Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study

Abstract

<p><strong>Aim</strong>. Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment. <strong>Methods</strong>. 13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases). <strong>Results</strong>. Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively). <strong>Conclusion</strong>. Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.</p><p> </p><p> </p>

Subclinical cardiac disease in ankylosing spondylitis

“…Even though there is no study on the effects of anti–TNF‐α on subclinical systolic dysfunction in AS patients, a study has been done on rheumatoid arthritis (RA) patients. Vizzardi et al evaluated left ventricular systolic function in RA patients using STE and LVGLS measurements prior to and following the commencement of anti–TNF‐α treatment. They did not find a significant change in EF or LVGLS.…”

The Effect of Anti-TNF Therapy on Cardiac Function in Rheumatoid Arthritis: An Observational Study

“…The sample size was based on the primary outcome, i.e., diastolic LV function as assessed with Doppler echocardiography and was calculated using the McNemar’s test for sample size estimation. With an expected improvement of 25% in diastolic LV function during anti-TNF therapy [ 23 , 30 ] and a significance level of 5% and 90% power, the total calculated sample size was forty four subjects. To account for a loss to follow-up of 10%, fifty one patients were included.…”

“…Two imaging studies assessing the effect of infliximab on the cardiac function with echocardiography showed improved measures of systolic and diastolic function, subsequently an increased left ventricular ejection fraction (LVEF) and a decrease of E/e’ (parameter for diastolic function) after at least 3 months treatment, suggesting improvement of the systolic as well as diastolic function [ 21 , 22 ]. Finally, one study investigating the effect of anti-TNF on the cardiac function with Speckle tracking echocardiography did not show improvement of function [ 23 ]. Overall, it should be realized that these studies had relatively small sample sizes and altogether, it is presently unknown whether and to what extent TNF blocking therapy has a favorable effect on the cardiac function in patients with RA.…”

Chronic Heart Failure in Rheumatoid Arthritis Patients (Part III): Effects of Antirheumatic Drugs

“…В другом исследовании иФНО-α не ассоциировались с увеличением риска госпитализаций по поводу ХСН (ОР 0,85; 95%ДИ 0,63-1,14) [49]. В двух пилотных исследованиях показано отсутствие влияния терапии иФНО-α (инфликсимаб, этанерцепт, адалимумаб) в течение 1 года наблюдения на функцию сердца по данным стандартной трансторакальной и «speckle tracking» эхокардиографии у больных РА [50,51].…”