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Gök M, Özmen Ç, Çağlıyan ÇE, Arslan D, Bozkurt A. Anti-inflammatory treatment improves systolic and diastolic tissue doppler parameters in patients with newly diagnosed rheumatoid arthritis. Acta Cardiol 2023:1-10. [PMID: 37694900 DOI: 10.1080/00015385.2023.2252617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The frequency of cardiovascular system involvement is increased in rheumatoid arthritis (RA) and may result in serious morbidity and mortality. Early intervention and control of the disease activity may reduce the risk of cardiovascular events. The purpose of this study is to examine the effects of steroids and methotrexate (Mtx) on the heart functions of newly diagnosed RA patients. METHODS Our study is a prospective cohort study involving thirty-six newly diagnosed RA patients according to the American Society of Rheumatology classification criteria. Right and left ventricular echocardiography, and Doppler parameters were evaluated in these patients thrice; before treatment, after one month of steroid treatment, and after three months of Mtx treatment, and laboratory/clinical parameters were noted. RESULTS The mean age of the patients was 52.66 ± 13.66 years. After the treatment, a significant decrease was observed in the values of inflammatory markers (ESR and CRP) and disease activity score (DAS28) [p < .05]. Left ventricular tissue Doppler showed an increase in lateral S, septal S, and mitral S waves compared to baseline (8.37 ± 1.89 vs 10.0 ± 1.8 cm/s p = .001). While there was a decrease in tissue Doppler tricuspid a wave (18.33 ± 4.76 vs 15.63 ± 4.36 p = .016), an increase in Tricuspid E/e' value and Tricuspid tissue Doppler e/a value was detected after treatment (0.76 ± 0.30) vs 0.94 ± 0.53) p < .010). Significant changes were found to be more prominent after the Mtx treatment. CONCLUSION In RA patients, steroid and Mtx treatment significantly positively affects left ventricular systolic and right ventricular diastolic functions.
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Affiliation(s)
- Mustafa Gök
- Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey
| | - Çağlar Özmen
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Çağlar Emre Çağlıyan
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Didem Arslan
- Department of Rheumatology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Abdi Bozkurt
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Kumar K, Seetharam K, Poonam F, Gulati A, Sadiq A, Shetty V. The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic Diseases. Cureus 2021; 13:e20708. [PMID: 35106243 PMCID: PMC8788898 DOI: 10.7759/cureus.20708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/05/2022] Open
Abstract
For systemic diseases like rheumatoid arthritis, systemic lupus erythematosus (SLE), systemic sclerosis, systemic vasculitis, myopathies, and mixed connective tissue diseases, cardiac disease is a major contributing factor for morbidity and mortality. The cardiovascular manifestations are the result of various pathophysiological components, which complicate management. Furthermore, the signs and symptoms can be subtle and missed due to the complex nature of the underlying condition. As a result, various imaging approaches play an imperative role in diagnosis and prognosis. The evolving role of these modalities could lead to risk stratification and improved therapies in the future. In conclusion, our review article will highlight the role of cardiac imaging in the evaluation of cardiac involvement for systemic diseases.
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Rodrigues P, Ferreira B, Fonseca T, Costa RQ, Cabral S, Pinto JL, Saraiva F, Marinho A, Huttin O, Girerd N, Bozec E, Carvalho HC, Ferreira JP. Subclinical ventricular dysfunction in rheumatoid arthritis. Int J Cardiovasc Imaging 2020; 37:847-859. [PMID: 33052554 DOI: 10.1007/s10554-020-02057-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022]
Abstract
Patients with rheumatoid arthritis (RA) are at higher risk for having underdiagnosed heart failure, however there are no recommendations regarding echocardiographic screening. We aimed to determine the prevalence of subclinical ventricular dysfunction in RA applying current echocardiographic guidelines, its association with patients' characteristics, biomarkers and prognostic parameters and compare the 2016 guidelines to the recommendations from 2009. Prospective study of RA patients without known heart disease, categorized as preserved ventricular function (PVF), systolic dysfunction (SD), isolated diastolic dysfunction (DD) or indeterminate diastolic function (IDF) as per the 2016 echocardiography guidelines-or any ventricular dysfunction (AVD) comprehending the last 3. The median age was 58 years and 78% were females. The majority had PVF (73%), followed by DD (13%), IDF (11%) and SD (4%). Concordance with the 2009 echocardiographic guidelines was low. Compared with PVF, AVD patients were older (65 vs 55 years, p < 0.001), had a higher prevalence of hypertension and dyslipidaemia (56% vs 38%, p = 0.003 and 60% vs 41%, p = 0.002, respectively). In multivariable analysis, age (particularly > 57 years) was the only independent predictor of AVD or DD. AVD was significantly associated with higher NT-proBNP and lower distance in 6-min walk test. There were no significant independent associations between characteristics of RA disease and ventricular function. A total of 17% of RA patients without known cardiovascular disease presented subclinical systolic or diastolic dysfunction, which was associated with older age. The echocardiographic screening may have clinical value in identifying subclinical ventricular dysfunction, especially in older RA patients.
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Affiliation(s)
- Patrícia Rodrigues
- Centro Hospitalar Universitário Do Porto (Cardiology Department), Porto, Portugal. .,Unit of Multidisciplinary Research in Biomedicine (UMIB), Porto, Portugal. .,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. .,Centro Hospitalar Universitário Do Porto - Hospital Santo António - Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
| | - Betânia Ferreira
- Unit of Multidisciplinary Research in Biomedicine (UMIB), Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,Hospital da Luz Arrábida, Porto, Portugal
| | - Tomás Fonseca
- Centro Hospitalar Universitário Do Porto (Internal Medicine Department), Porto, Portugal
| | - Rita Quelhas Costa
- Centro Hospitalar Universitário Do Porto (Internal Medicine Department), Porto, Portugal
| | - Sofia Cabral
- Centro Hospitalar Universitário Do Porto (Cardiology Department), Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | - Francisca Saraiva
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António Marinho
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,Centro Hospitalar Universitário Do Porto (Internal Medicine Department), Porto, Portugal
| | - Olivier Huttin
- French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
| | - Nicolas Girerd
- French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
| | - Erwan Bozec
- French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
| | - Henrique Cyrne Carvalho
- Centro Hospitalar Universitário Do Porto (Cardiology Department), Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - João Pedro Ferreira
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal.,French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
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Ghaleb RM, Abd Elazeem MI, Amin OA. Diastolic dysfunction in patients with rheumatoid arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_6_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians. Autoimmun Rev 2018; 17:201-214. [DOI: 10.1016/j.autrev.2017.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
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6
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Ilter A, Kiris A, Karkucak M, Sahin M, Serdar OF, Ugan Y. Arterial stiffness is associated with left ventricular dysfunction in patients with rheumatoid arthritis. Clin Rheumatol 2016; 35:2663-2668. [DOI: 10.1007/s10067-015-3163-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/17/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022]
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7
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Kirillova IG, Novikova DS, Popkova TV, Gorbunova YN, Markelova EI, Korsakova YO, Volkov AV, Alexandrova EN, Novikov AA, Fomicheva OA, Luchikhina EL, Karateev DE, Nasonov EL. [Left and right ventricular diastolic dysfunction in patients with early rheumatoid arthritis before prescribing disease-modifying antirheumatic therapy]. TERAPEVT ARKH 2015; 87:16-23. [PMID: 26155615 DOI: 10.17116/terarkh201587516-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To estimate the rate of diastolic dysfunction (DD) of the left and right ventricles (LV and RV) in patients with early rheumatoid arthritis (RA) before using disease-modifying antirheumatic drugs (DMARDs) therapy and to investigate its association with traditional risk factors (TRFs) for cardiovascular diseases (CVD) and inflammatory markers. SUBJECTS AND METHODS The investigation enrolled 74 patients with a valid diagnosis of RA, including 56 (74%) women (median age, 54 years; disease duration, 7 months); the patients who were seropositive for rheumatoid factor (RF) (87%) and/or anti-cyclic citrullinated peptide (anti-CCP) antibodies (100%) who had not been on DMARDs or glucocorticosteroids. TRFs for CVD and carotid artery atherosclerosis were assessed from duplex scanning data and echocardiography was performed in all the patients with early RA before starting the therapy. The ratio of the maximum blood flow velocity during early diastolic filling (E) to that during atrial systole (A) was used as a criterion for LVDD and RVDD. There were 3 types of impaired ventricular filling: 1) E/A <1; 2) E/A = 1-2; 3) E/A > 2. RESULTS LVDD and RVDD were detected in 35 (48%) and 17 (23%) patients, respectively. RVDD was recorded only in conjunction with LVDD. Among LVDD and RVDD, the former was prevalent. All the patients with early RA were divided into 3 groups: 1) patients with LVDD and RVDD; 2) those with LVDD; 3) those without ventricular DD. All the three groups were matched for the level of DAS28, anti-CCP antibodies, and RF. The incidence of arterial hypertension, dyslipidemia, and abdominal obesity was higher in the patients of Groups 1 and 2 than in those of Group 3. There was a progressive decrease in high-density lipoprotein (HDL) cholesterol concentrations and increases in triglyceride (TG) levels and atherogenic index from Group 3 to Group 1, with the concentrations of total cholesterol and low-density lipoprotein cholesterol being similar in the 3 groups. Coronary heart disease was recorded more frequently in Group 2 than in Group 3. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) proved to be also significantly higher in the patients with DD than in those without DD. Correlations were found between LV E/A and ESR, CRP, HDL cholesterol, TG, RV E/A and ESR, DAS28, TG. CONCLUSION The patients with early-stage RA were found to have high incidence rates of LVDD and RVDD, which is related to the high prevalence of CVD, the high spread of TRF for CVD, and the high activity of an inflammatory process.
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Affiliation(s)
- I G Kirillova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - D S Novikova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T V Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Yu N Gorbunova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - E I Markelova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Yu O Korsakova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - A V Volkov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - E N Alexandrova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - A A Novikov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - O A Fomicheva
- Russian Cardiology Research-and-Production Complex, Ministry of Health of Russia, Moscow, Russia
| | - E L Luchikhina
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - D E Karateev
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - E L Nasonov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Abstract
Rheumatic diseases are associated with an increased risk of cardiovascular (CV) mortality attributed to a higher incidence of heart failure (HF) and ischemic heart disease. Although traditional CV risk factors contribute to the increased incidence seen in this population, by themselves they do not account for the increased risk; in fact, obesity and hyperlipidemia may play a paradoxic role. Immune-mediated mechanisms and chronic inflammation likely play a role in the pathogenesis of CV disease in patients with rheumatic diseases. The usual clinical features of ischemic heart disease and HF are less likely to be seen in this patient population.
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Affiliation(s)
- Kerry Wright
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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9
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Heart involvement in rheumatoid arthritis: multimodality imaging and the emerging role of cardiac magnetic resonance. Semin Arthritis Rheum 2013; 43:314-24. [PMID: 23786873 DOI: 10.1016/j.semarthrit.2013.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) exhibit a high risk of cardiovascular disease (CVD). CVD in RA can present in many guises, commonly detected at a subclinical level only. METHODS Modern imaging modalities that allow the noninvasive assessment of myocardial performance and are able to identify cardiac abnormalities in early asymptomatic stages may be useful tools in terms of screening, diagnostic evaluation, and risk stratification in RA. RESULTS The currently used imaging techniques are echocardiography, single-photon emission computed tomography (SPECT), and cardiac magnetic resonance (CMR). Between them, echocardiography provides information about cardiac function, valves, and perfusion; SPECT provides information about myocardial perfusion and carries a high amount of radiation; and CMR-the most promising imaging modality-evaluates myocardial function, inflammation, microvascular dysfunction, valvular disease, perfusion, and presence of scar. Depending on availability, expertise, and clinical queries, "right technique should be applied for the right patient at the right time." CONCLUSIONS In this review, we present a short overview of CVD in RA focusing on the clinical implication of multimodality imaging and mainly on the evolving role of CMR in identifying high-risk patients who could benefit from prevention strategies and early specific treatment targeting the heart. Advantages and disadvantages of each imaging technique in the evaluation of RA are discussed.
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10
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Amaya-Amaya J, Sarmiento-Monroy JC, Mantilla RD, Pineda-Tamayo R, Rojas-Villarraga A, Anaya JM. Novel risk factors for cardiovascular disease in rheumatoid arthritis. Immunol Res 2013; 56:267-86. [DOI: 10.1007/s12026-013-8398-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review. Arthritis Care Res (Hoboken) 2013; 65:534-43. [DOI: 10.1002/acr.21861] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 09/10/2012] [Indexed: 12/11/2022]
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12
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Cardiovascular disease in rheumatoid arthritis: a systematic literature review in latin america. ARTHRITIS 2012. [PMID: 23193471 PMCID: PMC3501796 DOI: 10.1155/2012/371909] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background. Cardiovascular disease (CVD) is the major predictor of poor prognosis in rheumatoid arthritis (RA) patients. There is an increasing interest to identify "nontraditional" risk factors for this condition. Latin Americans (LA) are considered as a minority subpopulation and ethnically different due to admixture characteristics. To date, there are no systematic reviews of the literature published in LA and the Caribbean about CVD in RA patients. Methods. The systematic literature review was done by two blinded reviewers who independently assessed studies for eligibility. The search was completed through PubMed, LILACS, SciELO, and Virtual Health Library scientific databases. Results. The search retrieved 10,083 potential studies. A total of 16 articles concerning cardiovascular risk factors and measurement of any cardiovascular outcome in LA were included. The prevalence of CVD in LA patients with RA was 35.3%. Non-traditional risk factors associated to CVD in this population were HLA-DRB1 shared epitope alleles, rheumatoid factor, markers of chronic inflammation, long duration of RA, steroids, familial autoimmunity, and thrombogenic factors. Conclusions. There is limited data about CVD and RA in LA. We propose to evaluate cardiovascular risk factors comprehensively in the Latin RA patient and to generate specific public health policies in order to diminish morbi-mortality rates.
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Davis JM, Knutson KL, Strausbauch MA, Crowson CS, Therneau TM, Wettstein PJ, Roger VL, Matteson EL, Gabriel SE. A signature of aberrant immune responsiveness identifies myocardial dysfunction in rheumatoid arthritis. ACTA ACUST UNITED AC 2011; 63:1497-506. [PMID: 21384332 DOI: 10.1002/art.30323] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Heart failure is an important cause of death in patients with rheumatoid arthritis (RA). Evidence suggests that immune mechanisms contribute to myocardial injury and fibrosis, leading to left ventricular diastolic dysfunction (LVDD). The purpose of this study was to identify a signature of LVDD in patients with RA by analyzing the responsiveness of the innate and adaptive immune systems to stimulation ex vivo. METHODS RA patients (n=212) enrolled prospectively in a population-based cohort underwent echocardiography, and LV function was classified as normal, mild LVDD, or moderate-to-severe LVDD. The release of 17 cytokines by blood mononuclear cells in response to stimulation with a panel of 7 stimuli or in media alone was analyzed using multiplex immunoassays. Logistic regression models were used to test for associations between a multicytokine immune response score and LVDD, after adjusting for clinical covariates. RESULTS An 11-cytokine profile effectively differentiated patients with moderate-to-severe LVDD from those with normal LV function. An immune response score (range 0-100) was strongly associated with moderate-to-severe LVDD (odds ratio per 10 units 1.5 [95% confidence interval 1.2-2.1]) after adjusting for serum interleukin-6 levels, brain natriuretic peptide values, and glucocorticoid use, as well as other RA characteristics and LVDD risk factors. CONCLUSION The major finding of this study was that aberrant systemic immune responsiveness is associated with advanced myocardial dysfunction in patients with RA. The unique information added by the immune response score concerning the likelihood of LVDD warrants future longitudinal studies of its value in predicting future deterioration in myocardial function.
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Marasovic-Krstulovic D, Martinovic-Kaliterna D, Fabijanic D, Morovic-Vergles J. Are the anti-cyclic citrullinated peptide antibodies independent predictors of myocardial involvement in patients with active rheumatoid arthritis? Rheumatology (Oxford) 2011; 50:1505-12. [DOI: 10.1093/rheumatology/ker121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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ABDUL MUIZZ AM, MOHD SHAHRIR MS, SAZLIYANA S, OTEH M, SHAMSUL AS, HUSSEIN H. A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity. Int J Rheum Dis 2011; 14:18-30. [DOI: 10.1111/j.1756-185x.2010.01593.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Liang KP, Myasoedova E, Crowson CS, Davis JM, Roger VL, Karon BL, Borgeson DD, Therneau TM, Rodeheffer RJ, Gabriel SE. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Ann Rheum Dis 2010; 69:1665-70. [PMID: 20498217 DOI: 10.1136/ard.2009.124362] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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> or =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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Affiliation(s)
- Kimberly P Liang
- Department of Health Sciences Research, Mayo Clinic, Mayo Clinic College of Medicine, 200 First Street SW, Rochester MN 55905, USA
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Davis JM, Roger VL, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population. ACTA ACUST UNITED AC 2010; 58:2603-11. [PMID: 18759286 DOI: 10.1002/art.23798] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the clinical presentation, management, and outcome of heart failure in patients with rheumatoid arthritis (RA) compared with non-RA patients. METHODS We conducted a community-based cohort study in the setting of Olmsted County, Minnesota, from 1979 to 2000. One hundred three patients with RA and 852 non-RA patients with incident heart failure (physician diagnosed and Framingham criteria validated) were compared. Age- and sex-adjusted rates/frequencies and multivariable logistic regression models were used to compare the clinical features and mortality of heart failure following its onset in the 2 groups of patients. RESULTS The patients with RA were more often female and less frequently were obese, were hypertensive, or had ischemic heart disease. Patients with RA and heart failure had fewer typical symptoms and signs and were less likely to undergo echocardiography compared with non-RA patients. After adjusting for differences, the patients with RA and heart failure were more likely to have preserved ejection fraction (>or=50%). Mortality at 1 year following heart failure was higher in patients with RA compared with non-RA patients (35% versus 19%; multivariable hazard ratio 1.89, 95% confidence interval 1.26-2.84). CONCLUSION Both the clinical presentation and the outcome of heart failure differ significantly between patients with and those without RA from the same population. Among patients with RA, the presentation of heart failure is more subtle, myocardial function is more likely preserved, while mortality from heart failure is significantly higher. These findings emphasize the importance of more vigilant screening of patients with RA for early signs of heart failure and may represent important insights into the biologic mechanisms underlying heart failure in RA.
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Cardiel MH. Heart failure in patients with rheumatoid arthritis is clinically different and has a worse prognosis. FUTURE RHEUMATOLOGY 2008; 3:437-439. [DOI: 10.2217/17460816.3.5.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Danila MI, Patkar NM, Curtis JR, Saag KG, Teng GG. Biologics and heart failure in rheumatoid arthritis: are we any wiser? Curr Opin Rheumatol 2008; 20:327-33. [PMID: 18388526 PMCID: PMC4097098 DOI: 10.1097/bor.0b013e3282fb03d8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To summarize the recent literature concerning the role of TNF-alpha in heart failure, epidemiology of heart failure in rheumatoid arthritis and risk of heart failure associated with biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. RECENT FINDINGS TNF-alpha has been implicated in the pathogenesis of heart failure. It has direct deleterious effects on the myocardium in the setting of acute injury or chronic heart failure. In animal models, TNF-alpha is important in cardiac remodeling, leading to cardiac dysfunction following acute injury. Both incident and worsening heart failure have been reported in patients with rheumatoid arthritis who are treated with anti-TNF-alpha therapy. Recent cohort studies, however, have shown no increased risk and, in some, a protective effect on the risk of heart failure. Certain traditional cardiovascular risk factors have a relatively lesser contribution to cardiovascular morbidity and mortality in patients with rheumatoid arthritis, suggesting that disease-related perturbations of the cytokine network may contribute to the excess risk of heart failure in these patients. SUMMARY Overall mortality in rheumatoid arthritis has remained stagnant despite advances in rheumatoid arthritis and heart failure management and improved cardiovascular mortality in the general population. Heart failure prevalence is increased in patients with rheumatoid arthritis and leads to greater mortality. Despite current expert consensus contraindicating the use of anti-TNF-alpha agents in patients with moderate to severe heart failure, epidemiological studies in rheumatoid arthritis have not consistently substantiated this association.
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Affiliation(s)
- Maria I. Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nivedita M. Patkar
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gim Gee Teng
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
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Wislowska M, Jaszczyk B, Kochmański M, Sypuła S, Sztechman M. Diastolic heart function in RA patients. Rheumatol Int 2007; 28:513-9. [DOI: 10.1007/s00296-007-0473-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
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Birdane A, Korkmaz C, Ata N, Cavusoglu Y, Kasifoglu T, Dogan SM, Gorenek B, Goktekin O, Unalir A, Timuralp B. Tissue Doppler imaging in the evaluation of the left and right ventricular diastolic functions in rheumatoid arthritis. Echocardiography 2007; 24:485-93. [PMID: 17456067 DOI: 10.1111/j.1540-8175.2007.00422.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Previous studies have reported that cardiovascular involvement in rheumatoid arthritis (RA) occurs frequently. Although ventricular functions of RA have been investigated through the standard Doppler in RA, they have yet to be investigated thoroughly by means of the relatively new and advantageous tissue Doppler imaging (TDI). The present study aims to investigate left and right ventricular functions in RA patients by means of TDI and standard Doppler echocardiography. METHODS A total of 60 patients with longstanding RA and 40 control subjects were included in the study and their left and right ventricular functions were assessed by standard pulsed-wave Doppler echocardiography, the color M-mode flow propagation velocity, and TDI. The left ventricular TDI was achieved at four different sites (lateral, septal, anterior, and inferior walls), while the right ventricular TDI was achieved through the tricuspid lateral annulus. RESULTS When compared with controls, the RA group showed that basal clinic and echocardiographic parameters, early (E) and late (A) diastolic velocities of atrioventricular valves, E/A ratio, and pulmonary venous Doppler parameters of these two groups were similar. It was determined that left and right ventricular E-wave deceleration times and isovolumic relaxation times of the RA patients were determined to have increased in comparison with those of the subjects in the healthy Control Group (P < 0.05). RA patients had significantly lower color M-mode flow propagation velocity (P < 0.05). While S' peak and E' peak, two of the left and right ventricular TDI parameters, were similar in both groups, A' peak, E'/A', and E/E' parameters in RA showed statistically significant differences in RA patients. CONCLUSION A comparison between age and sex of RA patients and healthy individuals revealed that left and right ventricular TDI parameters of RA patients were impaired, which led us to conclude that both of the ventricles could have been involved.
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Affiliation(s)
- Alparslan Birdane
- Department of Cardiology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.
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22
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Rexhepaj N, Bajraktari G, Berisha I, Beqiri A, Shatri F, Hima F, Elezi S, Ndrepepa G. Left and right ventricular diastolic functions in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Int J Clin Pract 2006; 60:683-8. [PMID: 16805753 DOI: 10.1111/j.1368-5031.2006.00746.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to assess the prevalence of diastolic dysfunction of the left ventricle (LV) and of the right ventricle in patients with rheumatoid arthritis (RA) without clinically evident cardiovascular manifestations and to estimate whether there is a correlation between the duration of RA and the degree of LV diastolic dysfunction. The study included 81 patients (61 females and 20 males) with RA without clinically evident heart disease (group 1) and 40 healthy subjects (29 females and 11 males) who served as a control group (group 2). Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects. There were significant differences between patients with RA vs. control group with regard to early diastolic flow velocity (E), atrial flow velocity (A) and the E/A ratio (0.68 +/- 0.19 m/s vs. 0.84 +/- 0.14 m/s, p < 0.001; 0.73 +/- 0.15 m/s vs. 0.66 +/- 0.13 cm/s, p = 0.01; and 0.97 +/- 0.3 vs. 1.32 +/- 0.37, p < 0.001, respectively). There was significant difference between groups regarding the right ventricular early diastolic (Er)/atrial (Ar) flow velocities (Er/Ar ratio) (1.07 +/- 0.3 vs. 1.26 +/- 0.3, p = 0.002). There was a weak correlation between transmitral E/A ratio and the duration of RA (r = - 0.22, p = 0.001). Myocardial performance index (MPI) appeared to differ little in patients with RA as compared with control group (0.51 +/- 0.1 vs. 0.52 +/- 0.2, p = NS). In patients with RA without clinically evident cardiovascular disease, the left ventricular diastolic function and the right ventricular diastolic function are reduced. Left ventricular wall thickness, dimensions, systolic function and MPI were found to be normal. LV diastolic function had a weak correlation with the duration of RA.
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Affiliation(s)
- N Rexhepaj
- Service of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosova, Prishtina, Kosova
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Gonzalez-Juanatey C, Amigo-Diaz E, Miranda-Filloy JA, Testa A, Revuelta J, Garcia-Porrua C, Martin J, Llorca J, Gonzalez-Gay MA. Lack of Echocardiographic and Doppler Abnormalities in Psoriatic Arthritis Patients Without Clinically Evident Cardiovascular Disease or Classic Atherosclerosis Risk Factors. Semin Arthritis Rheum 2006; 35:333-9. [PMID: 16616156 DOI: 10.1016/j.semarthrit.2005.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the prevalence of echocardiographic and Doppler abnormalities in psoriatic arthritis (PsA) patients without clinically evident cardiovascular manifestations or classic atherosclerosis risk factors. METHODS Fifty PsA patients were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients seen during the period of recruitment that had classic cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Fifty healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. RESULTS In PsA patients the frequency of aortic and tricuspid (10%) and mitral regurgitation (16%) was not different from that seen in matched controls (10, 4, and 12%). Also, the pulmonary artery systolic pressure was normal in the group of PsA patients (23.4+/-3.9 mm Hg). The prevalence of diastolic dysfunction, in all cases due to impaired relaxation, was similar in PsA patients (28%) and controls (24%) (P=0.65). In addition, no significant echocardiographic and Doppler differences were observed when PsA patients with polyarticular pattern were compared with the remaining PsA patients. CONCLUSIONS The present study shows that actively treated PsA patients without cardiovascular risk factors or clinically evident cardiovascular disease do not exhibit silent subclinical echocardiographic abnormalities.
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Gonzalez-Gay MA, Gonzalez-Juanatey C, Martin J. The increased risk of ventricular diastolic dysfunction and congestive heart failure in patients with rheumatoid arthritis is independent of the duration of the disease. Semin Arthritis Rheum 2006; 35:132-3. [PMID: 16194698 DOI: 10.1016/j.semarthrit.2005.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arslan S, Bozkurt E, Sari RA, Erol MK. Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease. Clin Rheumatol 2005; 25:294-9. [PMID: 16222411 DOI: 10.1007/s10067-005-0014-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 04/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate left ventricular diastolic function in patients with active rheumatoid arthritis (RA), analyzing conventional Doppler and tissue Doppler echocardiographic imaging (TDI) which is a new echocardiographic application, with special regard to disease duration. METHODS Fifty-two patients with active RA and 47 healthy persons were included in this study. Duration of disease ranged from 3 to 324 months (mean 76+/-85 months). All patients and the control group were evaluated by M-mod, two-dimensional, conventional Doppler echocardiography and TDI. RESULTS Among conventional Doppler transvalvular mitral flow parameters, late diastolic flow velocity (A) and deceleration time (DT) values were higher in patients with RA than that in the control group (p<0.001). E (early diastolic flow velocity)/A ratio was found to be lower in patients with RA than that in the control group (p<0.001). Mitral annular early diastolic velocity (E (m)), among TDI parameters, was found to be lower in patients with RA than that in the control group (p<0.001). E (m)/A (m) (mitral annular late diastolic velocity) ratio was found to be lower in RA patients compared with that in the control group (p<0.001). The relation was found between A (r=0.43, p=0.001), DT (r=0.30, p=0.03), E/A ratio (r=0.40, p=0.004), E (m) (r=0.32, p=0.02), E (m)/A (m) ratio (r=0.30, p=0.03), and E/E (m) (r=0.32, p=0.02), with disease duration in patients with RA. CONCLUSION At present, it is concluded that active RA patients, in the absence of clinical evidence of heart disease, show diastolic dysfunction characterized by impaired E/A ratio, E (m)/A (m) ratio, and DT. The relation between diastolic dysfunction and disease duration suggests a subclinical myocardial involvement.
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Affiliation(s)
- Sakir Arslan
- Cardiology Department, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
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Giles JT, Fernandes V, Lima JAC, Bathon JM. Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis. Arthritis Res Ther 2005; 7:195-207. [PMID: 16207349 PMCID: PMC1257451 DOI: 10.1186/ar1814] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Data from population- and clinic-based epidemiologic studies of rheumatoid arthritis patients suggest that individuals with rheumatoid arthritis are at risk for developing clinically evident congestive heart failure. Many established risk factors for congestive heart failure are over-represented in rheumatoid arthritis and likely account for some of the increased risk observed. In particular, data from animal models of cytokine-induced congestive heart failure have implicated the same inflammatory cytokines produced in abundance by rheumatoid synovium as the driving force behind maladaptive processes in the myocardium leading to congestive heart failure. At present, however, the direct effects of inflammatory cytokines (and rheumatoid arthritis therapies) on the myocardia of rheumatoid arthritis patients are incompletely understood.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Monoclonal/therapeutic use
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/physiopathology
- Autoimmune Diseases/complications
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/physiopathology
- Comorbidity
- Cytokines/physiology
- Disease Models, Animal
- Double-Blind Method
- Etanercept
- Female
- Heart Failure/diagnostic imaging
- Heart Failure/epidemiology
- Heart Failure/etiology
- Humans
- Immunoglobulin G/therapeutic use
- Incidence
- Inflammation
- Infliximab
- Male
- Mice
- Mice, Transgenic
- Middle Aged
- Randomized Controlled Trials as Topic
- Receptors, Tumor Necrosis Factor/therapeutic use
- Risk Factors
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factor-alpha/physiology
- Ultrasonography
- Ventricular Dysfunction, Left/etiology
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Jon T Giles
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Arslan S, Bozkurt E, Sari RA, Erol MK. Use of tissue Doppler and its comparison with other conventional Doppler techniques in the assessment of diastolic functions in patients with active rheumatoid arthritis. Rheumatol Int 2005; 26:229-33. [PMID: 15973539 DOI: 10.1007/s00296-004-0561-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 10/18/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aims to assess left ventricular diastolic functions with tissue Doppler imaging (TDI), which is a new technique, and to compare it with conventional Doppler echocardiography techniques in patients with active rheumatoid arthritis (RA). METHODS Fifty-two patients with active RA and 47 healthy persons were included in this study. All patients and the control group were evaluated by M-mod, two-dimensional, conventional Doppler echocardiography and TDI. RESULTS Left ventricular early diastolic (E)/late diastolic (A) flow velocity (E/A ratio) was found to be lower in patients with RA than in the control group (p<0.001). Mitral annular early diastolic (E(m))/late diastolic (A(m)) velocity(E(m)/A(m) ratio) was found to decrease in RA patients compared with the control group (p<0.001). E/E(m) ratio was higher in patients with RA than in the control group (p<0.001). CONCLUSION Left ventricular diastolic functions were impaired in patients with RA. We have concluded that TDI alone, or together with conventional Doppler echocardiography, is useful for the evaluation of diastolic functions in RA patients.
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Affiliation(s)
- Sakir Arslan
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
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Hagendorff A, Pfeiffer D. Echokardiographische Funktionsdiagnostik bei Patienten mit rheumatoider Arthritis und Kollagenosen. Z Rheumatol 2005; 64:239-48. [PMID: 15909084 DOI: 10.1007/s00393-005-0734-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 03/04/2005] [Indexed: 10/25/2022]
Abstract
Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients with collagenoses, the coagulation system is activated and the reactivity of the endothelium is reduced. Thus, thrombus formation at the heart valves with consecutive stenosis and/or regurgitations as well as ischemia-induced regional wall motion defects due to reduced vasodilator response of the coronary arteries can be expected. In the literature in patients with rheumatoid arthritis and other collagenoses, pericardial effusion and pulmonary hypertension are most frequently described. The echocardiographic analysis, however, is more complex due to the variability of the patient cohort. Quantification of valve defects and the analysis of wall motion and perfusion at rest and during stress is necessary to detect early changes of the diseases. The prerequisites for successful diagnostic echocardiography in these patients are the knowledge of modern echocardiographic techniques like tissue Doppler and contrast echocardiography and clinical experience with patients with rheumatoid arthritis and other collagenoses. The standardization of the echocardiographic diagnostic procedure becomes more and more important for reproducibility and comparability of the results.
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Affiliation(s)
- A Hagendorff
- Medizinische Universitätsklinik und Poliklinik, Abteilung Kardiologie/Angiologie, Johannisallee 32, 04103, Leipzig, Germany.
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Bhatia GS, Sosin MD, Grindulis KA, Davis RC, Lip GYH. Rheumatoid disease and the heart: from epidemiology to echocardiography. Expert Opin Investig Drugs 2005; 14:65-76. [PMID: 15709923 DOI: 10.1517/13543784.14.1.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rheumatoid disease (RD) is a common chronic inflammatory condition associated with progressive joint destruction. Sufferers of RD experience reduced life expectancy, reflected in the increased standardised mortality rates reported in several studies over the last 50 years. Most studies indicate that the increased mortality affecting this population is mainly due to cardio-vascular disease. Epidemiological data have revealed an increased risk of developing ischaemic heart disease and heart failure in RD. The increased risk of ischaemic heart disease may result from traditional risk factors but data suggest that RD may confer risk independently. Although pericardial involvement, valvopathy and myocarditis are the most well-recognised cardiac manifestations of RD, and constitute a rheumatoid heart disease, these features are relatively benign. The current prevalence of rheumatoid heart disease in the era of early administration of disease-modifying therapy requires evaluation.
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Affiliation(s)
- Gurbir S Bhatia
- University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK
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Nicola PJ, Maradit-Kremers H, Roger VL, Jacobsen SJ, Crowson CS, Ballman KV, Gabriel SE. The risk of congestive heart failure in rheumatoid arthritis: A population-based study over 46 years. ACTA ACUST UNITED AC 2005; 52:412-20. [PMID: 15692992 DOI: 10.1002/art.20855] [Citation(s) in RCA: 317] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE It is hypothesized that the systemic inflammation associated with rheumatoid arthritis (RA) promotes an increased risk of cardiovascular (CV) morbidity and mortality. We examined the risk and determinants of congestive heart failure (CHF) in patients with RA. METHODS We assembled a population-based, retrospective incidence cohort from among all individuals living in Rochester, Minnesota, in whom RA (defined according to the American College of Rheumatology 1987 criteria) was first diagnosed between 1955 and 1995, and an age- and sex-matched non-RA cohort. After excluding patients in whom CHF occurred before the RA index date, all subjects were followed up until either death, incident CHF (defined according to the Framingham Heart Study criteria), migration from the county, or until January 1, 2001. Detailed information from the complete medical records (including all inpatient and outpatient care provided by all local providers) regarding RA, ischemic heart disease, and traditional CV risk factors was collected. Cox models were used to estimate the effect of RA on the development of CHF, adjusting for CV risk factors and/or ischemic heart disease. RESULTS The study population included 575 patients with RA and 583 subjects without RA. The CHF incidence rates were 1.99 and 1.16 cases per 100 person-years in patients with RA and in non-RA subjects, respectively (rate ratio 1.7, 95% confidence interval [95% CI] 1.3-2.1). After 30 years of followup, the cumulative incidence of CHF was 34.0% in patients with RA and 25.2% in non-RA subjects (P< 0.001). RA conferred a significant excess risk of CHF (hazard ratio [HR] 1.87, 95% CI 1.47-2.39) after adjusting for demographics, ischemic heart disease, and CV risk factors. The risk was higher among patients with RA who were rheumatoid factor (RF) positive (HR 2.59, 95% CI 1.95-3.43) than among those who were RF negative (HR 1.28, 95% CI 0.93-1.78). CONCLUSION Compared with persons without RA, patients with RA have twice the risk of developing CHF. This excess risk is not explained by traditional CV risk factors and/or clinical ischemic heart disease.
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