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Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis

A prospective tissue Doppler echocardiography study

Prävalenz und Faktoren einer linksventrikulären systolischen Funktionsstörung bei asymptomatischen Patienten mit rheumatoider Arthritis

Eine prospektive Studie zur Gewebsdopplerechokardiographie

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Abstract

Background

Patients with rheumatoid arthritis (RA) have a high risk for cardiovascular disease due to a chronic inflammatory state, accelerated atherosclerosis, and changes in left ventricular (LV) geometry. These conditions predispose patients to LV systolic dysfunction (LVSD). In this study we assessed whether RA is a condition associated with LVSD, and analyzed the prevalence and factors associated with LVSD in patients with RA.

Patients and methods

Echocardiographic and clinical data from 198 patients with RA without presence or history of symptoms of cardiac disease were compared with 198 non-RA controls matched for cardiovascular risk factors. LVSD was identified withtissue Doppler echocardiography (TDE) when mitral annular peak systolic velocity (S’) was < 9.0 cm/s.

Results

Patients with RA were 61 ± 12 years old and 71 % were female (disease duration 14 ± 10 years). LVSD was found in 89 patients with RA (45 %). By multiple regression analysis including both RA patients and controls, RA emerged as an independent condition associated with LVSD (exp β 3.89; CI: 1.87–8.08) together with higher E/E’ ratio (index of LV diastolic function) and diabetes mellitus. For the 198 patients with RA, the variables associated with LVSD were higher E/E’ ratio and systolic blood pressure.

Conclusions

Almost half of asymptomatic RA patients without history of cardiac disease have subclinical LVSD easily detectable with TDE. RA is closely related to LVSD. A higher degree of LV diastolic dysfunction and systolic blood pressure are associated with LVSD in these patients, whose risk for cardiovascular events could be better defined using such information in the asymptomatic stage of cardiac disease.

Zusammenfassung

Hintergrund

Das Vorliegen eines hohen Risikos für eine Herz-Kreislauf-Erkrankung ist bei Patienten mit rheumatoider Arthritis (RA) aufgrund chronischer Entzündungsprozesse, beschleunigter Arteriosklerose und Veränderungen der linksventrikulären (LV)-)Geometrie bekannt. Dies prädisponiert zu einer linksventrikulären systolischen Dysfunktion (LVSD). In der vorliegenden Studie untersuchten die Autoren, ob eine RA mit einer LVSD assoziiert ist sowie Prävalenz und Faktoren, die mit einer LVSD bei RA-Patienten einhergehen.

Methoden

Es wurden echokardiographische und klinische Daten von 198 Patienten ohne Bestehen oder Vorgeschichte von Symptomen einer Herzerkrankung mit 198 in Bezug auf kardiovaskuläre Risikofaktoren gematchte Kontrollen ohne RA verglichen. Eine LVSD wurde mittels Gewebedopplerechokardiographie (TDE) diagnostiziert, wenn die systolische Spitzengeschwindigkeit am Mitralring (S’) < 9,0 cm/s war.

Ergebnisse

Die Patienten mit RA waren in einem Alter von 61 ± 12 Jahren, 71 % Frauen (Krankheitsdauer: 14 ± 10 Jahre). Eine LVSD wurde bei 89 RA-Patienten (45 %) festgestellt. Bei der multiplen Regressionsanalyse mit Einschluss sowohl der RA-Patienten als auch der Kontrollen erwies sich eine RA als unabhängige Erkrankung mit Assoziation zur LVSD [Exp β 3,89 (Konfidenzintervall, KI: 1,87–8,08)], zusammen mit einem höheren E/E’-Quotienten (Index der LV diastolischen Funktion) und Diabetes mellitus. Betrachtet man nur die 198 Patienten mit RA, waren die mit einer LVSD assoziierten Variablen ein höherer E/E’-Quotient und der systolische Blutdruck.

Schlussfolgerung

Fast die Hälfte der asymptomatischen RA-Patienten ohne Vorgeschichte einer Herzerkrankung weisen eine subklinische LVSD auf, die mit der TDE leicht erkennbar ist. Die RA ist eng mit einer LVSD verknüpft. Ein höherer Grad einer LV diastolischen Dysfunktion und der systolische Blutdruck sind mit einer LVSD bei diesen Patienten assoziiert, deren Risiko für eine Herz-Kreislauf-Erkrankung besser bestimmt werden könnte, wenn solche Informationen im asymptomatischen Stadium der Herzerkrankung genutzt würden.

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Correspondence to Giovanni Cioffi MD.

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G. Cioffi, O. Viapiana, F. Ognibeni, A. Dalbeni, D. Gatti, S. Adami, C. Mazzone, G. Faganello, A. Di Lenarda, and M. Rossini state that there are no conflicts of interest.

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Cioffi, G., Viapiana, O., Ognibeni, F. et al. Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis. Herz 40, 989–996 (2015). https://doi.org/10.1007/s00059-015-4320-5

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  • DOI: https://doi.org/10.1007/s00059-015-4320-5

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