CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
AFRICA
173
shown by ‘better’ E/E
′
values following infliximab treatment.
E/E
′
value, which is used as an index of LV filling pressures,
correlates strongly with LV diastolic dysfunction.
33-35
There are two possible explanations for these findings. First,
we may speculate that LV diastolic dysfunction in patients
with RA may be a result of inflammation-induced endothelial
dysfunction, a common finding in this patient group.
21,22
Anti-
TNF-alpha agents may restore endothelial function in these
patients, which in turn reduces LV diastolic dysfunction and leads
to ‘relief’ of LA.
36,37
Second, as assessed with magnetic resonance
imaging, LA strain has been related to LA structural remodelling
and fibrosis of the atrial wall.
38
By reducing inflammation
Fig. 1.
Composite figures showing measurement of peak atrial longitudinal strain (A) and strain rate (B) using speckle tracking
echocardiography. AVO
=
aortic valve opening, AVC
=
aortic valve closure, MVO
=
mitral valve opening, MVC
=
mitral valve
closure, BA
=
basal anterior, BI
=
basal inferior, MA
=
mid-anterior, MI
=
mid-inferior, ApA
=
apical anterior, ApI
=
apical
inferior.
A
B
