Assessment of left ventricular systolic and diastolic function in juvenile rheumatoid arthritis

Abstract

Background and aims: Recognizing the paucity of data regarding echocardiographic studies of Left ventricular (LV) systolic and diastolic function in patients with juvenile rheumatoid arthritis (JRA), a study was carried out to study these parameters in these subjects. SETTINGS, DESIGN AND METHODS: Thirty-five patients with JRA and an equal number of age- and sex-matched controls were studied by two-dimensional and Doppler echocardiography.

Results: Patients with JRA had higher systolic and diastolic blood pressures, resting heart rates, LV systolic (26.9+/-4.3 vs. 22.4 +/- 4.1 mm, p=0.001) and diastolic size (42.3+/-4.6 vs. 35.4+/-3.8 mm, p< 0.001) and volumes. Though ejection fraction (EF) and fractional shortening (FS) were normal, they were lower in those with JRA as compared to controls (EF: 62.9+/-4.47 vs. 67.5+/-3.63 %, p< 0.001; FS: 36.4+/-4.5 vs. 38.5 +/- 6.87, p=0.2). On Doppler analysis the JRA group had lower peak E velocity, higher peak A velocity, higher A VTI and more prolonged IVRT. Male patients had higher A VTI and IVRT as compared to females. Those with longer duration of disease had larger LV systolic (r=0.517, p=0.01) and diastolic dimension (r=0.40, p=0.05) and lower FS (r=-0.506, p=0.01). Patients with polyarticular JRA had higher E and A VTI as compared to those with systemic or oligoarticular types.

Conclusion: Despite an asymptomatic cardiac status, significant systolic and diastolic functional abnormalities exist in patients with JRA. The duration of the disease, mode of presentation, patient's age and gender have a significant impact on the left ventricular systolic and diastolic functions in patients with JRA.