In this study, we evaluated the atrial and ventricular function of inflammatory rheumatic disease patients and compared them with healthy controls. Almost all parameters in patients with rheumatic disease except LVEF and RVEDD significantly differed from the control group. Subgroup analyses showed cardiac involvement in each SLE, SSc, and RA group.
Rheumatic diseases are responsible for myocardial, pericardial, valvular, electrical, and vascular changes in the cardiovascular system . Increased levels of proinflammatory cytokines , atherosclerosis , chronic inflammation , and underlying autoimmune mechanisms are related to cardiovascular involvement in patients with rheumatic diseases . As cardiovascular manifestations of rheumatic diseases may be silent or mild, early diagnosis and treatment help reduce mortality and morbidity . Our findings implied that even rheumatic disease patients on treatment may have abnormal TTE findings.
SLE is an autoimmune disease that can affect various organs, including the cardiovascular system . It has been shown that cardiovascular events are also higher in SLE patients compared with healthy controls . In our study, LVEF was not significantly different between SLE patients and healthy individuals, which is similar to the study by Huang et al. , although, a difference was observed when it came to the 3D echocardiography in this study. While LVEDD and LVESD were higher in SLE patients, RVEDD and RA were the only indifferent parameters between SLE and healthy subjects. Luo et al. assessed echocardiographic findings in SLE patients with different levels of pulmonary hypertension and they found no difference in terms of RVEDD and RV fractional area curve and TAPSE except for the ones with moderate/severe pulmonary hypertension . All in all, cardiac involvement is serious in SLE patients, and even in asymptomatic patients; a non-invasive method such as echocardiography can be helpful for the early detection of abnormalities .
Manifestations of SSc as another autoimmune disease are not limited to the skin, in a way that it can affect the whole body, including musculoskeletal, pulmonary, gastrointestinal, renal, endocrine, and cardiovascular systems . Cardiac complications of SSc may manifest as myocardial or pericardial damage, conduction system fibrosis, and valvular diseases; however, pulmonary hypertension caused by SSc is also responsible for cardiovascular involvement . In a study by Huez et al., right ventricular diastolic dysfunction was seen among patients diagnosed with SSc, caused by latent pulmonary hypertension . Following with the mentioned study, our study showed that the SPAP in the patient group was approximately 1.7 times that of the control group, indicating the presence of pulmonary hypertension in a significant proportion of SSc patients. Therefore, a simple TTE can have clinical implications in preventing this serious complication.
RA with a prevalence of about 1%, can have extra-articular presentations, including cardiovascular ones [21, 22]. Pericarditis is the most common cardiac manifestation, followed by myocarditis, congestive heart failure, cardiomyopathy, and pericardial effusion . The findings of our study suggest left ventricular dysfunction in RA cases shown by several parameters. This is in line with the results of a study by Myasoedova et al., which showed abnormal LV remodeling in RA patients without heart failure .
Although we did our best to make the study flawless, there were some limitations to our study. First, all the patients were selected from one center with the same ethnicity, which may threaten its generalizability. Second, despite highly-skilled cardiologists performing the TTE, this test is operator-related and may be erroneous in some cases. Finally, echocardiographic assessment in inflammatory rheumatic diseases has not been done much in the literature, and further research with more sample size is highly recommended.