Objective:

To investigate subclinical left ventricular dysfunction in rheumatoid arthritis patients with preserved left ventricular ejection fraction using myocardial work analysis, and to determine the association of myocardial damage with disease duration.

Approach:

• Study Design: Prospective cross-sectional study enrolling 59 RA patients with preserved LVEF between January 2021 and September 2023, and 35 healthy controls.
• Assessment Methods: Left ventricular function assessed using LV-PSL technology to derive GLS and myocardial work parameters.
• Stratification: RA cohort stratified by disease duration into short-duration (≤10 years) and long-duration (>10 years) groups.
• Disease Activity Measurement: Disease activity quantified using DAS28-CRP.

Key Findings:

• Both RA groups showed significantly impaired myocardial mechanics compared to controls (all p < 0.05).
• Global constructive work (GCW) was significantly reduced in the long-duration group (p < 0.05).
• Global work efficiency (GWE) was negatively correlated with inflammatory activity (DAS28-CRP: r = −0.369, p = 0.004).
• No significant correlation was found between myocardial work parameters and disease duration (all p > 0.05).

Interpretation:

Subclinical myocardial dysfunction is detectable in RA patients regardless of disease duration, linked more closely to current disease activity than to cumulative disease duration.

Limitations:

• The study is limited by its cross-sectional design, which does not allow for causal inferences.
• Sample size may limit the generalizability of findings.

Conclusion:

Myocardial work analysis is a sensitive tool for identifying subclinical myocardial work impairment in RA.