Background Cardiac MRI (CMR) has merit in the assessment of cardiovascular disease (CVD) with increased left ventricular mass/end-diastolic volume (LVmass/EDV) associated (ass.) with greater CV risk. CMR-RA studies are few; unclear if CMR assessments are applicable to RA.
Objectives To describe and quantify CV risk and sub-clinical CVD in an asymptomatic (CVD perspective) established RA cohort, using gold standard CMR-measured outcomes and a clinically deliverable comprehensive CV assessment.
Methods 78 RA patients (pts) (1980 ACR criteria) with disease >5yrs, no CVD/diabetes, assessed for traditional CV risk factors (RFs), RA profile, pulse wave velocity (PWV), and a subset of 58; non-contrast 3.0T CMR reported by CMR cardiologists. 10yr JBS CV risk scores calculated (x1.5 if required)[2,3]. Univariable analysis (UVA) variables marked* in Table 1. CMR values (exc. LVEF) adj. for body surface area (BSA); “abnormal” values adj. for age/sex.
Results 73% were female, mean (SD) age 60 (9.3)yrs, 91% white British (RA profile in Table 1). JBS risk: median (IQR) 13.3 (7.4, 20.8)%; 16 (22%) pts >20% (only 5/16 were on primary prevention therapy). Only age (B0.065, p=0.001) and syst. BP (B0.036, p<0.001) were ass. with higher PWV on multivariable analysis (MVA) (R2 0.482). CMR abnormalities were common (Table 1). Greater LV mass/BSA was ass. with male gender, HTN, ever-smoking, waist/hip ratio (WHR); only gender (B13.519, p<0.001) and HTN (B5.658 p=0.003) sig. on MVA (R2 0.643). Greater LVmass/EDV was ass. with male gender, age, HTN; only gender (B0.064, p<0.001) and HTN (B0.039, p=0.012) sig. on MVA (R2 0.411). 59% had reduced LV mass/BSA, more common in females (69% vs. 38% males, p=0.038). LVmass/EDV was reduced referent to published controls ; lower in females (p<0.001). No RA variables were ass. with PWV/CMR measures.
Conclusions CMR-detected subclinical CVD abnormalities are common in asymptomatic RA pts and ass. with traditional CV RFs. Despite enhanced CV risk in RA, we demonstrate reduced LV mass/BSA and LVmass/EDV, similar to the only other comparably sized CMR-RA study. This suggests usual LV geometry interpretations may not apply to RA and implies complex mechanisms, with perhaps different compensatory remodelling in RA; warranting further study.
JACC Card Img 2010; v3i6.
ARD 2010; 69v2.
A&R 2010; 62v4.
Disclosure of Interest None declared