
0.82
LAV (ml)
38.7
±
4.8
39.8
±
4.0
39.4
±
3.3
40.4
±
4.6
0.29
0.43
S
′
(cm/s)
7.6
±
2.9
7.3
±
3.2
7.2
±
1.8
7.4
±
2.5
0.16
0.1
E
′
(cm/s)
9.0
±
3.1
8.6
±
2.1
7.9
±
2.5
8.3
±
1.9
0.18
0.09
E/ E
′
7.8
±
2.0
9.0
±
2.6
9.4
±
3.9
8.5
±
2.5
<
0.05
<
0.05
IVRT (ms)
86.8
±
5.5
93.7
±
10.4
96.7
±
10.8
90.3
±
10.1
<
0.01
0.56
E (cm/s)
78.1
±
12.5
76.9
±
7.7
76.1
±
7.4
77.9
±
8.2
0.13
0.48
A (cm/s)
49.5
±
9.3
69.3
±
10.6
67.5
±
9.9
71.3
±
11.2
<
0.001 0.28
E/A
1.4
±
0.2
1.14
±
0.25
1.1
±
0.2
1.1
±
0.2
<
0.001 0.66
DT (ms)
179.8
±
25.5
199.3
±
32.6
199.1
±
35.3
198.6
±
30.3
<
0.001 0.86
Values are expressed as mean
±
SD.
*For comparisons between RA patients and control group.
#
For comparisons between infliximab- and prednisolone-treated patients.
LV
=
left ventricle, EDV
=
end-diastolic volume, ESV
=
end-systolic volume, EF
=
ejection fraction, IVS
=
interventricular septum, PW
=
posterior
wall, LAV
=
left atrial volume, IVRT
=
isovolumic relaxation time, DT
=
deceleration time.
Table 3. Effects of infliximab treatment on RA parameters
versus prednisolone-treated patients
Infliximab-treated RA
patients (
n
=
20)
Prednisolone-treated RA
patients (
n
=
18)
Baseline 3-month
p
-value Baseline 3-month
p
-value
CRP
(mg/dl) 19.9
±
6.4 4.7
±
1.2
<
0.05 17.5
±
7.5 5.6
±
2.2
<
0.05
DAS-28 6.4
±
1.0 5.4
±
1.1
<
0.05 7.1
±
0.7 6.2
±
1.0
<
0.05
DASI
3.9
±
0.8 6.8
±
0.5
<
0.05 3.6
±
1.0 6.1
±
0.9
<
0.05
Values are expressed as mean
±
SD.
CRP
=
C-reactive protein, DAS-28
=
disease activity score 28, DASI
=
Duke activity status index.
Table 4. Comparisons of left atrial echocardiographic
and electrocardiographic parameters between
rheumatoid arthritis patients and the control group
Controls
(n
=
30)
RA
patients
(n
=
38) p-value
LAVI
max
(ml/m
2
)
19.7
±
3.9 23.4
±
3.3
<
0.001
LAVI
preA
(ml/m
2
)
15.1
±
3.3 17.1
±
3.4
<
0.01
LAVI
min
(ml/m
2
)
10.9
±
3.2 10.9
±
2.6 0.915
P
max
(ms)
83.3
±
9.5 88.6
±
9.0
<
0.05
P
min
(msec)
41.3
±
5.7 43.1
±
7.3 0.255
P dispersion (msec)
42.0
±
8.0 45.5
±
6.4 0.056
LA global strain (%)
34.1
±
10.1 28.3
±
13.4
<
0.05
LA global systolic strain rate (/s)
1.8
±
0.3 1.7
±
0.3 0.053
LA global early diastolic strain
rate (/s)
–1.2
±
0.2 –1.2
±
0.3 0.434
LA global late diastolic strain
rate (/s)
–1.0
±
0.3 –1.1
±
0.2 0.492
Values are expressed as mean
±
SD.
LA
=
left atrium, LAVI
=
left atrial volume index, P
=
electrocardio-
graphic P wave.
