Evaluation of Diastolic Dysfunction in Rheumatoid Arthritis Patients

Abstract

Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory disorder which can also affect cardiovascular system. Cardiovascular system involvement can be seen in many forms such as pericarditis, myocarditis, coronary artery disease or heart failure. Diastolic dysfunction is especially important for preserved ejection fraction heart failure patients. With this study we aim to investigate echocardiographic diastolic dysfunction parameters in RA patients.77 RA patients and 76 control subjects without coronary artery disease, heart failure, valvular heart diseases were included for the study and echocardiography was performed. Interventricular septum (p=0.041), posterior wall diameter (p=0.008), left ventricular mass index (p=0.037) values were significantly higher and E wave (p=0.000), E/A (p=0.000), e’ (p=0.018) values were significantly lower in RA patients compared to control group. In conclusion echocardiographic diastolic dysfunction parameters were declined in RA patients.

Keywords

• Rheumatoid arthritis,Diastolic dysfunction,Echocardiography

References

1. [1]Turesson, C., et al., “Extra‑articular disease manifestations in rheumatoid arthritis: Incidence trends and risk factors over 46 years”, Ann Rheum Dis, 62, 722‑727, 2003.
2. [2]Wolfe, F., et al., “The mortality of rheumatoid arthritis”, Arthritis Rheum, 37, 481-494, 1994.
3. [3]Solomon, D.H., et al., “Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis”, Circulation, 107, 1303-1307, 2003.
4. [4]Kaplan, M.J., “Cardiovascular disease in rheumatoid arthritis”, Curr Opin Rheumatol, 18, 289-297, 2006.
5. [5]Nicola, P.J., et al., “The risk of congestive heart failure in rheumatoid arthritis: a population based study over 46 years”, Arthritis & Rheumatology, 52, 412-420, 2005.
6. [6] Nicola, P.J., et al., “Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis”, Arthritis & Rheumatism, 54, 60-67, 2006.
7. [7] Avina-Zubieta, J.A., “Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies”, Arthritis Rheum, 59, 1690-1697, 2008.
8. [8]Liao, K.P., Solomon, D.H., “Traditional cardiovascular risk factors, inflammation and cardiovascular risk in rheumatoid arthritis”, Rheumatology, 52, 45-52, 2013.

9. [9]Daviz, J.M., et al., “A signature of aberrant immune responsiveness identifies myocardial dysfunction in rheumatoid arthritis”, Arthritis Rheum, 63, 1497-1506, 2011.
10. [10]Tsang, T.S., “Left atrial volume as a morpho-physiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden”, Am J Cardiol, 90, 1284-1289, 2002.
11. [11]Little, W.C., Cheng, C.P., “Diastolic dysfunction”, Cardiol Rev, 6, 231-239, 1998.
12. [12]Devereux, R.B., et al., “Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings”, Am J Cardiol, 57, 450-458, 1986.
13. [13]Yazmalar, L., et al., “Seasonal disease activity and serum vitamin D levels in rheumatoid arthritis, ankylosing spondylitis and osteoarthritis”, Afr Health Sc, 13, 47-55, 2013.
14. [14]Pincus, T., et al. “Taking mortality in rheumatoid arthritis seriously - predictive markers, socioeconomic status and comorbidity”, J Rheumatol, 13, 841-845, 1986.
15. [15]Mutru, O., et al., “Cardiovascular mortality in patients with rheumatoid arthritis”, Cardiology, 76, 71-77, 1989.
16. [16]Lebowits, W.B., “The heart in rheumatoid arthritis (rheumatoid disease). A clinical and pathological study of 62 cases”, Ann Intern Med, 58, 102-123, 1963.
17. [17]Redfield, M.M., et al., “Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic”, JAMA, 289, 194-202, 2003.
18. [18]Bursi, F., et al., “Systolic and diastolic heart failure in the community”, JAMA, 296, 2209-2216, 2006.
19. [19]Di Franco, M., et al., “Diastolic function abnormalities in rheumatoid arthritis. Evaluation By echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease”, Ann Rheum Dis, 59, 227-229, 2000.
20. [20]Erdem, F., et al. “Epicardial fat thickness in patients with rheumatoid arthritis”, Afr Health Sci, 15, 489-495, 2015.
21. [21]Udayakumar, N., et al., “Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease”, Singapore Med J, 48, 537-542, 2007.
22. [22]Rudominer, R.L., et al., “Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction”, Arthritis Rheum, 60, 22-29, 2009.
23. [23]Myasoedova, E., et al., “Brief report: rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a populationbased cross-sectional study”, Arthritis Rheum, 65, 1713-1718, 2013.
24. [24] Midtbø, H., et al., “Disease activity and left ventricular structure in patients with rheumatoid arthritis”, Rheumatology (Oxford), 54, 511-519, 2015.