Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Cardiology Reports
Published in: Current Cardiology Reports 8/2016

01-08-2016 | Echocardiography (JM Gardin, Section Editor)

Echocardiography in the Assessment of Patients with Rheumatologic Diseases

Authors: Maha A. Al-Mohaissen, Kwan-Leung Chan

Published in: Current Cardiology Reports | Issue 8/2016

Login to get access

Abstract

Cardiovascular disease is an important extra-articular manifestation of rheumatologic diseases leading to considerable mortality and morbidity. Echocardiography emerges as a useful non-invasive technique for the screening and evaluation of cardiac involvement in these patients. With the technological advancement in echocardiographic techniques, we have gained a greater appreciation of the prevalence and nature of the cardiac involvement in these patients, as detection of subclinical disease is increasingly feasible. This review discusses cardiac involvement in patients with rheumatoid arthritis, systemic lupus erythematosus, anti-phospholipid antibody syndrome, systemic sclerosis and ankylosing spondylitis, and the role of different echocardiographic modalities in their evaluation.
Literature
1.•
Prasad M et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nat Rev Cardiol. 2015;12(3):168–76. A recent review on the cardiovascular manifestations in patients with rheumatic diseases, their underlying pathophysiology and management strategies.CrossRefPubMed
2.
Hollan I et al. Cardiovascular disease in autoimmune rheumatic diseases. Autoimmun Rev. 2013;12(10):1004–15.CrossRefPubMed
3.
Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford). 2006;45 Suppl 4:iv4–7.
4.
Aslam F et al. Diastolic dysfunction in rheumatoid arthritis: a meta-analysis and systematic review. Arthritis Care Res (Hoboken). 2013;65(4):534–43.CrossRef
5.••
Faccini, A., J.C. Kaski, and P.G. Camici, Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases. Eur Heart J, 2016. This recent paper reviewed coronary microvascular dysfunction (CMD) in chronic inflammatory rheumatoid diseases and the authors proposed a diagnostic algorithm which involves non-invasive imaging for the identification of CMD in these patients.
6.
Wislowska M, Sypula S, Kowalik I. Echocardiographic findings, 24-hour electrocardiographic Holter monitoring in patients with rheumatoid arthritis according to Steinbrocker’s criteria, functional index, value of Waaler-Rose titre and duration of disease. Clin Rheumatol. 1998;17(5):369–77.CrossRefPubMed
7.
Roldan CA et al. Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. Am J Cardiol. 2007;100(3):496–502.CrossRefPubMed
8.
9.
Wislowska M et al. Systolic and diastolic heart function in SLE patients. Rheumatol Int. 2009;29(12):1469–76.CrossRefPubMed
10.
Miner JJ, Kim AH. Cardiac manifestations of systemic lupus erythematosus. Rheum Dis Clin North Am. 2014;40(1):51–60.CrossRefPubMed
11.
Leal GN et al. Subclinical right ventricle systolic dysfunction in childhood-onset systemic lupus erythematosus: insights from two-dimensional speckle-tracking echocardiography. Lupus. 2015;24(6):613–20.CrossRefPubMed
12.
Shazzad MN et al. Echocardiographic assessment of cardiac involvement in systemic lupus erythematosus patients. Mymensingh Med J. 2013;22(4):736–41.PubMed
13.•
Denas G et al. Antiphospholipid syndrome and the heart: a case series and literature review. Autoimmun Rev. 2015;14(3):214–22. A recent comprehensive review on antiphospholipid antibody syndrome.CrossRefPubMed
14.
Taraborelli M, Andreoli L, Tincani A. Much more than thrombosis and pregnancy loss: the antiphospholipid syndrome as a ‘systemic disease’. Best Pract Res Clin Rheumatol. 2012;26(1):79–90.CrossRefPubMed
15.
Erdogan D et al. Assessment of cardiac structure and left atrial appendage functions in primary antiphospholipid syndrome: a transesophageal echocardiographic study. Stroke. 2005;36(3):592–6.CrossRefPubMed
16.
17.
Kahan A, Coghlan G, McLaughlin V. Cardiac complications of systemic sclerosis. Rheumatology (Oxford). 2009;48 Suppl 3:iii45–8.
18.
Ciurzynski M et al. Assessment of left and right ventricular diastolic function in patients with systemic sclerosis. Kardiol Pol. 2008;66(3):269–76. discussion 277–8.PubMed
19.
Heslinga SC et al. Diastolic left ventricular dysfunction in ankylosing spondylitis--a systematic review and meta-analysis. Semin Arthritis Rheum. 2014;44(1):14–9.CrossRefPubMed
20.
Ungprasert P, Srivali N, Kittanamongkolchai W. Risk of coronary artery disease in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Transl Med. 2015;3(4):51.PubMedPubMedCentral
21.
Caliskan M et al. Impaired coronary microvascular and left ventricular diastolic functions in patients with ankylosing spondylitis. Atherosclerosis. 2008;196(1):306–12.CrossRefPubMed
22.
Roldan CA et al. Aortic root disease and valve disease associated with ankylosing spondylitis. J Am Coll Cardiol. 1998;32(5):1397–404.CrossRefPubMed
23.
Turiel M et al. The role of echocardiographic techniques in connective tissue diseases. Autoimmun Rev. 2005;4(3):171–7.CrossRefPubMed
24.
Perez-Villa F et al. Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term, followup study. Arthritis Rheum. 2005;53(3):460–7.CrossRefPubMed
25.
Ungprasert P et al. Cardiac involvement in mixed connective tissue disease: a systematic review. Int J Cardiol. 2014;171(3):326–30.CrossRefPubMed
26.
Sen D, Gonzalez-Mayda M, Brasington Jr RD. Cardiovascular disease in rheumatoid arthritis. Rheum Dis Clin North Am. 2014;40(1):27–49.CrossRefPubMed
27.
Corrao S et al. Rheumatoid arthritis affects left ventricular mass: systematic review and meta-analysis. Eur J Intern Med. 2015;26(4):259–67.CrossRefPubMed
28.
Myasoedova E et al. Brief report: rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a population-based cross-sectional study. Arthritis Rheum. 2013;65(7):1713–8.CrossRefPubMedPubMedCentral
29.
Midtbo H et al. Disease activity and left ventricular structure in patients with rheumatoid arthritis. Rheumatology (Oxford). 2015;54(3):511–9.CrossRef
30.
31.
Toutouzas K et al. Myocardial ischaemia without obstructive coronary artery disease in rheumatoid arthritis: hypothesis-generating insights from a cross-sectional study. Rheumatology (Oxford). 2013;52(1):76–80.CrossRef
32.•
Kakuta, K., et al., Chronic Inflammatory Disease Is an Independent Risk Factor for Coronary Flow Velocity Reserve Impairment Unrelated to the Processes of Coronary Artery Calcium Deposition. J Am Soc Echocardiogr, 2015. This recent paper described the prevalence of CMD in patients with rheumatologic diseases using stress Doppler echocardiography.
33.
Saghir MK et al. Exercise echocardiography in rheumatoid arthritis: a case-control study. J Am Soc Echocardiogr. 2009;22(11):1228–31.CrossRefPubMed
34.
Kakuta K et al. Detection of coronary artery disease using coronary flow velocity reserve by transthoracic Doppler echocardiography versus multidetector computed tomography coronary angiography: influence of calcium score. J Am Soc Echocardiogr. 2014;27(7):775–85.CrossRefPubMed
35.
Rigo F et al. Usefulness of coronary flow reserve over regional wall motion when added to dual-imaging dipyridamole echocardiography. Am J Cardiol. 2003;91(3):269–73.CrossRefPubMed
36.
Turiel M et al. Non-invasive assessment of coronary flow reserve and ADMA levels: a case-control study of early rheumatoid arthritis patients. Rheumatology (Oxford). 2009;48(7):834–9.CrossRef
37.
Vizzardi E et al. Echocardiographic evaluation of asymptomatic patients affected by rheumatoid arthritis. J Investig Med. 2012;60(8):1204–8.CrossRefPubMed
38.
Bhatia GS et al. Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden? J Am Coll Cardiol. 2006;47(6):1169–74.CrossRefPubMed
39.
Sitia S 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;160(1):8–14.CrossRefPubMed
40.
Fine NM et al. Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography. Ann Rheum Dis. 2014;73(10):1833–9.CrossRefPubMed
41.
Baktir AO et al. Preclinical impairment of myocardial function in rheumatoid arthritis patients. Detection of myocardial strain by speckle tracking echocardiography. Herz. 2015;40(4):669–74.CrossRefPubMed
42.
Ikonomidis I et al. Association of soluble apoptotic markers with impaired left ventricular deformation in patients with rheumatoid arthritis. Effects of inhibition of interleukin-1 activity by anakinra. Thromb Haemost. 2011;106(5):959–67.CrossRefPubMed
43.
Nicola PJ et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum. 2005;52(2):412–20.CrossRefPubMed
44.
Vizzardi, E., et al., Prognostic value of diastolic dysfunction in asymptomatic rheumatoid arthritis patients without cardiovascular risk factors. Clin Exp Rheumatol, 2015.
45.
Corrao S et al. Heart involvement in rheumatoid arthritis: systematic review and meta-analysis. Int J Cardiol. 2013;167(5):2031–8.CrossRefPubMed
46.
47.
Bourre-Tessier J et al. Features associated with cardiac abnormalities in systemic lupus erythematosus. Lupus. 2011;20(14):1518–25.CrossRefPubMed
48.
Leal, G.N., et al., Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study. Scand J Rheumatol, 2015: p. 1–8.
49.
Foocharoen C et al. Asymptomatic cardiac involvement in Thai systemic sclerosis: prevalence and clinical correlations with non-cardiac manifestations (preliminary report). Rheumatology (Oxford). 2015;54(9):1616–21.CrossRef
50.
Roldan CA, Shively BK, Crawford MH. An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. N Engl J Med. 1996;335(19):1424–30.CrossRefPubMed
51.•
Roldan CA et al. Libman-Sacks endocarditis: detection, characterization, and clinical correlates by three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr. 2015;28(7):770–9. This prospective study described the complementary value of 3D transesophageal echocardiography in the detection and characterization of Libman-Sacks endocarditis and the associated clinical manifestations.CrossRefPubMedPubMedCentral
52.
Roldan CA. Diagnostic value of transesophageal echocardiography in Libman-Sacks endocarditis. Minerva Cardioangiol. 2009;57(4):467–81.PubMed
53.
Hojnik M et al. Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation. 1996;93(8):1579–87.CrossRefPubMed
54.
55.
Maksimovic R et al. Cardiac imaging in rheumatic diseases. Rheumatology (Oxford). 2006;45 Suppl 4:iv26–31.
56.
Cauduro SA et al. Clinical and echocardiographic characteristics of hemodynamically significant pericardial effusions in patients with systemic lupus erythematosus. Am J Cardiol. 2003;92(11):1370–2.CrossRefPubMed
57.
Roldan CA. Valvular and coronary heart disease in systemic inflammatory diseases: systemic disorders in heart disease. Heart. 2008;94(8):1089–101.CrossRefPubMed
58.
Hinchcliff M et al. Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol. 2012;30(2 Suppl 71):S30–7.PubMedPubMedCentral
59.•
Khanna D et al. Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rheum. 2013;65(12):3194–201. This systematic review provided recommendations for the screening and diagnosis of pulmonary hypertension in connective tissue disease.CrossRefPubMed
60.••
Galie N et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119. These are the latest guidelines on the diagnosis and treatment of patients with pulmonary hypertension.CrossRefPubMed
61.
Chin K, Mathai SC. Exercise Echocardiography in Connective Tissue Disease. J Am Coll Cardiol. 2015;66(4):385–7.CrossRefPubMed
62.•
Coghlan JG et al. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis. 2014;73(7):1340–9. This study proposed a novel, non-invasive evidence-based algorithm for the detection of pulmonary hypertension in systemic sclerosis.CrossRefPubMed
63.
Fukuda, Y., et al., Comprehensive Functional Assessment of Right-Sided Heart Using Speckle Tracking Strain for Patients with Pulmonary Hypertension. Echocardiography, 2016.
64.•
Kusunose K et al. Prediction of Future Overt Pulmonary Hypertension by 6-Min Walk Stress Echocardiography in Patients With Connective Tissue Disease. J Am Coll Cardiol. 2015;66(4):376–84. This paper described exercise testing using 6 minute walk test in predicting risk of developing pulmonary hypertension in patients with connective tissue disease.CrossRefPubMed
65.
Svealv BG et al. Prevalence of diastolic dysfunction in patients with ankylosing spondylitis: a cross-sectional study. Scand J Rheumatol. 2015;44(2):111–7.CrossRefPubMed
66.
Ustun N et al. Left ventricular systolic dysfunction in patients with ankylosing spondylitis without clinically overt cardiovascular disease by speckle tracking echocardiography. Rheumatol Int. 2015;35(4):607–11.CrossRefPubMed
67.
Park SH et al. Early cardiac valvular changes in ankylosing spondylitis: a transesophageal echocardiography study. J Cardiovasc Ultraso. 2012;20(1):30–6.CrossRef
Metadata
Title
Echocardiography in the Assessment of Patients with Rheumatologic Diseases
Authors
Maha A. Al-Mohaissen
Kwan-Leung Chan
Publication date
01-08-2016
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 8/2016
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-016-0757-2

Other articles of this Issue 8/2016

Current Cardiology Reports 8/2016 Go to the issue

Myocardial Disease (M Patel, Section Editor)

Hypertrophic Cardiomyopathy: New Evidence Since the 2011 American Cardiology of Cardiology Foundation and American Heart Association Guideline

Cardiovascular Genomics (TL Assimes, Section Editor)

Genetics of Insulin Resistance and the Metabolic Syndrome

New Therapies for Cardiovascular Disease (KW Mahaffey, Section Editor)

Bioresorbable Stents in PCI

Cardiac PET, CT, and MRI (SE Petersen and F Pugliese, Section Editors)

Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging

Invasive Electrophysiology and Pacing (EK Heist, Section Editor)

Use of the Wearable Cardioverter Defibrillator in High-Risk Populations

Management of Acute Coronary Syndromes (AS Jaffe, Section Editor)

Revascularization Strategies in Patients with Diabetes Mellitus and Acute Coronary Syndrome