Background Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular adverse events, favored by the progression of arterial stiffness leading to coronary atherosclerosis and concentric left ventricular (LV) geometry. These conditions can lead to LV systolic dysfunction (LVSD) that can be expressed by different parameters such as stress-corrected midwall shortening (sc-MS), a prognostic of CV events in patients with arterial hypertension and diabetes.
Objectives To evaluate the prevalence of LVSD in RA patients.
Methods From January to June 2014, 198 recruited RA patients were investigated and compared with 198 controls matched for age, gender, body mass index, prevalence of hypertension and diabetes. Echocardiography was performed measuring many parameters expressing LV systolic function: sc-MS (impaired if <86,5%) and S' (impaired if <9.0 cm/sec). Combined circumferential and longitudinal (C&L) function was evaluated by impairment of both sc-MS and S'. LV ejection fraction (LVEF) was considered impaired if <50%. Moreover, we evaluated through E/E' ratio a diastolic function and the presence of an excess of LV mass (inappropriate if >123% of measured/predicted ratio). This last parameter has been evaluated in a group of 235 patient.
Results LVSD defined by S' reduction was found in 45% of RA patient, by sc-MS in 56% of patients vs 15% of controls (p<0.001). LVEF was impaired in 3% of RA patients and in 1% of controls (p=non significant). A combined C&L dysfunction was detected in 28% of patients and associated with ventricular mass (OR 1.03, p=0.04) and concentric LV geometry (OR 2.76, p=0.03). RA was independently associated with impaired sc-MS and C&L dysfunction. Among RA patient, variables associated with LVSD were higher E/E' ratio and systolic blood pressure. LVM was increased in 64% of patients and in 15% of controls (p<0.001)
Conclusions In conclusion we demonstrate through different parameters that among RA patients there is a significant prevalence of LVSD that precedes LVEF impairment. RA has turn to be an independent risk factor for LVSD. These data confirm the need for a careful evaluation of CV risk in RA patients.
Disclosure of Interest None declared