Background Heart failure contributes to the excess mortality experienced by patients with rheumatoid arthritis (RA) (1). Impaired diastolic function represents a pre-clinical cardiac alteration which is highly predictive of cardiac events and often progresses to heart failure. Diastolic dysfunction is the most common cause of heart failure in patients with a preserved ejection fraction. Whereas RA is associated with an increased prevalence of impaired diastolic function (2,3), the pathophysiological mechanisms that mediate this comorbidity await further elucidation.
Objectives This study aimed to identify potential determinants of ventricular (LV) diastolic function in patients with RA.
Methods LV diastolic function was determined in 176 patients with RA; 9 patients had established cardiovascular disease. LV diastolic function was determined by echocardiography from the ratio of early-to-late transmitral blood flow velocity (E/A), the ratio of E to the mean of the lateral and septal wall myocardial tissue lengthening at the mitral annulus (e') (E/e'), and the lateral e'. Relationships of comprehensively evaluated traditional cardiovascular risk factors and RA characteristics with markers of LV diastolic function were determined in confounder adjusted multivariate regression models.
Results Disease duration (partial r=-0.23, p=0.00), rheumatoid factor status (partial r=-0.16, p=0.04) and erythrocyte sedimentation rate (partial r=-0.16, p=0.04) were associated with lower logarithmically transformed (log) E/A. Upon further adjustment for left ventricular mass index or relative wall thickness, these relationships remained significant (p≤0.05). Diastolic blood pressure was related to log E/e' (partial r=-0.16, p=0.04); this association was no longer significant after additional adjustment for left ventricular mass index (p=0.06) or relative wall thickness (p=0.06). Disease duration (partial r=-0.32, p=0.00), waist-to-hip ratio (partial r=-0.29, p=0.00) and triglycerides (partial r=-0.17, p=0.03) were related to log lateral e'. These relationships remained significant upon further adjustment for left ventricular mass index (for all p=0.00) or relative wall thickness (for all p=0.00). In sensitivity analysis among RA patients without established cardiovascular disease (n=167), the results were not materially altered.
Conclusions Modifiable traditional cardiovascular disease risk factor and disease characteristics are consistently associated left ventricular diastolic function in RA.
Nicola PJ, Crowson CS, Maradit-Kremers H et al. Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis. Arthritis Rheum 2006;54:60–7.
Gonzalez-Juanatey C, Testa A, Garcia-Castelo A et al. Echocardiographic findings in long-term treated rheumatoid arthritis patients without clinically evident cardiovascular disease. Semin Arthritis Rheum 2004;33:231–8.
Liang KP, Myasoedova E, Crowson CS et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Ann Rheum Dis 2010;69:1665–70.
Disclosure of Interest None declared
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