The Forgotten Chamber: Right-Ventricular Functions in Juvenile Idiopathic Arthritis

Abstract

Cardiac involvement, such as pericarditis, myocarditis, and endocarditis, is seen in juvenile idiopathic arthritis. Although there have been some reports about right-ventricular systolic and diastolic functions of adults with rheumatoid arthritis and left-ventricular systolic and diastolic functions of children with JIA, there have been no studies about RV functions of children with JIA. The aim of this study was to determine RV functions in children with JIA. We performed conventional echocardiography and tissue Doppler imaging measurements of the right ventricle of patients with JIA. All patients were in sinus rhythm at the time of examination without overt LV heart failure and with normal LV ejection fraction. Fifty-five children with the diagnosis of JIA and 33 healthy control subjects were included in the study. Peak systolic, early, and late diastolic tricuspid annular velocities were significantly decreased in JIA patients compared with healthy controls (p < 0.05). Isovolumic accelaration (IVA), as a measure of myocardial acceleration during isovolumic contraction of the right ventricle, was also significantly lower in JIA patients than in healthy controls (p < 0.05). RV systolic and diastolic functions, in addition to the previously shown LV functions, are affected in JIA patients. IVA decreases in JIA patients and may be used as an alternative, noninvasive parameter for the assessment of RV systolic function in children with JIA.

A deeper look into the functions of right ventricle using three-dimensional echocardiography: the forgotten ventricle in children with systemic lupus erythematosus

“…The RV evaluation studies in other pediatric rheumatological disorders are scarce. RV systolic and diastolic functions were reported to be impaired in children with juvenile idiopathic arthritis (JIA) compared to healthy controls but with no correlation of ECHO parameters to clinical manifestations of the disease [59], consistent with our findings in the current c-SLE cohort. Several mechanisms have been proposed for diastolic impairment in adults with rheumatoid arthritis (RA) and children with JIA, including fibrous scarring of the heart muscle, myocarditis, arteritis, nodular granulomatosis, amyloidosis, and cardiotoxic therapies [60].…”

Right Ventricular Function in Juvenile Idiopathic Arthritis Patients

“…We read with interest the article by Abul et al [1] entitled The Forgotten Chamber: Right Ventricular Functions in Juvenile Idiopathic Arthritis. In our opinion, this is an excellent statement describing the current need for a more detailed investigation of the right ventricle (RV).…”

“…In our opinion, this is an excellent statement describing the current need for a more detailed investigation of the right ventricle (RV). The authors clearly state that a need exists for a detailed evaluation of the right ventricular function parameters (e.g., the tricuspid annular peak systolic velocity (TAPSV) in the pediatric population with juvenile idiopathic arthritis) [1].…”

“…In our opinion, this is an excellent statement describing the current need for a more detailed investigation of the right ventricle (RV). The authors clearly state that a need exists for a detailed evaluation of the right ventricular function parameters (e.g., the tricuspid annular peak systolic velocity (TAPSV) in the pediatric population with juvenile idiopathic arthritis) [1].For the convenience of the pediatric cardiology audience, especially centers performing detailed echocardiographic investigations, we add that quite recently, our group has published normal TAPSV values with z-scores for healthy pediatric patients [2]. In addition, we also have described decreased TAPSV values for pediatric patients with congenital heart diseases [3].…”