Electrocardiographic and Echocardiographic Changes in Rheumatoid Arthritis Patients

Abstract

The present study was designed to evaluate ECG and echocardiographic changes in patients with RA and to assess relation between inflammatory markers such as (ESR and CRP), RF, disease duration, disease activity (DAS28) and damage index measured by Larsen Score and cardiac parameters included LVH, LAD, QRS axis and diastolic dysfunction. The study enrolled fifty RA patients with no history of CVD, dyslipidemia, smoking, hypertension and DM. All included patients were subjected to full history taking with special emphasis on history of RA, history of CVD, other comorbidities (e.g., DM, dyslipidemia, hypertension), history of smoking and family history of CVD, diabetes and hypertension. Through clinical examination was done with special emphasis on musculoskeletal examination. Assessment of RA disease activity state was done for all RA patients using the DAS28 score. Laboratory investigations included measurement of CBC, ESR, CRP, RF, kidney functions and liver functions. Radiological joint damage assessment was done by Larsen score. In the present study the age of RA patients ranged from 18-61 years, with female to male ratio of about 3:1. Disease duration ranged from 1-15 years. In the present study there was statistically significant relation between age( ≥50 years) and LVH, diastolic dysfunction, EF and heart rate while there was no statistically significant relation between age and LAD. In the present study there was no statistically significant relation between sex and different cardiac parameters. Our study showed that there was statistically significant relation between age (>50 years) and LVH,diastolic dysfunction,EF and heart rate. The present study showed that there was statistically significant relation between RA patient didn't received methotrexate and different cardiac parameters including LVH, diastolic dysfunction, LAD and decreased EF. As regards disease duration there was highly significant relation between disease duration and diastolic dysfunction, as RA patients with high disease duration had more left ventricular diastolic dysfunction. The present study showed that no significant relation between ESR and different cardiac parameter in RA patients. We found that highly significant relation between CRP and diastolic dysfunction in RA patients. As regards RA disease activity, 4 patients (8%) had mild disease activity, 31 patients (62%) had moderate disease activity, while 5 patients (10%) had high disease activity and 10 patients (20%) were in remission. The study yielded that there was significant relation between RA patients with disease activity and LVH, and no significant relation with other cardiac parameters. As regards radiological joint damage assessment using Larsen score there was no significant relation between joint damage and different cardiac parameters in RA patients. RA patients with positive RF have high risk to develop LAD, LVH and left ventricular diastolic dysfunction, also RA patients with positive RF had left QRS axis deviation. In the present study there was significant relation between RA patient didn’t received methotrexate and different cardiac parameters.