Rheumatoid Arthritis Linked to Subclinical Myocardial Dysfunction

anatomical heart
anatomical heart
Investigators used speckle-tracking echocardiography to evaluate myocardial functionality in patients with inflammatory joint disease.

Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are likely to have subclinical myocardial dysfunction despite a lack of traditional cardiovascular risk factors, according to results published in Atherosclerosis.

In this patient population, disease activity is the main predictor of myocardial strain impairment.

The study included participants with early RA (n=41) and PsA (n=35) without traditional cardiovascular risk factors, as well as matched healthy controls (n=58). Each participant had their myocardial functionality assessed via speckle-tracking echocardiography (STE).

The researchers estimated their global longitudinal and circumferential strain (GLS and GCS). They measured pulse wave velocity and carotid intima-media thickness as surrogate markers of atherosclerosis. They evaluated circulating CD34 þ counts using flow cytometry and quantified vitamin D levels by high performance liquid chromatography (HPLC). Disease activity was assessed by Disease Activity Score-28 (DAS28).

Participants with RA had impaired GLS and GCS compared with controls (P <.001 for both). Participants with PsA had impaired GLS compared with healthy controls (P =.020).

In participants with RA, DAS28 scores were correlated with GLS (r=0.908; P <.001) and GCS (r=0.868; P<.001).

Participants with PsA who had high disease activity had impaired GLS and GCS compared with healthy controls, and GLS was a predictor of cIMT in these participants.

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Vitamin D was negatively associated with carotid intima-media thickness (r=0.308, P =.026) in control participants but not in participants with RA or PsA. Vitamin D was an independent predictor of decreased CD34 þ levels in participants with PsA and RA.

In participants with RA, CD34 þ counts negatively correlated with DAS28, GLS, and GCS.

“Overall, our results clearly confirm a role for the inflammatory burden in both subclinical endothelial and myocardial dysfunction in these patients, hence providing a rationale for the utilization of STE assessment for the [cardiovascular] risk assessment in [inflammatory joint diseases],” the researchers wrote.


Gullo AL, Rodriguez-Carrio J, Aragona CO, et al. Subclinical impairment of myocardial and endothelial functionality in very early psoriatic and rheumatoid arthritis patients: association with vitamin D and inflammation. Atherosclerosis. 2018;271:214-222.