Background
As an inflammatory autoimmune disease, rheumatoid arthritis (RA) can manifest as various extra-articular disorders, but left ventricular (LV) thrombosis and heart failure with preserved ejection fraction are rarely reported in patients with RA.
Method(s)
A 58-year-old woman was admitted to our hospital for progressive worsening of fatigue and dyspnea over 2 months. She had an approximately 30-year history of RA and complained of arthralgia for 1 year. Blood count and eosinophil count were normal except increased related rheumatoid factor levels and NT-ProBNP. Transthoracic echocardiography (TTE) revealed prominent obliteration of LV apex possibly due to thrombosis formation, significant biatrial enlargement with moderate mitral and tricuspid regurgitation, restrictive pattern of diastolic dysfunction (grade III), and preserved LV EF (65%). The estimated systolic pulmonary artery pressure (SPAP) was 85 mmHg. Two-dimensional speckle-tracking echocardiography (STE) revealed subclinical myocardial dysfunction with a global longitudinal strain (GLS) of -7.5%. Cardiac magnetic resonance imaging and percutaneous endomyocardial biopsy revealed slight endocardial and interstitial fibrin deposit. The patient was treated with a corticosteroid, warfarin, furosemide, spironolactone, salazosulfapyridine, cyclophosphamide, and anakinra.
Result(s)
Her related rheumatoid factor levels and NT-ProBNP level decreased or returned to normal consistently at followup. At one-month followup, TTE showed decreased thrombus size, mild to moderate mitral and tricuspid regurgitation. At 3-month followup, TTE showed slight biatrial enlargement with mild mitral and tricuspid regurgitation and a significant improvement in diastolic function (grade I). The GLS significantly increased to 14.5%. Conclusion(s)
The use of echocardiography should be encouraged for the detection and management of cardiac involvement in cases of RA.

Left ventricular thrombus and heart failure with preserved ejection fraction in a patient with rheumatoid arthritis: a comprehensive assessment using serial echocardiography

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.