Objectives to determine the frequency of diastolic dysfunction (DD) of the left (LVDD) and right ventricles (RVDD) in patients with early RA prior to therapy with basic anti-inflammatory drugs (BAID), examine its relationship with traditional risk factors (TRF) of cardiovascular disease (CVD) and markers of inflammation.
Methods a total of 76 patients (pts) with a valid diagnosis of RA (ACR/EULAR, 2010): 56 f (73,7%)/20 m (26,3%) were included, median (Me) age - 54 [interquartile range (IR) 45;60] years, Me duration-7 [IR 4;8] months; seropositive for IgM RF (87%) and/or ACCP (100%) without any experience of administration of BAID and glucocorticoides. All pts were assessed for TRF of CVD (ESC guidelines, 2011), ECG, 24-h ECG and blood pressure monitoring, echocardiography, tissue Doppler imaging, carotid artery ultrasound. Coronary calcium index was determined by 64-slice computed tomograph (the Agatston score). DD was allocated according to the ESC guidelines for the diagnosis and treatment of heart failure (2012).
Results all pts with early RA demonstrated a high disease activity (Me DAS28–5,5, IR 5,0;6,1). LVDD was detected in 36 (48,6%) pts, RVDD-18 (24,7%). The prevailing type of LVDD and RVDD are I type: 31 (41,9%), 12 (66,7%); type II - 2 (4,1%), 5 (6,8%), type III - 2 (2,7%), 1 (1,4%) respectively. All pts were divided into 3 groups: 1 - pts with the LVDD and RVDD, 2 - with the LVDD, 3 - without ventricular DD, table 1. All groups were comparable in terms DAS 28, ACCP, RF. The frequency of carotid atherosclerosis, coronary artery calcinosis (CAC) and hypertension was higher in group 1 and 2 as compared with group 3. Ischemic heart disease (IHD) were more frequent in group 2 compared with group 3. Noted a progressive reduction of the concentration of HDL and an increase in triglycerides (TG), atherogenic index (AI) from 3 to 1 group. Body mass index (BMI) was higher in group 1 compared with group 3. CRP level was higher in pts with the presence of DD (29[11;55] mg/l, n=36) compared to those pts without the DD (14[6;41] mg/l, n=38, p<0,05). There were negative correlation between the level of E/A LV and ESR (r=-0,3, p<0,03), CRP (r=-0,3, p<0,05); E/A RV and CRP (r=-0,3, p<0,03), DAS28 (r=-0,3, p<0,02).
Conclusions in pts with early RA frequently (48,6%) were detected LVDD and RVDD, which are associated with a high incidence of CVD, TRF and the high activity of the inflammatory process.
Disclosure of Interest None declared