Review ArticleSpeckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients.☆
Introduction
The actual prevalence of cardiovascular (CV) involvement in inflammatory rheumatic diseases (IRD) has been underestimated for a long time. However, the availability of advanced and improved therapeutic tools, together with increased patients' life expectancy and better clinical responses to treatments, has led to a closer look to the “behind-the-scene” complications of rheumatic diseases. CV manifestations of rheumatic diseases are increasingly recognized and, in some patients, might also be the initial presentation of the rheumatic disorder.1 The spectrum of CV disease (CVD) manifestations associated with IRD is considerably broad, since rheumatic disorders can directly affect the myocardium, the cardiac valves, the pericardium, the conduction system, and the vasculature. Fatal CVD outcomes are preceded by a subclinical CVD involvement, which is largely prevalent in patients with systemic conditions and mostly attributed to early development and accelerated progression of atherosclerosis and vascular repair failure. This subclinical stage allows early detection, risk stratification and management in these patients2 if properly identified. However, in the absence of an appropriate management, accumulating damage culminates in life-threatening complications in the long term. Therefore, assessing and managing the risk of CV manifestations is essential in IRD, and early diagnosis through non-invasive diagnostic tools is highly warranted to prevent accumulating damage. In this review, we aim to thoroughly and comprehensively review the literature focused on the early detection of the cardiac involvement in a wide spectrum of IRD by Speckle Tracking Echocardiography (STE).
Section snippets
Cardiac imaging biomarkers: an unmet need for the clinical setting
Traditional CV risk factors cannot fully account for the actual CVD occurrence in IRD and hence, they cannot be used as predictive tools for the clinical setting. As a consequence, new biomarkers are needed in this scenario. Serum and laboratory biomarkers are still of uncertain value, and imaging biomarkers have been proposed to stratify the risk. Although atherosclerosis measurement, including carotid intimal-medial thickness (cIMT) and vascular function surrogate markers, such as Pulse Wave
STE: a potential new tool
The human left ventricle (LV) consists of two muscular helixes that surround the mid-ventricular circumferential layer of muscle fibers. The contraction of these endocardial and epicardial helixes results in a twisting motion that is thought to minimize the transmural stress of the LV muscle. In the healthy myocardium, the LV twist response to stimuli that alter preload, afterload, or contractility has been described and it is deemed to be relatively consistent and predictable.4
The value of
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting about 1% of the global population. It is characterized by chronic joint and systemic inflammation and enhanced atherosclerosis. In particular, CVD represents the leading cause of morbidity and mortality, accounting for 40–50% of all deaths. The excess of CV mortality and morbidity could be explained by chronic inflammation, disease duration and activity, immunosuppressive therapy, in addition to traditional CV risk factors.2
Conclusion
IRD are definitely burdened by increased CV risk, and there is a compelling body of evidence supporting a notable, early impairment of myocardial function in these conditions, mostly linked to the inflammatory burden and independently of traditional CV risk factors. As a result, there is an unmet need in estimating and reporting the cardiac involvement in a standardized and uniform manner so far.
The STE is able to detect and measure the subclinical myocardial dysfunction, and growing evidence
Statement of conflict of interest
The authors declared no conflicts of interest. Funders have no role in study conception and design, data analysis and interpretation or decision to publish.
Acknowledgements
JR-C is supported by the “Juan de la Cierva” program (IJCI-2017-32070; Ministry of Science, Innovation and Universities, Spain), “Fondo de Investigación Sanitaria” (PI16/00113; Instituto de Salud Carlos III, Spain), and "PCTI-Plan de Ciencia, Tecnologíae Innovación 2018–2022" (IDI/2018/00152; FICYT, Spain). This research did not receive any specific grant from funding agencies in the commercial or not-for-profit sectors.
References (106)
- et al.
Ischemic stroke as initial manifestation of systemic lupus erythematosus: a case report and review of the literature
eNeurologicalSci
(2018) - et al.
Prevention of cardiovascular disease in rheumatoid arthritis
Autoimmun Rev
(2015) - et al.
Intervendor differences in the accuracy of detecting regional functional abnormalities: a report from the EACVI-ASE strain standardization task force
JACC Cardiovasc Imaging
(2018) - et al.
A test in context: myocardial strain measured by speckle-tracking echocardiography
J Am Coll Cardiol
(2017) - et al.
Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging
J Am Coll Cardiol
(2006) - et al.
Role of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters
J Am Soc Echocardiogr
(2017) - et al.
Detection of preclinical impairment of myocardial function in rheumatoid arthritis patients with short disease duration by speckle tracking echocardiography
Int J Cardiol
(2012) - et al.
Prognostic role of subclinical left ventricular systolic dysfunction evaluated by speckle-tracking echocardiography in rheumatoid arthritis
J Am Soc Echocardiogr
(2017) - et al.
Subclinical impairment of myocardial and endothelial functionality in very early psoriatic and rheumatoid arthritis patients: association with vitamin D and inflammation
Atherosclerosis
(2018) - et al.
Ankylosing spondylitis
Lancet
(2007)
Aortic root disease and valve disease associated with ankylosing spondylitis
J Am Coll Cardiol
Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications
J Am Soc Echocardiogr
Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes
J Electrocardiol
Churg-Strauss syndrome
Kidney Int
Sarcoidosis
Lancet
Cardiac sarcoidosis
Am Heart J
Myocardial mechanics for the early detection of cardiac sarcoidosis
Int J Cardiol
Early detection of cardiac involvement in sarcoidosis with 2-dimensional speckle-tracking echocardiography
Int J Cardiol
Myocardial damage detected by two-dimensional speckle-tracking echocardiography in patients with extracardiac sarcoidosis: comparison with magnetic resonance imaging
J Am Soc Echocardiogr
The heart and cardiac conduction system in polymyositis-dermatomyositis: a clinicopathologic study of 16 autopsied patients
Am J Cardiol
EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update
Ann Rheum Dis
Left ventricular function in hypertension: new insight by speckle tracking echocardiography
Echocardiography
Left ventricular ejection fraction and volumes: it depends on the imaging method
Echocardiography
Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study
Eur Heart J Cardiovasc Imaging
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
Eur Heart J Cardiovasc Imaging
Myocardial strain imaging: how useful is it in clinical decision making?
Eur Heart J
Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction
Heart
Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging
Eur. Heart J. Cardiovasc. Imaging
Left ventricular function at two-year follow-up in treatment-naive rheumatoid arthritis patients is associated with anti-cyclic citrullinated peptide antibody status: a cohort study
Scand J Rheumatol
Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography
Ann Rheum Dis
Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis
Ann Rheum Dis
Lowering interleukin-1 activity with anakinra improves myocardial deformation in rheumatoid arthritis
Heart
Left ventricular function in rheumatoid arthritis during anti-TNF-alpha treatment: a speckle tracking prospective echocardiographic study
Monaldi Arch Chest Dis
Effect of long-term TNF-alpha inhibition with infliximab on left ventricular torsion in patients with rheumatoid arthritis
Hellenic J Cardiol
Chronic inhibition of tumor necrosis factor-alpha with infliximab improves myocardial deformation in parallel with aortic elasticity in rheumatoid arthritis
Turk Kardiyol Dern Ars
Increased benefit of interleukin-1 inhibition on vascular function, myocardial deformation, and twisting in patients with coronary artery disease and coexisting rheumatoid arthritis
Circ Cardiovasc Imaging
Increased burden of inflammation over time is associated with the extent of atherosclerotic plaques in patients with psoriatic arthritis
Ann Rheum Dis
Incidence and predictors for cardiovascular events in patients with psoriatic arthritis
Ann Rheum Dis
Impaired left ventricular apical rotation is associated with disease activity of psoriatic arthritis
J Rheumatol
Impaired myocardial deformation in psoriatic arthritis patients assessment by speckle tracking echocardiography
Acta Reumatol Port
Time trends in incidence, clinical features, and cardiovascular disease in ankylosing spondylitis over three decades: a population-based study
Arthritis Care Res (Hoboken)
Evaluation of right ventricular function by speckle-tracking echocardiography in patients with ankylosing spondylitis: a case-control study
Acta Cardiol Sin
Left ventricular systolic myocardial function in ankylosing spondylitis
Arthritis Care Res (Hoboken)
Left ventricular myocardial dysfunction and premature atherosclerosis in patients with axial spondyloarthritis
Rheumatology (Oxford)
Left ventricular systolic dysfunction in patients with ankylosing spondylitis without clinically overt cardiovascular disease by speckle tracking echocardiography
Rheumatol Int
Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus
Am J Epidemiol
Left ventricular remodeling and dysfunction in systemic lupus erythematosus: a three-dimensional speckle tracking study
Echocardiography
Evaluation of left atrial function by speckle tracking echocardiography in patients with systemic lupus erythematosus
Lupus
Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography
Echo Res Pract
Assessment of right atrium function in patients with systemic lupus Erythematosus with different pulmonary artery systolic pressures by 2-dimensional speckle-tracking echocardiography
J Ultrasound Med
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Statement of conflict of interest: See page 339.