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Extended report
Increased prevalence of diastolic dysfunction in rheumatoid arthritis
  1. Kimberly P Liang1,
  2. Elena Myasoedova2,
  3. Cynthia S Crowson2,
  4. John M Davis3,
  5. Véronique L Roger2,4,
  6. Barry L Karon4,
  7. Daniel D Borgeson4,
  8. Terry M Therneau2,
  9. Richard J Rodeheffer4,
  10. Sherine E Gabriel2,3
  1. 1Department of Medicine and Division of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh, USA
  2. 2Department of Health Sciences Research, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  3. 3Division of Rheumatology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  4. 4Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Sherine E Gabriel, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic College of Medicine, 200 First Street SW, Rochester MN 55905, USA; gabriel.sherine{at}


Objective To compare the prevalence of left ventricular (LV) diastolic dysfunction in subjects with and without rheumatoid arthritis (RA), among those with no history of heart failure (HF), and to determine risk factors for diastolic dysfunction in RA.

Methods A cross-sectional, community-based study comparing cohorts of adults with and without RA and without a history of HF was carried out. Standard two-dimensional/Doppler echocardiography was performed in all participants. Diastolic dysfunction was defined as impaired relaxation (with or without increased filling pressures) or advanced reduction in compliance or reversible or fixed restrictive filling.

Results The study included 244 subjects with RA and 1448 non-RA subjects. Mean age was 60.5 years in the RA cohort (71% female) and 64.9 years (50% female) in the non-RA cohort. The vast majority (>98%) of both cohorts had preserved ejection fraction (EF≥50%). Diastolic dysfunction was more common in subjects with RA at 31% compared with 26% (age and sex adjusted) in non-RA subjects (OR=1.6; 95% CI 1.2 to 2.4). Patients with RA had significantly lower LV mass, higher pulmonary arterial pressure and higher left atrial volume index than non-RA subjects. RA duration and interleukin 6 (IL-6) level were independently associated with diastolic dysfunction in RA even after adjustment for cardiovascular risk factors.

Conclusion Subjects with RA have a higher prevalence of diastolic dysfunction than those without RA. RA duration and IL-6 are independently associated with diastolic dysfunction, suggesting the impact of chronic autoimmune inflammation on myocardial function in RA. Clinical implications of these findings require further investigation.

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  • Funding This work was funded by grants from the National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (R01 AR46849) and National Heart, Lung and Blood Institute (R01 HL 55502) and made possible by a grant from the NIH, NIAMS (AR-30582).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Mayo Clinic and Olmsted Medical Center Institutional Review Boards.