Assessment of Left Ventricular Function in Juvenile Rheumatoid Arthritis

Background and Aims: Despite an asymptomatic cardiac status, significant systolic and diastolic functional abnormalities exist in patients with JRA. There is, however, paucityn of data concerning systolic and diastolic functions of the left ventricle (LV) in children with JIA. The aim of this study was to identify cardiac involvement with concern to study the systolic and diastolic function of left ventricle in a group of children with JRA. Methods: A total of 32 JRA children (24 females and 8 males) without any cardiac symptoms were included in this study. The control group consisted of 32 age- and sex- matched healthy children. M-mode, two-dimensional and pulsed Doppler echocardiography (ECHO) was performed on both groups to assess both systolic and diastolic functions of the left ventricle. Results: Patients with JRA had significantly higher LVESD and LVEDD as well as higher LVEDV and LVESV than in the control group (p=0.027, 0.004, 0.013, 0.001 respectively). EF and FS were within the normal range but were lower among patients with JRA as compared to controls (p=0.003, 0.082 respectively). Diastolic parameters like peak transmitral E velocity was lower and peak A velocity was higher amongst the patients with JRA (p=0.015, 0.128 respectively). This was also reflected by the E/A velocity ratio, which was significantly lower among patients as compared to the control group (p=0.001). PVS/PVD ratios was much lower in JRA patient (p=0.008). Isovolumic relaxation time was found to be higher in JRA patient as compared to the control group (p=0.004). Conclusion: In conclusion, children with JRA should be assessed for systolic and diastolic functions with serial echocardiography. In this way it may be possible to reduce the mortality and morbidity of the disease from cardiac causes.