Background In patients with rheumatoid arthritis (RA) the role of autoimmunity and especially auto antibody status and the time-course of left ventricular (LV) function is unknown.
Objectives To assess LV function as well as the amount of coronary calcium by coronary computer tomography (CCT) in relation to anti-cyclic citrullinated peptide antibody (anti-CCP) status in a cohort of treatment-naive RA patients. Furthermore to assess changes in these parameters during a 2-year follow-up period.
Methods Sixty-six steroid- and DMARD-naive RA patients (42 women) were included and treated with methotrexate according to the national guidelines. We assessed both the LV function by conventional echocardiography and speckle-tracking echocardiography. Furthermore, we performed CCT to estimate the amount and progression of coronary calcium. Patients were examined at he time of diagnosis and after 2-years of efficient anti-inflammatory treatment.
Results All patients fulfilled the international criteria for RA. We found no clinical significant differences in LV function parameters during the 2-year follow-up period in the total population. However, we found that patients with a persistently elevated anti-CCP both had a significantly lack of improvement in S'(1±1.4 cm/s versus 0.2±0.9 cm/s; p=0.04) and had a worsening in global longitudinal systolic strain (GLS) (0.6±1.8% versus -1±2.8%; p=0.04) compared to patients with non-persistently elevated anti-CCP over a 2-year time period. Furthermore, we observed a significant correlation between ΔGLS over 2 years and anti-CCP at 2-year follow-up (r=0.36;p=0.006). It remained significantly correlated (p=0.008) after correction for relevant cofounders (age, gender, blood pressure, heart rate, and baseline GLS). The circumferential strain improved in the group with non-persistently elevated anti-CCP compared to the group with persistently elevated anti-CCP (-4.2±3.8% versus 0.3±1.9%; p=0.009). We observed a mean progression of calcium score during the 2-year follow-up period of 22.4±68.9. We observed no differences in progression in calcium score in patients with persistently elevated anti-CCP (n=12) versus not persistently elevated (n=32) (23.8±40.3 versus 22.6±68.9; p=0.96).
Conclusions LV function and deformation is reduced in treatment-naive RA patients with persistently elevated anti-CCP. Deformation abnormalities is associated with the degree of anti-CCP positivity in a 2-year follow-up period. No differences in the amount of coronary calcium was observed according to inflammatory burden.
Disclosure of Interest None declared
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