Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study



  • Enrico Vizzardi University of Brescia, Italy.
  • Ilaria Cavazzana Spedali Civili and University of Study of Brescia, Italy.
  • Franco Franceschini Spedali Civili and University of Study of Brescia, Italy.
  • Ivano Bonadei University of Brescia, Italy.
  • Edoardo Sciatti | edoardo.sc@tin.it University of Brescia, Italy.
  • Carlo M Lombardi University of Brescia, Italy.
  • Angela Tincani Spedali Civili and University of Study of Brescia, Italy.
  • Marco Metra University of Brescia, Italy.


Aim. Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment. Methods. 13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases). Results. Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively). Conclusion. Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.





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Cardiology - Original Articles
Global longitudinal strain, Rheumatoid arthritis, TNF-α inhibition, 2D strain, heart failure.
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How to Cite
Vizzardi, Enrico, Ilaria Cavazzana, Franco Franceschini, Ivano Bonadei, Edoardo Sciatti, Carlo M Lombardi, Angela Tincani, and Marco Metra. 2016. “Left Ventricular Function in Rheumatoid Arthritis During Anti-TNF-α Treatment: A Speckle Tracking Prospective Echocardiographic Study”. Monaldi Archives for Chest Disease 84 (1-2). https://doi.org/10.4081/monaldi.2015.716.

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