Myocardial work abnormalities in rheumatoid arthritis with preserved left ventricular ejection fraction are more closely related to disease activity than to disease duration: a prospective cross-sectional study.

OBJECTIVE

To investigate subclinical left ventricular (LV) dysfunction in rheumatoid arthritis (RA) patients with preserved left ventricular ejection fraction (pLVEF) using myocardial work (MW) analysis, and to determine if myocardial damage is closely associated with disease duration.

PATIENTS AND

METHODS

We prospectively enrolled 59 RA patients with preserved LVEF between January 2021 and September 2023 at Wujin Hospital Affiliated to Jiangsu University. The RA cohort was stratified by disease duration into a short-duration group (≤10 years, n = 28) and a long-duration group (>10 years, n = 31), and 35 healthy controls. LV function was assessed using left ventricular pressure-strain loop (LV-PSL) technology to derive global longitudinal strain (GLS) and MW parameters, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Disease activity was quantified using the Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP).

RESULTS

Compared to controls, both RA groups demonstrated significantly impaired myocardial mechanics, with reduced absolute values of GLS, GWI, and GCW (all p < 0.05). GCW was significantly reduced in the long-duration group (p < 0.05), while the short-duration group showed a borderline decreasing trend. Crucially, GWE was negatively correlated with inflammatory activity (DAS28-CRP: r = -0.369, p = 0.004). However, no significant correlation was found between any MW parameter and disease duration (all p > 0.05).

CONCLUSION

In RA patients, subclinical myocardial dysfunction is detectable across disease durations, characterized by impaired myocardial work. This dysfunction is associated with current disease activity rather than cumulative disease duration. MW analysis offers a sensitive tool for identifying subclinical myocardial work impairment in RA, and should be considered for incorporation into proactive cardiovascular risk screening protocols for RA patients.