Assesment of right heart functions and pulmonary hemodinamics in patients with rheumatoid arthritis

Introduction and Aim: Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory joint disease in which many different factors play a role. During the disease process, many extraarticular organs and systems such as skin, eye, lung and cardiovascular involvement are affected. The chronic inflammatory process also negatively affects cardiac myositis. Studies on cardiac involvement of RA are often related to the left ventricle. Evaluation of the right heart is challenging due to its complex anatomy. Echocardiographic examinations have shown in many studies that right ventricular (RV) involvement is a strong predictor of mortality and major complications in hospitalized patients. In this study, we aimed to investigate right ventricular functions and related pulmonary arterial hemodynamics in patients with RA who are not yet symptomatic. Materials and Methods: Seventy-five RA patients and 65 healthy volunteers, aged 18-65 years, without any comorbidity, smoking, or history of cardiac or pulmonary disease were included in the study. Clinical, laboratory and ECG findings were noted, and disease activity scores were calculated. Conventional parameters, Doppler parameters and RV parameters (TAPSE, S', FAC, TEI, RVOT-SE, pPTT) were measured echocardiographically. Statistical analysis was performed. Results: There was no statistically significant difference between the groups in terms of age, gender, BMI, pulse, blood pressure and conventional echo parameters. TAPSE, S', FAC, RVOT-SE, pPTT were significantly lower in the RA patient group compared to the control group. MPI was significantly higher in the RA patient group compared to the control group. TAPSE, RVOT- SE and pPTT were negatively correlated with PAP and MPI, and DAS28-CRP activity score was correlated with TAPSE, FAC. In the RA patient group, pPTT was positively correlated with TAPSE and RVOT-SE was positively correlated with PAP and MPI. In the ROC analysis for pPTT and RVOT-SE, cut-off for pPTT was 169.5 ms sensitivity was 61.3%, specificity was 87.7%, cut-off value for RVOT-SE was 0.64cm, sensitivity was 69.3%, specificity was 67.7%. Conclusion: In our study, subclinical right ventricular dysfunction and pulmonary arterial hemodynamic changes were detected in RA patients. The RVOT-SE, pPTT, which was studied for the first time in the literature, was significantly lower in the RA patient group compared to the control. We found that disease duration and TAPSE, FAC, pPTT, S' values were correlated in the RA patient group. S', RVOT-SE and pPTT parameters were examined for the first time in the literature in our study, and in the light of our findings, it can be considered to be used in our daily practice as echocardiographic parameters that will affect and guide the treatment of patients by predicting right ventricular involvement in the subclinical stage in RA patients.