Left ventricular (LV) function plays a crucial role in maintaining systemic circulation, and its impairment results in heart failure. LV function consists of systolic and diastolic function. LV systolic function determines the ejection of blood from the left ventricle to the aorta, and diastolic function regulates the filling from the left atrium to the left ventricle. Systolic function can be assessed with a simple index, ejection fraction; however, there is no established method for the assessment of diastolic function. There are several indices derived from LV filling flow, pulmonary venous flow, the movement of the mitral annulus, structure of the left atrium and ventricle, and their structural changes during a cardiac cycle. However, most of the indices detect the elevation of LV filling pressure secondary to LV diastolic dysfunction, and cannot directly assess diastolic function. Some indices are proposed as useful in directly evaluating diastolic function, but are not widely used. In addition, all of the indices have limitation and cannot be used in all of the patients. Currently, we have to measure several indices, and the synthetic judgment is mandatory in the detection of diastolic dysfunction.

View full abstract

Since the introduction of biologics for the treatment of rheumatoid arthritis (RA), many patients have been able to achieve a state of clinical remission, which is the goal of treatment. It has also been possible to withdraw biologics in some cases after achievement of clinical remission. We experienced one case in which clinical remission could be maintained after withdrawal of adalimumab (ADA), and another case in which the activity of RA was recurred after ADA withdrawal. We report a study comparing the ultrasonographic assessment in those cases. Case 1: The patient was a 41-year-old man in whom clinical remission was maintained for more than 12 months by combination therapy of methotrexate (MTX) and ADA. Power Doppler (PD) ultrasound examination was negative at all fingers and both wrists before withdrawal of ADA. After withdrawal of ADA, clinical remission was maintained for over three months. Case 2: The patient was a 33-year-old woman in whom clinical remission was maintained for 12 months by combination therapy of MTX and ADA. PD ultrasound examination was positive at both wrists before withdrawal of ADA. After withdrawal of ADA, pain and swelling in many joints of the body recurred within one month. From these two cases, it may be suggested that if PD-positive synovial tissue is observed on ultrasonography even during clinical remission, the activity of RA may recur after withdrawal of biologics.

View full abstract