Assessment of left atrial functions in active rheumatoid arthritis patients using different echo-Doppler modalities

Abstract Background: left atrium (LA) plays an important role in maintaining optimal cardiac output. Rheumatoid arthritis (RA) has been considered an independent cardiovascular risk factor that can affect all cardiac chambers and functions, especially in active disease. Aim of the study: To evaluate the effect of the activity of rheumatoid arthritis disease on left atrial functions using different echo-Doppler modalities. Methods: Sixty-five patients with RA without evidence of previous cardiovascular disease and 36 healthy control subjects were included. Echo-Doppler examination was done with measurements included LV dimensions, ejection fraction, trans-mitral Doppler flow and tissue Doppler velocities , LA dimensions, volumes, phasic LA peak strain and LA global longitudinal strain. Results: 39 patients had an active disease while 26 were in remission. The two patients’ groups had higher values of LV internal dimensions, LA volumes, and early diastolic peak strain as a surrogate of the conduit function compared to the control group. On the other hand, they had lower values of LV-EF, FS, mitral E/A ratio & Em and lower values of parameters of reservoir & contractile function, compared to the control subjects. There were no significant differences between the 2 patients’ groups in all measures except for a significantly lower value of LA GLS in active RA compared to patients in remission (p=0.001). The LA-GLS correlated significantly with RA disease activity score (r=0.60, p<0.001). Conclusion: LA function is impaired in RA and this impairment correlates with the disease activity. The LA-GLS is superior in the detection of subclinical left atrial dysfunction.