Left Atrial Function and Dimensions As Predictors of Disease Activity in Rheumatoid Arthritis Patients

Rheumatoid arthritis (RA) is a chronic progressive disease associated with systemic inflammation that affects mainly synovial joints leading to tissue destruction, disability and excess mortality (1). With a prevalence ranging from 0.4% to 1.3% of the population depending on both sex (women are affected two to three times more often than men), age (frequency of new RA diagnoses peaks in the sixth decade of life (2). RA has extra-articular manifestations that can impact multiple organ systems (3).

RA patients remain at higher cardiovascular risk compared to non-RA patients(4).Cardiovascular manifestations of RA include accelerated atherosclerosis, heart failure, pericarditis, myocarditis, endocarditis, rheumatoid nodules, and amyloidosis. Inflammation is an important mediator of endothelial dysfunction and is a key driver of cardiovascular risk and complications in patients with RA (3). The increased prevalence of atherosclerosis in RA seems to be associated with excess inflammatory burden and requires tailored screening strategies and management (1).

Heart structural abnormalities are more prevalent in RA-patients than in general population, such as pericarditis, increased left ventricle mass and valvular disease (5). Left atrial (LA) dilation predicts atrial fibrillation and congestive heart failure. It also increases the risk of developing thromboembolic events(6).

Echocardiography, including transthoracic two and three-dimensional echocardiography, Doppler imaging, myocardial deformation and transesophageal echo, is an established and widely available imaging technique for the identification of cardiovascular manifestations that are crucial for prognosis in rheumatic diseases. Echocardiography is also important for monitoring the impact of drug treatment on cardiac function, coronary microcirculatory function, valvular function and pulmonary artery pressures (7).

Left atrial volume index (LAVI), measured by two-dimensional (2D) echocardiography, is an accurate descriptor of LA volume, and is recommended in the latest guidelines for the diagnosis of heart failure with preserved ejection fraction (HFpEF) (8). At present, most previous studies focus solely on detecting the associations between baseline LAVI and clinical outcomes, with few attentions paid to the prognostic value of LAVI alteration for HFpEF.