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Anakinra in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Med Sci (Basel) 2022; 11:medsci11010004. [PMID: 36649041 PMCID: PMC9844326 DOI: 10.3390/medsci11010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Heart failure (HF) has become increasingly difficult to manage given its increasing incidence. Despite the availability of novel treatment target relieving inhibition and congestions for neurohormonal activation, heart failure is one of leading health conditions associated with high hospitalization and readmission rates, resulting in poor quality of life. In light of this, this article serves to demonstrate the effect of anakinra as one of the treatment paradigms for HF to explore the need for advanced novel interventions. Methods: We conducted a search in five electronic databases, including Embase, MEDLINE, Cochrane, Scopus, and PubMed, for RCTs (randomized controlled trials) evaluating the effects of anakinra against placebo in HF. Meta-analysis was performed using RevMan version 5.4. Results: Eight RCTs were obtained and included for analysis in this study. The results demonstrate that anakinra significantly reduces the levels of CRP (C-reactive protein), with significant difference between anakinra- and placebo-treated groups. Analyses also show that CRP failed to cause an improvement in peak oxygen consumption and ventilatory efficiency. Additionally, the treatment-related adverse events were insignificant. Some considerable limitations are that the same set of researchers were involved in most of the studies; hence, more independent studies need to be encouraged. Conclusion: Anakinra was associated with a reduction in CRP levels, indicating some anti-inflammatory effects but no effect on function, exercise capacity, and adverse effects.
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Manilall A, Mokotedi L, Gunter S, Le Roux R, Fourie S, Flanagan CA, Millen AME. Increased protein phosphatase 5 expression in inflammation-induced left ventricular dysfunction in rats. BMC Cardiovasc Disord 2022; 22:539. [PMID: 36494772 PMCID: PMC9732989 DOI: 10.1186/s12872-022-02977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Titin phosphorylation contributes to left ventricular (LV) diastolic dysfunction. The independent effects of inflammation on the molecular pathways that regulate titin phosphorylation are unclear. METHODS We investigated the effects of collagen-induced inflammation and subsequent tumor necrosis factor-α (TNF-α) inhibition on mRNA expression of genes involved in regulating titin phosphorylation in 70 Sprague-Dawley rats. LV diastolic function was assessed with echocardiography. Circulating inflammatory markers were quantified by enzyme-linked immunosorbent assay and relative LV gene expression was assessed by Taqman® polymerase chain reaction. Differences in normally distributed variables between the groups were determined by two-way analysis of variance (ANOVA), followed by Tukey post-hoc tests. For non-normally distributed variables, group differences were determined by Kruskal-Wallis tests. RESULTS Collagen inoculation increased LV relative mRNA expression of vascular cell adhesion molecule 1 (VCAM1), pentraxin 3 (PTX3), and inducible nitric oxide synthase (iNOS) compared to controls, indicating local microvascular inflammation. Collagen inoculation decreased soluble guanylate cyclase alpha-2 (sGCα2) and soluble guanylate cyclase beta-2 (sGCβ2) expression, suggesting downregulation of nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling. Inhibiting TNF-α prevented collagen-induced changes in VCAM1, iNOS, sGCα2 and sGCβ2 expression. Collagen inoculation increased protein phosphatase 5 (PP5) expression. Like LV diastolic dysfunction, increased PP5 expression was not prevented by TNF-α inhibition. CONCLUSION Inflammation-induced LV diastolic dysfunction may be mediated by a TNF-α-independent increase in PP5 expression and dephosphorylation of the N2-Bus stretch element of titin, rather than by TNF-α-induced downregulation of NO-sGC-cGMP pathway-dependent titin phosphorylation. The steady rise in number of patients with inflammation-induced diastolic dysfunction, coupled with low success rates of current therapies warrants a better understanding of the systemic signals and molecular pathways responsible for decreased titin phosphorylation in development of LV diastolic dysfunction. The therapeutic potential of inhibiting PP5 upregulation in LV diastolic dysfunction requires investigation.
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Affiliation(s)
- Ashmeetha Manilall
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
| | - Lebogang Mokotedi
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
| | - Sulè Gunter
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
| | - Regina Le Roux
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
| | - Serena Fourie
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
| | - Colleen A. Flanagan
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
| | - Aletta M. E. Millen
- grid.11951.3d0000 0004 1937 1135Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
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Aiewruengsurat D, Phongnarudech T, Liabsuetrakul T, Nilmoje T. Correlation of rheumatoid and cardiac biomarkers with cardiac anatomy and function in rheumatoid arthritis patients without clinically overt cardiovascular diseases: A cross-sectional study. IJC HEART & VASCULATURE 2022; 44:101161. [PMID: 36510582 PMCID: PMC9735267 DOI: 10.1016/j.ijcha.2022.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
Background Cardiac biomarkers have been shown to be related to cardiac abnormalities; nonetheless, few studies have confirmed the association between cardiac and rheumatoid biomarkers in rheumatoid arthritis (RA) patients. This study assessed the correlation of rheumatoid and cardiac biomarker levels with cardiac anatomy and function and explored the interaction between cardiac and rheumatoid biomarkers in RA patients without clinically overt cardiovascular diseases. Methods A cross-sectional study was conducted among RA patients aged 18-65 years without other connective tissue diseases, overlap syndrome, heart disease, or renal failure were included. Main cardiac and rheumatoid biomarkers, including high-sensitivity troponin T (hsTropT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), rheumatoid factor, and anti-cyclic citrullinated peptide antibody (ACPA), were collected. Echocardiography was performed to examine cardiac anatomy and function. Results The mean left ventricular mass index (LVMI) was 80.8 g/sqm, and the relative wall thickness was 0.4. The mean left ventricular ejection fraction was 70.3%. The hsTropT levels showed a weak positive correlation with LVMI and E/e' ratio and a very weak correlation with E/A ratio. Interaction effect between hsTropT and ACPA on LVMI was found in univariate analysis, not in multivariate analysis. Higher systolic blood pressure (SBP) and the use of non-steroidal anti-inflammatory drug (NSAID) increased the LVMI. Only age was related to the E/e' increase. Conclusion The effect of hsTropT on LVMI was probably modified by ACPA in RA patients without clinically overt cardiovascular diseases. Age, SBP, and NSAID use among RA patients should be taken into account due to their relations to cardiac abnormalities.
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Affiliation(s)
- Duangkamol Aiewruengsurat
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Thanyakamol Phongnarudech
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Thanapon Nilmoje
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand,Corresponding author.
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Pironti G, Gastaldello S, Rassier DE, Lanner JT, Carlström M, Lund LH, Westerblad H, Yamada T, Andersson DC. Citrullination is linked to reduced Ca 2+ sensitivity in hearts of a murine model of rheumatoid arthritis. Acta Physiol (Oxf) 2022; 236:e13869. [PMID: 36002394 PMCID: PMC9788013 DOI: 10.1111/apha.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/29/2023]
Abstract
AIMS Cardiac contractile dysfunction is prevalent in rheumatoid arthritis (RA), with an increased risk for heart failure. A hallmark of RA has increased levels of peptidyl arginine deaminases (PAD) that convert arginine to citrulline leading to ubiquitous citrullination, including in the heart. We aimed to investigate whether PAD-dependent citrullination in the heart was linked to contractile function in a mouse model of RA during the acute inflammatory phase. METHODS We used hearts from the collagen-induced arthritis (CIA) mice, with overt arthritis, and control mice to analyze cardiomyocyte Ca2+ handling and fractional shortening, the force-Ca2+ relationship in isolated myofibrils, the levels of PAD, protein post-translational modifications, and Ca2+ handling protein. Then, we used an in vitro model to investigate the role of TNF-α in the PAD-mediated citrullination of proteins in cardiomyocytes. RESULTS Cardiomyocytes from CIA mice displayed larger Ca2+ transients than controls, whereas cell shortening was similar in the two groups. Myofibrils from CIA hearts required higher [Ca2+ ] to reach 50% of maximum shortening, ie Ca2+ sensitivity was lower. This was associated with increased PAD2 expression and α-actin citrullination. TNF-α increased PAD-mediated citrullination which was blocked by pre-treatment with the PAD inhibitor 2-chloroacetamide. CONCLUSION Using a mouse RA model we found evidence of impaired cardiac contractile function linked to reduced Ca2+ sensitivity, increased expression of PAD2, and citrullination of α-actin, which was triggered by TNF-α. This provides molecular and physiological evidence for acquired cardiomyopathy and a potential mechanism for RA-associated heart failure.
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Affiliation(s)
- Gianluigi Pironti
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden,Department of Medicine, Cardiology Research UnitKarolinska InstitutetStockholmSweden
| | - Stefano Gastaldello
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Dilson E. Rassier
- Department of Kinesiology and Physical EducationMcGill UniversityMontrealCanada
| | - Johanna T. Lanner
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Mattias Carlström
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Lars H. Lund
- Department of Medicine, Cardiology Research UnitKarolinska InstitutetStockholmSweden,Heart, Vascular and Neurology Theme, Cardiology UnitKarolinska University HospitalStockholmSweden
| | - Håkan Westerblad
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Takashi Yamada
- School of Health Sciences, Sapporo Medical UniversitySapporoJapan
| | - Daniel C. Andersson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden,Heart, Vascular and Neurology Theme, Cardiology UnitKarolinska University HospitalStockholmSweden
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Giachi A, Cugno M, Gualtierotti R. Disease-modifying anti-rheumatic drugs improve the cardiovascular profile in patients with rheumatoid arthritis. Front Cardiovasc Med 2022; 9:1012661. [PMID: 36352850 PMCID: PMC9637771 DOI: 10.3389/fcvm.2022.1012661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting about 0. 5–1% of the adult population and manifesting as persistent synovitis, systemic inflammation and production of autoantibodies. Patients affected by RA not only experience chronic disease progression, but are also burdened by a 1.5-fold increased cardiovascular (CV) risk, which is comparable to the risk experienced by patients with type 2 diabetes mellitus. RA patients also have a higher incidence and prevalence of coronary artery disease (CAD). Although RA patients frequently present traditional CV risk factors such as insulin resistance and active smoking, previous studies have clarified the pivotal role of chronic inflammation–driven by proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha)–in accelerating the process of atherosclerosis and impairing the coagulation system. Over the last years, a number of studies have shown that disease-modifying anti-rheumatic drugs (DMARDs) reducing the inflammatory state in general improve the CV risk, however some drugs may carry some apparent negative effects. Thus, RA is a model of disease in which targeting inflammation may counteract the progression of atherosclerosis and reduce CV risk. Clinical and experimental evidence indicates that the management of RA patients should be tailored based on the positive and negative effects of DMARDs on CV risk together with the individual traditional CV risk profile. The identification of genetic, biochemical and clinical biomarkers, predictive of evolution and response to treatment, will be the next challenge for a precision approach to reduce the burden of the disease.
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Affiliation(s)
- Andrea Giachi
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Cugno
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
- *Correspondence: Massimo Cugno
| | - Roberta Gualtierotti
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
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6
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Park E, Ito K, Iqbal R, Amigues I, Bokhari S, Van Eyk J, Depender C, Giles JT, Bathon J. Prospective changes in diastolic function in patients with rheumatoid arthritis. Arthritis Res Ther 2022; 24:184. [PMID: 35932048 PMCID: PMC9354314 DOI: 10.1186/s13075-022-02864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic function and its associated RA and cardiovascular (CV) predictors. Methods In this study, 158 RA patients without clinical CV disease (CVD) were enrolled and followed up at 4 to 6 years, undergoing baseline and follow-up echocardiography to assess for DD, as well as extensive characterization of RA disease activity and CV risk factors. Novel measures of myocardial inflammation and perfusion were obtained at baseline only. Using baseline and follow-up composite DD (E/e′, Left Atrial Volume Index (LAVI) or peak tricuspid regurgitation (TR) velocity; ≥ 1 in top 25%) as the outcome, multivariable regression models were constructed to identify predictors of DD. Results DD was prevalent in RA patients without clinical heart failure (HF) (40.7% at baseline) and significantly progressed on follow-up (to 57.9%). Baseline composite DD was associated with baseline RA disease activity (Clinical Disease Activity Index; CDAI) (OR 1.39; 95% CI 1.02–1.90; p=0.034). Several individual diastolic parameters (baseline E/e′ and LAVI) were associated with troponin-I and brain natriuretic peptide (BNP). Baseline and follow-up composite DD, however, were not associated with myocardial inflammation, myocardial microvascular dysfunction, or subclinical atherosclerosis. Conclusions DD is prevalent in RA patients without clinical HF and increases to >50% over time. Higher RA disease activity at baseline predicted baseline composite DD. Future longitudinal studies should explore whether adverse changes in diastolic function lead to clinical HF and are attenuated by disease-modifying antirheumatic drugs (DMARDs). Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02864-0.
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Affiliation(s)
- Elizabeth Park
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA.
| | - Kazato Ito
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, USA
| | - Rabia Iqbal
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Isabelle Amigues
- Division of Rheumatology, National Jewish Health, Denver, CO, USA
| | - Sabahat Bokhari
- Lehigh Valley Heart and Vascular Institute, Allentown, PA, USA
| | - Jennifer Van Eyk
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christopher Depender
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Joan Bathon
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
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7
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Haq IU, Lodhi FK, Anan AR, Alzu’bi H, Agboola KM, Lee HC, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Safety and Efficacy Outcomes of Atrial Fibrillation Ablation in Patients with Rheumatoid Arthritis. Heart Rhythm O2 2022; 3:261-268. [PMID: 35734296 PMCID: PMC9207736 DOI: 10.1016/j.hroo.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease associated with atrial fibrillation (AF) and stroke. Objective The purpose of this study was to evaluate the safety and efficacy of AF ablation in patients with RA. Methods All patients with RA undergoing AF ablation at our institution from 2010 to 2021 were propensity matched to patients without RA using 9 baseline characteristics. The primary outcome was procedural efficacy defined by clinical AF recurrence, the need for antiarrhythmic drugs (AADs), and repeat catheter ablation. Secondary outcome was safety. Results A total of 45 patients with RA (age 66.3 ± 7.7 years) were matched to 45 patients without a history of RA (age 68.0 ± 7.3 years). Both groups had similar procedural and periprocedural characteristics. Before ablation, RA patients had statistically higher C-reactive protein (CRP) levels (P ≤.01) and erythrocyte sedimentation rates (ESRs) (P <.05) compared to non-RA patients. After ablation, RA patients had statistically significant higher rates of AF recurrence (P = .006), were more likely to be taking AADs (P <.05), and more likely to undergo repeat ablations (P <.05). The use of immunosuppression or corticosteroids at the time of ablation did not influence the primary endpoint of AF recurrence, AADs, or repeat ablation. Multivariate regression analysis showed CRP and ESR were independent predictors of AF recurrence. CRP was an independent predictor of repeat ablation. Conclusion Patients with RA are at higher risk of clinical AF recurrence, and are more likely to be taking AADs and require repeat ablation. Preablation CRP and ESR are independent predictors of AF recurrence, and CRP is an independent predictor of repeat catheter ablation.
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Park E, Griffin J, Bathon JM. Myocardial Dysfunction and Heart Failure in Rheumatoid Arthritis. Arthritis Rheumatol 2022; 74:184-199. [PMID: 34523821 PMCID: PMC8795468 DOI: 10.1002/art.41979] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) patients have almost twice the risk of heart failure (HF) as individuals without RA, even with adjustment for the presence of ischemic heart disease. Moreover, RA patients remain at a 2-fold higher risk of mortality from HF compared to non-RA patients. These observations suggest that RA-specific inflammatory pathways are significant contributors to this increased risk of HF. Herein we summarize the epidemiology of HF in RA patients, the differences in myocardial structure or function between RA patients and non-RA patients without clinical signs of HF, and data on the role of systemic and local inflammation in RA HF pathophysiology. We also discuss the impact of subduing inflammation through the use of RA disease-modifying therapies on HF and myocardial structure and function, emphasizing gaps in the literature and areas needing further research.
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Affiliation(s)
- Elizabeth Park
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Jan Griffin
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Joan M Bathon
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
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9
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Saha S, Singh R, Mir IA, Bansal N, Singh PK, Nadeem M. Epicardial Fat Thickness: A Cardiometabolic Risk Marker in Rheumatoid Arthritis. Cureus 2022; 14:e21397. [PMID: 35198304 PMCID: PMC8855100 DOI: 10.7759/cureus.21397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown etiology which mainly involves synovial joints. However, the corresponding systemic inflammation may result in disorders of multiple other organ systems. Several organs and organ systems are potentially involved in RA, particularly in severe diseases. The organs most involved are the lung, heart, eyes, and nervous system. Extra-articular manifestations of RA may develop even before the onset of arthritis. Emerging epidemiological evidence shows that cardiovascular disease (CVD) accounts for near about 50% of RA-associated death. Epicardial fat thickness (EFT) has recently emerged as a new marker of cardiometabolic risk. Although Epicardial fat (EF) is needed for heart muscle function, given its intrinsic inflammatory status, EFT displays the potential to serve as a therapeutic target in patients with RA. Objectives: To evaluate EFT using echocardiography in RA patients compared to age and sex-matched control and to find the factors associated with EFT in RA patients. Materials and methods: This current study was conducted in the Department of Medicine, Postgraduate Institute of Medical Education & Research. The study was conducted from November 2016 to March 2018. Patients with BMI ≥ 30 kg/m2, diabetes mellitus, primary hyperlipidemia, and uncontrolled hypertension were particularly excluded. Thirty patients of age and sex-matched controls were also taken for the study. All the patients and controls selected for the study were subjected to detailed history taking and clinical examination. They were subjected to lab investigations and echocardiography. The 30 RA patients included in the study were diagnosed according to the 2010 ACR-EULAR criteria. Disease activity was measured by the disease activity score (DAS28) index. Results: Group 1 included 30 patients with RA and group 2 included 30 age and sex-matched controls. Pearson correlation analysis was done between EFT and other variables. Only HDL, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hS-CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), DAS28, and disease duration were found to have a significant correlation with EFT. Conclusion: In patients with RA, EFT, left ventricular mass, and diastolic dysfunction are increased in RA patients compared to healthy controls. Out of the conventional CVD risk factors, only HDL was associated with increased EFT in RA patients. In RA patients, DAS28, disease duration, RF, anti-CCP, and markers of inflammation (ESR, hs-CRP) were also associated with increased EFT.
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10
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Kobayashi M, Ferreira MB, Costa RQ, Fonseca T, Oliveira JC, Marinho A, Carvalho HC, Girerd N, Rossignol P, Zannad F, Rodrigues P, Ferreira JP. Circulating Biomarkers and Cardiac Structure and Function in Rheumatoid Arthritis. Front Cardiovasc Med 2021; 8:754784. [PMID: 34869664 PMCID: PMC8636810 DOI: 10.3389/fcvm.2021.754784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) increases the risk for abnormalities of the cardiac structure and function, which may lead to heart failure (HF). Studying the association between circulating biomarkers and echocardiographic parameters is important to screen patients with RA with a higher risk of cardiac dysfunction. Aim: To study the association between circulating biomarkers and echocardiographic parameters in patients with RA. Methods: Echocardiography was performed in 355 patients with RA from RA Porto cohort and the associations between echocardiographic characteristics and 94 circulating biomarkers were assessed. These associations were also assessed in the Metabolic Road to Diastolic Heart Failure (MEDIA-DHF) [392 patients with HF with preserved ejection fraction (HFpEF)] and the Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS) (1,672 healthy population) cohorts. Results: In the RA Porto cohort, mean age was 58 ± 13 years, 23% were males and mean RA duration was 12 ± 10 years. After adjustment and multiple testing correction, left ventricular mass index (LVMi), left atrial volume index (LAVi), and E/e′ were independently associated with biomarkers reflecting inflammation [i.e., bone morphogenetic protein 9 (BMP9), pentraxin-related protein 3 (PTX3), tumor necrosis factor receptor superfamily member 11a (TNFRSF11A)], extracellular matrix remodeling [i.e., placental growth factor (PGF)], congestion [i.e., N-terminal pro-brain natriuretic peptide (NT-proBNP), adrenomedullin (ADM)], and myocardial injury (e.g., troponin). Greater LVMi [hazard ratio (HR) (95% CI) per 1 g/m2 = 1.03 (1.02–1.04), p < 0.001], LAVi [HR (95% CI) per 1 ml/m2 = 1.03 (1.01–1.06), p < 0.001], and E/e′ [HR (95% CI) per 1 = 1.08 (1.04–1.13), p < 0.001] were associated with higher rates of cardiovascular events. These associations were externally replicated in patients with HFpEF and asymptomatic individuals. Conclusion: Circulating biomarkers reflecting inflammation, extracellular matrix remodeling, congestion, and myocardial injury were associated with underlying alterations of cardiac structure and function. Biomarkers might be used for the screening of cardiac alterations in patients with RA.
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Affiliation(s)
- Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Maria Betânia Ferreira
- Unit of Multidisciplinary Research in Biomedicine, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,Hospital da Luz Arrábida, Porto, Portugal
| | - Rita Quelhas Costa
- Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Aveiro, Portugal
| | - Tomás Fonseca
- Internal Medicine Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - José Carlos Oliveira
- Clinical Chemistry Service, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - António Marinho
- Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,Internal Medicine Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Henrique Cyrne Carvalho
- Unit of Multidisciplinary Research in Biomedicine, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Patrícia Rodrigues
- Unit of Multidisciplinary Research in Biomedicine, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - João Pedro Ferreira
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.,Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
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11
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Kim GH, Park YJ. Accelerated diastolic dysfunction in premenopausal women with rheumatoid arthritis. Arthritis Res Ther 2021; 23:247. [PMID: 34560895 PMCID: PMC8461933 DOI: 10.1186/s13075-021-02629-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background Disturbances of diastolic function precede systolic heart failure and, although clinically silent, represent the earliest sign of cardiac involvement. Diastolic dysfunction (DD) is associated with age, gender (female), and hypertension. However, little is known about the age-specific incidence rates and risk factors for DD in patients with rheumatoid arthritis (RA). Methods We used standard two-dimensional/Doppler echocardiography to screen for the presence of diastolic dysfunction in 61 patients with RA and 107 healthy subjects. All participants were premenopausal women with no history of hypertension. DD includes an impaired relaxation with or without increased left ventricular (LV) filling pressures, pseudonormal filling, and restrictive filling based on parameters measured using echocardiography. Results The two groups were similar with respect to age (P=0.269). Patients with RA had significantly higher LV mass index, LV filling pressure, and lower E/A velocity than controls. All patients had preserved ejection fraction (EF ≥50%). DD was more common in patients with RA at 47% compared to 26% in the controls (P=0.004). Women with RA in the 30- to 49-year age range were over 3.5 times more likely to have DD than those of similar age in the control group (OR=3.54; 95% CI 1.27 to 9.85). Among patients with RA, high CRP levels were independently associated with DD even after adjustment for cardiovascular risk factors (P=0.009). Conclusions In premenopausal women with RA, DD is much more common and the age of onset is reduced. Early screening of myocardial function may provide an opportunity for preventing future cardiovascular disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02629-1.
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Affiliation(s)
- Gee Hee Kim
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yune-Jung Park
- Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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12
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Nawata T, Kinoshita N, Okuda S, Kubo M, Wada Y, Kobayashi S, Tanaka N, Yano M. Echocardiographic features of acute-phase microscopic polyangiitis in Japanese patients: A single-centre retrospective study. Mod Rheumatol 2021; 32:606-612. [PMID: 34897502 DOI: 10.1093/mr/roab028] [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: 02/12/2021] [Revised: 04/13/2021] [Accepted: 06/12/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Microscopic polyangiitis (MPA) affects various organs. However, echocardiographic findings of MPA are unclear. We aimed to evaluate the echocardiographic features of acute-phase MPA in Japanese patients. METHODS This single-centre retrospective study included 15 patients with MPA who underwent echocardiography within 2 weeks of commencing steroid therapy for induction or reinduction. The echocardiography parameters of thetients were compared with those of 30 age- and sex-matched controls. RESULTS No significant differences in left ventricular (LV) diameter, LV ejection fraction, or e' were observed between the two groups. However, the MPA group showed a significantly higher left atrial (LA) diameter and LA volume index, as well as higher early diastolic filling velocity, diastolic pulmonary venous flow velocity, and trans-tricuspid pressure gradient, and a shorter deceleration time (DCT). Serum C-reactive protein levels were positively correlated with E wave, E/A, and DCT. These results may indicate that increased LV stiffness, rather than impairment of LV relaxation, contributed to LV diastolic function, resulting in LA enlargement. CONCLUSIONS Patients with acute-phase MPA had LA dilatation associated with LV diastolic dysfunction. This finding indicates the importance of cardiac assessment in patients with MPA, especially in patients with a strong inflammatory reaction.
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Affiliation(s)
- Takashi Nawata
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Natsu Kinoshita
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shinichi Okuda
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Makoto Kubo
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasuaki Wada
- Division of Clinical Laboratory, Yamaguchi University Hospital, Ube, Japan
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Nobuaki Tanaka
- Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguhi 755-8505, Japan
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13
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Huffman KM, Andonian BJ, Abraham DM, Bareja A, Lee DE, Katz LH, Huebner JL, Kraus WE, White JP. Exercise protects against cardiac and skeletal muscle dysfunction in a mouse model of inflammatory arthritis. J Appl Physiol (1985) 2021; 130:853-864. [PMID: 33411638 DOI: 10.1152/japplphysiol.00576.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory arthritis impacting primarily joints and cardiac and skeletal muscle. RA's distinct impact on cardiac and skeletal muscle tissue is suggested by studies showing that new RA pharmacologic agents strongly improve joint inflammation, but have little impact on RA-associated mortality, cardiovascular disease, and sarcopenia. Thus, the objective is to understand the distinct effects of RA on cardiac and skeletal muscle, and to therapeutically target these tissues through endurance-based exercise as a way to improve RA mortality and morbidity. We utilize the well-characterized RA mouse model, the K/BxN mouse, to investigate cardiac and skeletal muscle pathologies, including the use of wheel-running exercise to mitigate these pathologies. Strikingly, we found that K/BxN mice, like patients with RA, also exhibit both cardiac and skeletal muscle myopathies that were correlated with circulating IL-6 levels. Three months of wheel-running exercise significantly improved K/BxN joint swelling and reduced systemic IL-6 concentrations. Importantly, there were morphological, gene expression, and functional improvements in both the skeletal muscle and cardiac myopathies with exercise. The K/BxN mouse model of RA recapitulated important RA clinical comorbidities, including altered joint, cardiac and skeletal muscle function. These morphological, molecular, and functional alterations were mitigated with regular exercise, thus suggesting exercise as a potential therapeutic intervention to lessen disease activity in the joint and the peripheral tissues, including the heart and skeletal muscle.NEW & NOTEWORTHY RA, even when controlled, is associated with skeletal muscle weakness and greater risk of cardiovascular disease (CVD). Using exercise as a therapeutic against, the progression of RA is often avoided due to fear of worsening RA pathology. We introduce the K/BxN mouse as an RA model to study both myocardial and skeletal muscle dysfunction. We show that endurance exercise can improve joint, cardiac, and skeletal muscle function in K/BxN mice, suggesting exercise may be beneficial for patients with RA.
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Affiliation(s)
- Kim M Huffman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Brian J Andonian
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - Dennis M Abraham
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Akshay Bareja
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - David E Lee
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - Lauren H Katz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,UNC Adams School of Dentistry, Chapel Hill, North Carolina
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - William E Kraus
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - James P White
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
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14
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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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15
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Ikonomidis I, Pavlidis G, Katsimbri P, Lambadiari V, Parissis J, Andreadou I, Tsoumani M, Boumpas D, Kouretas D, Iliodromitis E. Tocilizumab improves oxidative stress and endothelial glycocalyx: A mechanism that may explain the effects of biological treatment on COVID-19. Food Chem Toxicol 2020; 145:111694. [PMID: 32822775 PMCID: PMC7434461 DOI: 10.1016/j.fct.2020.111694] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
We investigated the effects of tocilizumab on endothelial glycocalyx, a determinant of vascular permeability, and myocardial function in rheumatoid arthritis (RA). Eighty RA patients were randomized to tocilizumab (n = 40) or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and glucocorticoids (GC) (n = 40) for 3 months. Forty healthy subjects with similar age and sex served as controls. We measured: (a)perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), (b)pulse wave velocity (PWV), (c)global LV longitudinal strain (GLS), (d)global work index (GWI) using speckle tracking echocardiography and e)C-reactive protein (CRP), malondialdehyde (MDA) and protein carbonyls (PCs) as oxidative stress markers at baseline and post-treatment. Compared to controls, RA patients had impaired glycocalyx and myocardial deformation markers (P < 0.05). Compared with baseline, tocilizumab reduced PBR(2.14 ± 0.2 versus 1.97 ± 0.2 μm; P < 0.05) while no significant differences were observed post-csDMARDs + GC(P > 0.05). Compared with csDMARDs + GC, tocilizumab achieved a greater increase of GLS, GWI and reduction of MDA, PCs and CRP(P < 0.05). The percent improvement of glycocalyx thickness (PBR) was associated with the percent decrease of PWV, MDA, PCs and the percent improvement of GLS and GWI(P < 0.05). Tocilizumab improves endothelial function leading to a greater increase of effective myocardial work than csDMARDs + GC through a profound reduction of inflammatory burden and oxidative stress. This mechanism may explain the effects of tocilizumab on COVID-19. Clinical trial registration url: https://www.clinicaltrials.gov. Unique identifier: NCT03288584. Tocilizumab improves endothelial glycocalyx and increases effective myocardial work. IL-6 inhibition significantly reduces the inflammatory burden and oxidative stress. Tocilizumab may have favorable effects on diseases with excess IL-6 release.
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Affiliation(s)
- Ignatios Ikonomidis
- 2nd Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece.
| | - George Pavlidis
- 2nd Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece
| | - Pelagia Katsimbri
- 4th Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece
| | - John Parissis
- 2nd Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15741, Athens, Greece
| | - Maria Tsoumani
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15741, Athens, Greece
| | - Dimitrios Boumpas
- 4th Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece
| | - Dimitrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, 41500, Larissa, Greece
| | - Efstathios Iliodromitis
- 2nd Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, 12462, Athens, Greece
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16
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Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020; 16:361-379. [PMID: 32494054 DOI: 10.1038/s41584-020-0428-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
Patients with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease (CVD). Inflammation has a pivotal role in the pathogenesis of CVD. RA is an inflammatory joint disease and, compared with the general population, patients with RA have approximately double the risk of atherosclerotic CVD, stroke, heart failure and atrial fibrillation. Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA. This Review summarizes the evidence for atherosclerotic CVD in patients with RA and provides a contemporary analysis of what is known and what needs to be further clarified about recommendations for CVD prevention in patients with RA compared with the general population. The management of traditional CVD risk factors, including blood pressure, lipids, diabetes mellitus and lifestyle-related risk factors, as well as the effects of inflammation and the use of antirheumatic medication on CVD risk and risk management in patients with RA are discussed. The main aim is to provide a roadmap of atherosclerotic CVD risk management and prevention for patients with RA.
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17
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Liu S, Sun J, Xing L, Pang Y, Yang J, Ma C, Zhang L. Left Ventricular Thrombus and Heart Failure With Preserved Ejection Fraction in a Patient With Rheumatoid Arthritis: A Comprehensive Assessment Using Serial Echocardiography. Circ Cardiovasc Imaging 2020; 13:e010222. [PMID: 32460530 DOI: 10.1161/circimaging.119.010222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shuang Liu
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning (S.L., J.S., Y.P., J.Y., C.M., L.Z.)
| | - Jinglun Sun
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning (S.L., J.S., Y.P., J.Y., C.M., L.Z.)
| | - Liying Xing
- Department of Chronic Disease, Disease Control and Prevention of Liaoning Province, Shenyang, Liaoning, China (L.X.)
| | - Yanmin Pang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning (S.L., J.S., Y.P., J.Y., C.M., L.Z.)
| | - Jun Yang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning (S.L., J.S., Y.P., J.Y., C.M., L.Z.)
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning (S.L., J.S., Y.P., J.Y., C.M., L.Z.)
| | - Limin Zhang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning (S.L., J.S., Y.P., J.Y., C.M., L.Z.)
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18
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Mokotedi L, Michel FS, Mogane C, Gomes M, Woodiwiss AJ, Norton GR, Millen AME. Associations of inflammatory markers with impaired left ventricular diastolic and systolic function in collagen-induced arthritis. PLoS One 2020; 15:e0230657. [PMID: 32208438 PMCID: PMC7092986 DOI: 10.1371/journal.pone.0230657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background High-grade inflammation may play a pivotal role in the pathogenesis of left ventricular (LV) dysfunction. Evidence to support a role of systemic inflammation in mediating impaired LV function in experimental models of rheumatoid arthritis (RA) remains limited. The aim of the present study was to determine the effects of high-grade systemic inflammation on LV diastolic and systolic function in collagen-induced arthritis (CIA). Methods To induce CIA, bovine type-II collagen emulsified in incomplete Freund’s adjuvant was injected at the base of the tail into 21 three-month old Sprague Dawley rats. Nine-weeks after the first immunisation, LV function was assessed by pulsed Doppler, tissue Doppler imaging and Speckle tracking echocardiography. Cardiac collagen content was determined by picrosirius red staining; circulating inflammatory markers were measured using ELISA. Results Compared to controls (n = 12), CIA rats had reduced myocardial relaxation as indexed by lateral e’ (early diastolic mitral annular velocity) and e’/a’ (early-to-late diastolic mitral annular velocity) and increased filling pressures as indexed by E/e’. No differences in ejection fraction and LV endocardial fractional shortening between the groups were recorded. LV global radial and circumferential strain and strain rate were reduced in CIA rats compared to controls. Higher concentrations of circulating inflammatory markers were associated with reduced lateral e’, e’/a’, radial and circumferential strain and strain rate. Greater collagen content was associated with increased concentrations of circulating inflammatory markers and E/e’. Conclusion High-grade inflammation is associated with impaired LV diastolic function and greater myocardial deformation independent of haemodynamic load in CIA rats.
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Affiliation(s)
- Lebogang Mokotedi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Frederic S. Michel
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Conrad Mogane
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Monica Gomes
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J. Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R. Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aletta M. E. Millen
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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19
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Kirillova IG, Novikova DS, Popkova TV, Udachkina HV, Markelova EI, Gorbunova YN, Korsakova YO, Gluchova SN. Chronic Heart Failure in Early Rheumatoid Arthritis Patients Prior to Basic Antirheumatic Therapy. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-01-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study the clinical manifestations and factors associated with the presence of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA) prior to anti-inflammatory therapy. Material and methods. The study included 74 patients with valid diagnosis of RA (criteria ACR/EULAR, 2010), 56 women (74%), median age – 54 [46;61] years, disease duration – 7 [4;8] months; seropositive for IgM rheumatoid factor (87%) and/or antibodies to cyclic citrullinated peptide (100%) prior to taking disease modifying anti-rheumatic drugs and glucocorticoids. CHF was verified in accordance with actual guidelines. The assessment of traditional risk factors for cardiovascular diseases, echocardiography, tissue Doppler imaging, carotid artery ultrasound, were carried out before the start of therapy in all patients with early RA. The concentration of NT-proBNP was determined by electrochemiluminescence. The normal range for NT-proBNP was less than 125 pg/ml.Results. CHF was diagnosed in 24 (33%) patients: in 23 patients – CHF with preserved ejection fraction, in 1 patient – CHF with reduced ejection fraction. 50% of patients with RA under the age of 60 were diagnosed with CHF. NYHA class I was found in 5 (21%) patients, class II – in 15 (63%), class III – in 1 (4%). Positive predictive value of clinical symptoms did not exceed 38%. All patients with early RA were divided into two groups: 1 – with CHF, 2 – without CHF. Patients with RA+CHF compared with patients without CHF were older, had higher body mass index, frequency of carotid atherosclerosis, of ischemic heart disease (IHD), hypertension, C-reactive protein (CRP) levels and intima media thickness. Independent factors associated with the presence of CHF were identified by linear regression analysis: abdominal obesity, CRP level, systolic blood pressure, dyslipidemia, carotid intima thickness, IHD. The multiple coefficient of determination was R2=57.1 (R-0.76, p<0.001). Level of NT-proBNP in RA patients with CHF (192.0 [154.9; 255.7] pg/ml) was higher than in RA patients without CHF (77 [41.1; 191.2] pg/ml) and in control (49.0 [33.2; 65.8] pg/ml), p<0.0001 and p=0.01, respectively. To exclude CHF in patients with early RA, the optimal NT-proBNP level was 150.4 pg/ml (sensitivity – 80%, specificity – 79%), the area under the ROC curve = 0.957 (95% confidence interval 0.913-1.002, p<0.001).Conclusion. CHF was detected in a third of RA patients at the early stage of the disease. Factors associated with the presence of CHF were abdominal obesity, CRP level, systolic blood pressure, dyslipidemia, intima media thickness, IHD.
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Affiliation(s)
- I. G. Kirillova
- Research Institute of Rheumatology named after V.A. Nasonova
| | - D. S. Novikova
- Research Institute of Rheumatology named after V.A. Nasonova
| | - T. V. Popkova
- Research Institute of Rheumatology named after V.A. Nasonova
| | - H. V. Udachkina
- Research Institute of Rheumatology named after V.A. Nasonova
| | - E. I. Markelova
- Research Institute of Rheumatology named after V.A. Nasonova
| | | | | | - S. N. Gluchova
- Research Institute of Rheumatology named after V.A. Nasonova
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20
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Hanvivadhanakul P, Buakhamsri A. Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease. Adv Rheumatol 2019; 59:56. [PMID: 31843000 DOI: 10.1186/s42358-019-0100-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The cross-sectional study aimed to assess left ventricular systolic function using global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) and arterial stiffness using cardio-ankle vascular index (CAVI) in Thai adults with rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). METHODS Confirmed RA patients were selected from a list of outpatient attendees if they were 18 years (y) without clinical, ECG and echocardiographic evidence of CVD, diabetes mellitus, chronic kidney disease, and excess alcoholic intake. Controls were matched with age and sex to a list of healthy individuals with normal echocardiograms. All underwent STE and CAVI. RESULTS 60 RA patients (females = 55) were analysed. Mean standard deviation of patient and control ages were 50 ± 10.2 and 51 ± 9.9 y, respectively, and mean duration of RA was 9.0 ± 6.8 y. Mean DAS28-CRP and DAS28-ESR were 2.9 ± 0.9 and 3.4 ± 0.9, respectively. There was no between-group differences in left ventricular ejection fraction (LVEF), LV sizes, LVMI, LV diastolic function and CAVI were within normal limits but all GLSs values was significantly lower in patients vs. controls: 17.6 ± 3.4 vs 20.4 ± 2.2 (p = 0.03). Multivariate regression analysis demonstrated significant correlations between GLSs and RA duration (p = 0.02), and GLSs and DAS28-CRP (p = 0.041). CONCLUSIONS Patients with RA and no clinical CV disease have reduced LV systolic function as shown by lower GLSs. It is common and associated with disease activity and RA disease duration. 2D speckle-tracking GLSs is robust in detecting this subclinical LV systolic dysfunction.
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Affiliation(s)
- Punchong Hanvivadhanakul
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Thammasat University, 99/209 Moo 18, Paholyothin Road, Klong Luang, Pathumthanee, 12120, Thailand.
| | - Adisai Buakhamsri
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Thammasat University, 99/209 Moo 18, Paholyothin Road, Klong Luang, Pathumthanee, 12120, Thailand
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The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis. Rheumatol Int 2019; 40:347-357. [PMID: 31802210 DOI: 10.1007/s00296-019-04483-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023]
Abstract
Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.
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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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23
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Mokotedi L, Gunter S, Robinson C, Michel F, Solomon A, Norton GR, Woodiwiss AJ, Tsang L, Dessein PH, Millen AME. Early Wave Reflection and Pulse Wave Velocity Are Associated with Diastolic Dysfunction in Rheumatoid Arthritis. J Cardiovasc Transl Res 2019; 12:580-590. [PMID: 31119564 DOI: 10.1007/s12265-019-09892-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) impacts arterial and diastolic function. This study examined whether arterial properties can determine diastolic function in RA. In 173 RA patients, arterial function measures including carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification, and the magnitude and timing of the forward and reflected waves were measured using applanation tonometry. Diastolic function parameters including the ratio of early-to-late transmitral velocity (E/A) and ratio of E to the mean of the lateral and septal wall myocardial tissue lengthening (e') were measured using echocardiography. The timing of the reflected wave was associated with E/A; PWV was related to E/e'. The timing of the reflected wave, forward wave magnitude, and pulse pressure amplification were associated with impaired relaxation; PWV was related to increased left ventricular (LV) filling pressure. Early wave reflection and PWV are associated with LV-impaired relaxation and increased filling pressure, respectively, in RA.
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Affiliation(s)
- Lebogang Mokotedi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sulé Gunter
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederic Michel
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Solomon
- Department of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Tsang
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Free University and University Hospital, Brussels, Belgium
| | - Aletta M E Millen
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Novikova DS, Udachkina HV, Kirillova IG, Popkova TV. Chronic Heart Failure in Rheumatoid Arthritis Patients (Part II): Difficulties of Diagnosis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2018-14-6-879-886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rheumatoid arthritis (RA) is characterized by a twofold increase in morbidity and mortality due to chronic heart failure (CHF). At the same time, the prevalence of CHF among RA patients is significantly underestimated. The aim of the review was to analyze the results of the main studies on the features of the clinical presentation of heart failure (HF) in RA patients, the role of visualization techniques and biomarkers in the diagnosis of HF and preclinical dysfunction of the myocardium. HF in patients with RA is characterized by a predominance of HF with a preserved left ventricular ejection fraction (LVEF). The use of clinical diagnostic criteria in RA patients can lead to both over- or underdiagnosis of CHF. Systolic dysfunction estimated by LVEF is rare in RA and does not reflect the real frequency of myocardial dysfunction. Echocardiography (ECHO-CG) with tissue Doppler echocardiography (TDE) and visualization of myocardial deformation, magnetic resonance imaging (MRI) of the heart in RA patients revealed a high frequency of HF with preserved ejection fraction, left ventricular remodeling and hypertrophy, pre-clinical systolic and diastolic dysfunction. Determination of natriuretic peptides is useful for verifying the diagnosis of HF and estimating the prognosis in this cohort, despite the possible decrease in the sensitivity and specificity of these indicators in RA patients. The review discusses the advantages of MRI of the heart, including quantitative T1 and T2 regimens, in the diagnosis of myocarditis, myocardial fibrosis, and myocardial perfusion disorders in RA patients. In order to verify the diagnosis of heart failure and detect pre-clinical myocardial dysfunction in RA patients, the determination of natriuretic peptides concentration should become part of the routine examination, beginning with the debut of the disease, along with the collection of a cardiological history, physical examination, ECHO-CT with TDE, and visualization of myocardial deformation. Evaluation of the quantitative characteristics of tissue according to MRI of the heart could improve the diagnosis of myocardial damage.
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Abstract
Rheumatoid arthritis is a complex disease state with multiple associated comorbidities. Perioperative evaluation of the rheumatoid patient from a multidisciplinary approach is necessary to achieve favorable outcomes. A complete history and physical, laboratory, cervical, cardiovascular, pulmonary, and medication assessment before surgery should be performed. Educating the patient on potential complications, such as wound dehiscence, infection, and venous thromboembolism, as well as general postoperative expectations, is essential when evaluating the rheumatoid patient for surgery.
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Affiliation(s)
- Jesse Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA
| | - Joshua Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA
| | - H John Visser
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA.
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26
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Targońska-Stępniak B, Biskup M, Biskup W, Majdan M. Diastolic dysfunction in rheumatoid arthritis patients with low disease activity. Clin Rheumatol 2018; 38:1131-1137. [PMID: 30539352 DOI: 10.1007/s10067-018-4369-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/OBJECTIVES Patients with rheumatoid arthritis (RA) are at increased risk for congestive heart failure (CHF) and left ventricular diastolic dysfunction (LVDD), as compared to the general population. High disease activity is to be associated with higher incidence of cardiovascular disease (CVD), CHF, and mortality in RA patients. LVDD is not anticipated in RA patients without CVD symptoms and may be underdiagnosed especially in those with low disease activity. METHOD The study group consisted of 70 RA patients (54 women, 16 men) with no CVD and 33 healthy controls, of comparable age. All RA patients had low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. Laboratory and imaging assessments included metabolic, RA-related, and cardiovascular parameters. Echocardiographic and Doppler studies were conducted in patients and controls with assessment of ejection fraction (EF) and diastolic dysfunction (assessed as E/A ratio). RESULTS The mean E/A ratio did not differ significantly between RA patients and healthy controls (1.08 (0.28) vs 0.99 (0.21), NS); comparable numbers of patients and controls had abnormal E/A (< 1.0) (26 (37.1%) vs 10 (30.3%), NS). Patients with decreased E/A were significantly older and had higher disease duration, activity, and presence of bone erosions than their RA counterparts with normal E/A. The mean EF was not significantly different in patients and controls. CONCLUSIONS The prevalence of DD as expressed by E/A ratio in RA patients with continued low disease activity was not different from that of controls. Higher disease duration and severity may predispose to DD occurrence in patients with preserved EF.
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Affiliation(s)
- Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| | | | | | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland
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27
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Packer M. Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. J Am Coll Cardiol 2018; 71:2360-2372. [PMID: 29773163 DOI: 10.1016/j.jacc.2018.03.509] [Citation(s) in RCA: 324] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/20/2018] [Accepted: 03/18/2018] [Indexed: 02/07/2023]
Abstract
Epicardial adipose tissue has unique properties that distinguish it from other depots of visceral fat. Rather than having distinct boundaries, the epicardium shares an unobstructed microcirculation with the underlying myocardium, and in healthy conditions, produces cytokines that nourish the heart. However, in chronic inflammatory disorders (especially those leading to heart failure with preserved ejection fraction), the epicardium becomes a site of deranged adipogenesis, leading to the secretion of proinflammatory adipokines that can cause atrial and ventricular fibrosis. Accordingly, in patients at risk of heart failure with preserved ejection fraction, drugs that promote the accumulation or inflammation of epicardial adipocytes may lead to heart failure, whereas treatments that ameliorate the proinflammatory characteristics of epicardial fat may reduce the risk of heart failure. These observations suggest that epicardial adipose tissue is a transducer of the adverse effects of systemic inflammation and metabolic disorders on the heart, and thus, represents an important target for therapeutic interventions.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
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28
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Biskup M, Biskup W, Majdan M, Targońska-Stępniak B. Cardiovascular system changes in rheumatoid arthritis patients with continued low disease activity. Rheumatol Int 2018; 38:1207-1215. [PMID: 29774373 PMCID: PMC6006198 DOI: 10.1007/s00296-018-4053-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
Systemic inflammation and disease activity seem to contribute to excessive prevalence of cardiovascular (CV) diseases (CVDs) in patients with rheumatoid arthritis (RA). The objective of the study was to assess chosen CV parameters in RA patients who have continuous low disease activity. The study group consisted of 70 RA patients without known CVD and 33 healthy controls, of a comparable age. All RA patients had continued low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. The groups were assessed for: blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography (ECG), ejection fraction (EJ) and diastolic dysfunction (E/A ratio) in echocardiography. In RA patients in comparison with controls, significantly greater values of cIMT [0.83 (0.21) vs 0.62 (0.1) mm, p < 0.001] were found, as well as higher incidence of atherosclerotic plaques [43 (61.4%) vs 10 (30.3%), p = 0.003], prolonged QTc interval [439.6 (23.7) vs 414.0 (27.9) ms, p < 0.001]. High or very high Systemic Coronary Risk Evaluation (SCORE) was found in 32.9% of patients with RA and increased serum NT-proBNP in 71.4%. The mean values of CV parameters (cIMT, E/A, NT-proBNP, SCORE) were associated with age, disease duration, rheumatoid factor (RF-IgM), erythrocyte sedimentation rate (ESR). The results of our study indicate, that RA with continued low disease activity is associated with atherosclerosis and heart dysfunction. Strong relationships were found between CV parameters and patients' age, disease duration. Deterioration of CV parameters was associated with higher DAS28, ESR, RF-IgM concentration and bone erosions.
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Affiliation(s)
| | | | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland.
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29
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England BR, Thiele GM, Anderson DR, Mikuls TR. Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. BMJ 2018; 361:k1036. [PMID: 29685876 PMCID: PMC6889899 DOI: 10.1136/bmj.k1036] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.
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Affiliation(s)
- Bryant R England
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Geoffrey M Thiele
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel R Anderson
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ted R Mikuls
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Lehmonen L, Vuorinen AM, Koivuniemi R, Leirisalo-Repo M, Holmström M, Kivistö S, Kaasalainen T. One-Year Follow-up Study Detects Myocardial Changes with Cardiovascular Magnetic Resonance Tagging in Active Rheumatoid Arthritis. Acad Radiol 2018; 25:476-485. [PMID: 29199058 DOI: 10.1016/j.acra.2017.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 02/02/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the effects of 1 year of medical treatment on myocardial function in active rheumatoid arthritis (RA). MATERIALS AND METHODS Thirty-nine female patients with RA without any known cardiovascular disease underwent a cardiovascular magnetic resonance (CMR) examination before and after 1 year of antirheumatic treatment. The population comprised untreated active early RA (ERA) and chronic RA patients, who were grouped accordingly. The CMR protocol included volumetric determinations, late gadolinium enhancement imaging, myocardial tagging, and native T1 mapping. DAS28-CRP disease activity scores were calculated before and after the treatment. RESULTS Results are reported as median (quartile 1-quartile 3). Time to peak diastolic filling rate improved in ERA (495 [443-561] ms vs 441 [340-518] ms, P = .018). Peak diastolic mean mid short-axis circumferential strain rate of all six segments was improved (82 [74-91] %/s vs 91 [77-100] %/s, P = .05), particularly in the anterior segment (82 [63-98] %/s vs 86 [77-109] %/s, P = .013). DAS28-CRP decreased in ERA (3.8 [3.2-4.1] vs 1.6 [1.4-2.2], P < .001). In chronic RA, no statistically significant improvement was detected. CONCLUSIONS Early treatment of active RA is important, as myocardial function detected with CMR tagging improved in ERA in parallel with decreasing inflammatory activity.
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31
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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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Lazzerini PE, Capecchi PL, Galeazzi M, Laghi-Pasini F. Biologic drugs and arrhythmic risk in chronic inflammatory arthritis: the good and the bad. Immunol Res 2018; 65:262-275. [PMID: 27423435 DOI: 10.1007/s12026-016-8833-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Increasing evidence indicates that patients with chronic inflammatory arthritis (CIA), including rheumatoid arthritis and spondyloarthropathies, have an increased risk of arrhythmic events, significantly contributing to the higher cardiovascular disease (CVD) morbidity and mortality observed in these subjects compared to the general population. Although the mechanisms accounting for such an arrhythmogenic substrate are not fully understood, the main role is probably played by chronic systemic inflammation, able to accelerate the development of structural CVD, as well as to directly affect cardiac electrophysiology. In the past decade, biologic therapies have revolutionized the treatment of CIA by highly enhancing the probability to effectively control disease activity and its systemic consequences, including cardiovascular involvement. Accordingly, accumulating data demonstrated that by potently inhibiting systemic inflammation, biologic drugs can reduce CVD progression and ameliorate arrhythmic risk parameters, with a putative beneficial impact on arrhythmia incidence. Nevertheless, a significant number of reports from clinical trials and postmarketing experience suggest that some of these medications, particularly TNF inhibitor monoclonal antibodies and rituximab, may in some circumstances precipitate arrhythmia occurrence, probably by acutely amplifying myocardial electric instability intrinsically associated with these diseases. In this review, we analyze the intricate link between biologic drugs and arrhythmias in CIA in the effort to identify which factors are involved in the fine-tuning of antiarrhythmic/pro-arrhythmic balance, and understand how this knowledge should be translated in the clinical practice to obtain the most favorable benefit-to-risk profile when biologic drugs are used in these patients.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy.
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
| | - Mauro Galeazzi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
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Association Between Atrial, Ventricular and Vascular Morphofunctional Alterations in Rheumatoid Arthritis. High Blood Press Cardiovasc Prev 2018; 25:97-104. [DOI: 10.1007/s40292-017-0246-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/07/2023] Open
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The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis. Int J Rheumatol 2017; 2017:2323410. [PMID: 29348754 PMCID: PMC5733615 DOI: 10.1155/2017/2323410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022] Open
Abstract
This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = −0.28 ± 0.09, p = 0.0002) and lateral e′ (standardised β (SE) = 0.26 ± 0.09, p = 0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = −0.16 ± 0.08, p = 0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p < 0.0001). One SD increase in waist-hip ratio was associated with diastolic dysfunction when applying current criteria (OR = 2.61 (95% CI = 1.51–4.52), p = 0.0006), whereas one SD increase in diastolic blood pressure was inversely related to diastolic dysfunction upon using previous criteria (OR = 0.57 (95% CI = 0.40–0.81), p = 0.002). In conclusion, application of current and previous diastolic dysfunction criteria markedly alters the prevalence and risk factors associated with diastolic dysfunction in RA.
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35
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Masoud S, Lim PB, Kitas GD, Panoulas V. Sudden cardiac death in patients with rheumatoid arthritis. World J Cardiol 2017; 9:562-573. [PMID: 28824786 PMCID: PMC5545140 DOI: 10.4330/wjc.v9.i7.562] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/15/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death (SCD), has been shown in patients with rheumatoid arthritis (RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.
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36
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Davis JM, Lin G, Oh JK, Crowson CS, Achenbach SJ, Therneau TM, Matteson EL, Rodeheffer RJ, Gabriel SE. Five-year changes in cardiac structure and function in patients with rheumatoid arthritis compared with the general population. Int J Cardiol 2017; 240:379-385. [PMID: 28427850 DOI: 10.1016/j.ijcard.2017.03.108] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have increased risk of heart failure with preserved ejection fraction. The development and progression of left ventricular dysfunction before onset of clinical heart failure are unknown. The objective of this study was to evaluate longitudinal changes in cardiac structure and function of patients with RA compared with persons in the general population. METHODS A prospective longitudinal study of a population-based cohort of 160 patients with RA and a population-based cohort of 1391 persons without RA (non-RA cohort) was performed. Each participant underwent 2-dimensional, pulsed-wave tissue Doppler echocardiography at baseline and after 4 to 5years of follow-up. Age- and sex-adjusted linear regression models were used to test for differences between the RA and non-RA cohorts in annualized rates of change for echocardiographic parameters. RESULTS Mitral A velocity increased more rapidly among the patients with RA than the non-RA cohort (age- and sex-adjusted parameter estimate, 0.030; P<0.001). Correspondingly, the mean mitral inflow E/A ratio decreased faster in the RA cohort than the non-RA cohort (adjusted parameter estimate, -0.096; P<0.001). The left atrial volume index increased at a higher rate in the RA cohort than the non-RA cohort (adjusted parameter estimate, 0.150; P<0.001). CONCLUSIONS This pattern of echocardiographic findings confirms previous cross-sectional studies and indicates that subclinical changes in diastolic function occur more rapidly over 5years in RA patients than in the general population. Further research into the mechanisms of myocardial disease in these patients and the relationship with disease activity and treatment is warranted.
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Affiliation(s)
- John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States.
| | - Grace Lin
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Terry M Therneau
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
| | | | - Sherine E Gabriel
- Division of Epidemiology, Mayo Clinic, Rochester, MN, United States; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Løgstrup BB, Masic D, Laurbjerg TB, Blegvad J, Herly M, Kristensen LD, Urbonaviciene G, Hedemann-Nielsen A, Ellingsen T. Left ventricular function at two-year follow-up in treatment-naive rheumatoid arthritis patients is associated with anti-cyclic citrullinated peptide antibody status: a cohort study. Scand J Rheumatol 2017; 46:432-440. [PMID: 28121216 DOI: 10.1080/03009742.2016.1249941] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES In rheumatoid arthritis (RA), the role of autoimmunity, especially anti-cyclic citrullinated peptide antibody (anti-CCP) level, and the time-course of left ventricular (LV) function is unknown. The objective was to assess LV function and the amount of coronary calcium in relation to anti-CCP levels in a cohort of treatment-naive RA patients, and to assess changes in these parameters during a 2 year follow-up period. METHOD Sixty-six steroid- and disease-modifying anti-rheumatic drug-naive RA patients were treated with methotrexate according to the Danish national guidelines. We assessed LV function by conventional echocardiography and speckle-tracking echocardiography. We estimated the amount and progression of coronary calcium by coronary computed tomography. Patients were examined at the time of diagnosis and after 2 years. RESULTS Patients with elevated anti-CCP at baseline and after 2 years, compared to those with non-persistently elevated anti-CCP, had significantly less improvement in S´ (1 ± 1.4 cm/s vs 0.2 ± 0.9 cm/s; p = 0.04) and a worsening in global longitudinal systolic strain (GLS) (0.6 ± 1.8% vs -1 ± 2.8%; p = 0.04). There was a significant correlation between ΔGLS over 2 years and anti-CCP at 2 year follow-up (r = 0.36; p = 0.006). We observed a small progression of coronary calcium score during the 2 year follow-up period. No differences in progression were found between patients with high anti-CCP titres at baseline and 2 year follow-up (n = 12) and patients with normal/low anti-CCP titres (n = 32) (23.8 ± 40.3 vs 22.6 ± 68.9; p = 0.96). CONCLUSIONS Deformation analysis by speckle-tracking echocardiography is a valuable tool to detect early development of myocardial dysfunction despite normal ejection fraction in RA.
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Affiliation(s)
- B B Løgstrup
- a Department of Cardiology , Aarhus University Hospital Skejby , Aarhus , Denmark.,b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - D Masic
- b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - T B Laurbjerg
- b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - J Blegvad
- b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - M Herly
- b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - L D Kristensen
- b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - G Urbonaviciene
- b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | | | - T Ellingsen
- c The Danish National Registry DANBIO , Rigshospitalet Glostrup , Glostrup , Denmark.,d Department of Rheumatology , Odense University Hospital , Odense , Denmark
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Renjith AS, Marwaha V, Aggarwal N, Koshy V, Singal VK, Kumar KVSH. Prevalence of left ventricular dysfunction in rheumatoid arthritis. J Family Med Prim Care 2017; 6:622-626. [PMID: 29417020 PMCID: PMC5787967 DOI: 10.4103/2249-4863.214431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is a polyarticular disorder with many extra-articular features. Cardiovascular disorders, including heart failure (HF), are the leading causes of mortality in RA patients. We studied the prevalence of left ventricular dysfunction (LVD) in patients with RA. Materials and Methods: In this cross-sectional study, we evaluated 100 consecutive patients with RA (aged >18 years and duration >1 year) for the presence of LVD. We excluded patients with known cardiac and systemic disorders that may contribute to LVD. LVD is defined by the presence of either left ventricular systolic dysfunction (LVSD) or left ventricular diastolic dysfunction (LVDD), evaluated by the echocardiography. Descriptive statistics and relevant tests were used to analyze the results. Results: The study participants (n = 100; 80F and 20M) had a mean age of 45 ± 11.8 years, duration of disease 7.4 ± 5.4 years, and disease activity score of 3.5 ± 1.1. A total of 46 patients had symptoms of HF, but only 14% of them had signs of HF. LVD was seen in 59 (LVSD-4, LVDD-50, and both together in 5) patients, and none of the participants had severe grades of LVSD and LVDD. LVD showed no relation to the age of the patients (P = 0.186) and it was more with increasing duration of RA (P < 0.001) and higher disease activity (P = 0.042). Conclusion: LVD is more common in RA patients, which increases the associated morbidity and mortality. Higher threshold is required by the family practitioners to perform a screening echocardiography in long-standing RA patients.
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Affiliation(s)
- A S Renjith
- Department of Medicine, Military Hospital, Srinagar, India
| | - Vishal Marwaha
- Department of Rheumatology, Amrita University, School of Medicine, Kochi, India
| | - N Aggarwal
- Department of Cardiology, Army Hospital (R&R), Delhi, India
| | - Varghese Koshy
- Department of Rheumatology, Command Hospital, Chandimandir, India
| | - V K Singal
- Department of Rheumatology, Medanta Hospital, Delhi, India
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Abstract
The main objective was to determine the predictors of diastolic dysfunction in rheumatoid arthritis (RA). Articles pertaining to diastolic dysfunction in RA were retrieved from Scopus, EBSCO, PubMed, Web of Science, and Cochrane Library databases. Keywords such as: diastolic, cardiac, left ventricular function, heart failure, rheumatoid arthritis, and cardiac failure were used. Studies, which examined factors, or predictors of diastolic dysfunction in RA, and those with echocardiographic evaluation of diastolic dysfunction, were included. A total of 8 studies met the eligibility criteria. Most studies (6 out of 7 studies) demonstrated a significant inverse relationship between the E (early)/A (late) ratio and disease duration. The pooled analysis using the random effects model revealed a significant but weak inverse relationship between the ratio of the E to A ventricular filling velocities (E/A) ratio and the disease duration (p<0.05, r=-0.385). There was a significant relationship between E/A ratio and disease duration in RA.
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Affiliation(s)
- Rajalingham Sakthiswary
- Department of Medicine, The National University of Malaysia, Cheras, Kuala Lumpur, Malaysia. E-mail.
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Lee J, Jung SM, Ebert AD, Wu H, Diecke S, Kim Y, Yi H, Park SH, Ju JH. Generation of Functional Cardiomyocytes from the Synoviocytes of Patients with Rheumatoid Arthritis via Induced Pluripotent Stem Cells. Sci Rep 2016; 6:32669. [PMID: 27609119 PMCID: PMC5016736 DOI: 10.1038/srep32669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/12/2016] [Indexed: 12/29/2022] Open
Abstract
Cardiovascular disease is a leading cause of morbidity in rheumatoid arthritis (RA) patients. This study aimed to generate and characterise cardiomyocytes from induced pluripotent stem cells (iPSCs) of RA patients. Fibroblast-like synoviocytes (FLSs) from patients with RA and osteoarthritis (OA) were successfully reprogrammed into RA-iPSCs and OA-iPSCs, respectively. The pluripotency of iPSCs was confirmed by quantitative reverse transcription-polymerase chain reaction and immunofluorescence staining. Established iPSCs were differentiated into cardiomyocytes using a small molecule-based monolayer differentiation protocol. Within 12 days of cardiac differentiation from patient-specific and control-iPSCs, spontaneously beating cardiomyocytes (iPSC-CMs) were observed. All iPSC-CMs exhibited a reliable sarcomeric structure stained with antibodies against cardiac markers and similar expression profiles of cardiac-specific genes. Intracellular calcium signalling was recorded to compare calcium-handling properties among cardiomyocytes differentiated from the three groups of iPSCs. RA-iPSC-CMs had a lower amplitude and a shorter duration of calcium transients than the control groups. Peak tangential stress and the maximum contractile rate were also decreased in RA-iPSC-CMs, suggesting that contractility was reduced. This study demonstrates the successful generation of functional cardiomyocytes from pathogenic synovial cells in RA patients through iPSC reprogramming. Research using RA-iPSC-CMs might provide an opportunity to investigate the pathophysiology of cardiac involvement in RA.
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Affiliation(s)
- Jaecheol Lee
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Antje D Ebert
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Department of Cardiology and Pneumonology, Göttingen University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Haodi Wu
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sebastian Diecke
- Max Delbrück Center, Berlin, Germany Berlin Institute of Health, Berlin, Germany
| | - Youngkyun Kim
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Hyoju Yi
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Lazúrová I, Tomáš Ľ. Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment. Clin Rev Allergy Immunol 2016; 52:323-332. [DOI: 10.1007/s12016-016-8566-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Krause ML, Crowson CS, Bongartz T, Matteson EL, Michet CJ, Mason TG, Persellin ST, Gabriel SE, Davis JM. Determinants of Disability in Rheumatoid Arthritis: A Community-Based Cohort Study. Open Rheumatol J 2015; 9:88-93. [PMID: 26862353 PMCID: PMC4740964 DOI: 10.2174/1874312901409010088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/04/2015] [Accepted: 08/28/2015] [Indexed: 11/22/2022] Open
Abstract
Longitudinal care of a community-based cohort of patients with rheumatoid arthritis (RA) was evaluated retrospectively. Candidate determinants of disability included visual analog scales (VAS) for patient global assessment and pain, comorbidities, and medications. The outcome was the 'patient-acceptable symptom state' for disability as defined by the Health Assessment Questionnaire (HAQ) disability index, using a cutoff of <1.04. Two-sample t tests and multivariable logistic regression were used to determine odds ratios (OR) for associations between predictor variables and disability. Out of a total of 99 patients, 28 (28%) patients had HAQ ≥1.04 at their last visit. The greatest odds of not attaining the patient-acceptable symptom state in a multivariable model was associated with corticosteroids (OR: 5.1; p=0.02), antidepressants (OR: 5.3; p=0.02), and female sex (OR: 6.5; p=0.05). In the era of biologic therapy, female sex, corticosteroids, and antidepressants remain profound determinants of disability highlighting the need to understand the underlying mechanisms.
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Affiliation(s)
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | - Tim Bongartz
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Medicine;; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine;; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John M Davis
- Division of Rheumatology, Department of Medicine
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Giles JT. Cardiovascular disease in rheumatoid arthritis: Current perspectives on assessing and mitigating risk in clinical practice. Best Pract Res Clin Rheumatol 2015; 29:597-613. [DOI: 10.1016/j.berh.2015.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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44
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Aulie HA, Estensen ME, Selvaag AM, Lilleby V, Murbraech K, Flatø B, Aakhus S. Cardiac Function in Adult Patients with Juvenile Idiopathic Arthritis. J Rheumatol 2015; 42:1716-23. [DOI: 10.3899/jrheum.141351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/25/2022]
Abstract
Objective.To compare cardiac function in adults with longterm juvenile idiopathic arthritis (JIA) with that of healthy controls, and to investigate the influence of inflammation, disease severity, and use of antirheumatic medication on cardiac function.Methods.Eighty-five patients with JIA (median age 38.6 yrs) with active disease for at least 15 years were reexamined at a median of 29 years after disease onset and compared with 46 matched controls. Echocardiography, including tissue Doppler imaging and longitudinal peak-systolic global strain, was used to assess diastolic and systolic myocardial function, and 12-channel electrocardiography was performed.Results.The interventricular septum was thicker in patients than controls (mean ± SD 0.8 ± 0.2 cm vs 0.7 ± 0.1 cm, p = 0.036). Diastolic function in patients was altered compared with controls characterized by lower mitral E wave deceleration time (165 ± 36 ms vs 180 ± 40 ms, p = 0.029), higher surrogate marker of left ventricular (LV) filling pressure (median lateral E/e’ 5.3, interquartile range 4.6–6.3 vs 4.8, 3.9–5.7, p = 0.036), and larger left atrial area (16.4 ± 2.9 cm2vs 15.1 ± 2.8 cm2, p = 0.015). Systolic and diastolic blood pressures were higher in patients (120 ± 15 mmHg vs 114 ± 9 mmHg, p = 0.021 and 76 ± 10 mmHg vs 71 ± 8 mmHg, p = 0.009, respectively). QT corrected interval was similar in patients and controls. High high-sensitivity C-reactive protein (CRP), polyarticular disease course, and extended joint affection at 29-year followup, as well as duration of active disease, cumulative erythrocyte sedimentation rate, and CRP, and prednisolone use were associated with higher lateral E/e’.Conclusion.Adult patients with JIA did not differ from controls in LV systolic function, but had mildly thicker interventricular septum and indications for higher LV filling pressure, and most in patients with a higher disease burden.
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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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Corrao S, Argano C, Pistone G, Messina S, Calvo L, Perticone F. Rheumatoid arthritis affects left ventricular mass: Systematic review and meta-analysis. Eur J Intern Med 2015; 26:259-67. [PMID: 25753937 DOI: 10.1016/j.ejim.2015.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiovascular disease represents one of the most important extra-articular causes of morbidity and mortality in patients with rheumatoid arthritis (RA). Evidences showed that several cardiac structures can be affected during the course of the disease as well as abnormalities of left ventricular diastolic filling. Contrasting data are available about left ventricular mass (LVM) involvement in patients asymptomatic for cardiovascular disease. The purpose of this systematic review and meta-analysis is to summarize the effects of RA on LVM in rheumatoid arthritis patients without cardiovascular disease. METHODS A systematic research of the current case-control studies was conducted in Medline on November 20th, 2013. Studies were included if data of measurements of LVM were reported. The pooled mean effect size estimate was calculated according to methods described by Hedges and Olkin. RESULTS Sixteen eligible studies were included in this meta-analysis. RA determines an increase of absolute and indexed LVM compared with control patients [standardized mean difference (95% CI): 0.41(0.15-0.66) and 0.47(0.32-0.62), respectively]. On the contrary, posterior wall thickness did not show a significant RA effect. Finally, a significant positive effect of RA on interventricular wall thickness was found [standardized mean difference (95% CI): 0.39 (0.07-0.71)]. CONCLUSIONS Results of this meta-analysis suggest that increased absolute and indexed LVM seem to be characteristic of RA patients with a fundamental clinical significance since they are related to an increased risk of cardiovascular morbidity and mortality. Our data suggest the use of LVM as surrogate end-point for clinical trials involving RA patients.
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Affiliation(s)
- Salvatore Corrao
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy; National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy.
| | - Christiano Argano
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy
| | - Giovanni Pistone
- National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Silvia Messina
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy
| | - Luigi Calvo
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy
| | - Francesco Perticone
- Department of Experimental and Clinical Medicine, "G. Salvatore" University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Liu M, Fang F, Yu CM. Noncardiac comorbidities in heart failure with preserved ejection fraction - commonly ignored fact. Circ J 2015; 79:954-9. [PMID: 25739578 DOI: 10.1253/circj.cj-15-0056] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It has been well described that many patients with heart failure (HF) have a normal left ventricular ejection fraction. This entity has been termed "heart failure with preserved ejection fraction (HFPEF)". Significant advances have been made in understanding the clinical characteristics of HFPEF over the past 2 decades on the basis of large HF registries and randomized clinical trials. However, most multicenter clinical trials that investigated medical therapies in HFPEF have yielded disappointing results. HFPEF being a clinical syndrome involving multiple organ systems may be a potential explanation for treatment failure. In this review we discuss the prevalence of noncardiac comorbidities in HFPEF patients as well as their effect on the prognosis of HFPEF.
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Affiliation(s)
- Ming Liu
- Division of Cardiology, Department of Medicine and Therapeutics & Institute of Vascular Medicine & Institute of Innovative Medicine & Heart Education And Research Training (HEART) Center & Li Ka Shing Institute of Health Sciences & Prince of Wales Hospital, The Chinese University of Hong Kong
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Sharma A, Kaushik R, Kaushik RM, Kakkar R. Echocardiographic evaluation of diastolic dysfunction in rheumatoid arthritis - a case-control study. Mod Rheumatol 2015; 25:552-7. [PMID: 25529032 DOI: 10.3109/14397595.2014.998404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess left ventricular diastolic dysfunction (LVDD) and its predictors in rheumatoid arthritis (RA). METHODS This cross-sectional case-control study assessed 100 RA patients and 100 healthy controls for LVDD by M-mode, two-dimensional, colour Doppler echocardiography. RESULTS RA patients had higher prevalence of LVDD than controls (43% vs. 14%; p < 0.001). LVDD had significant association with duration (p = 0.033), severity of disease activity (p < 0.0001), Steinbrocker stage and functional class (p < 0.0001 each) and non-adherence to treatment (p = 0.047). Peak of late diastolic (A) mitral flow velocity and isovolumic relaxation time (IVRT) were higher (p < 0.05 each), whereas left ventricular ejection fraction, peak of early diastolic (E) mitral flow velocity and E/A ratio were lower (p < 0.05 each) in RA patients than in controls. Deceleration time (DT) was not significantly different in the two groups (p = 0.623). E/A ratio had significant correlation with anti-cyclic citrullinated peptide antibody (ACPA) (r = 0.233, p = 0.019) and age (r = 0.203, p = 0.042). IVRT had significant negative correlation with ACPA (r = -0.196, p = 0.044), while DT had significant correlation with Disease Activity Score with 28-joint (DAS28) counts (r = 0.244, p = 0.014). ACPA was an independent predictor of E/A ratio (p = 0.031). DAS28 was the only independent predictor of LVDD (odds ratio [OR] = 6.01; p = 0.007). CONCLUSIONS LVDD occurred commonly in RA patients and depended on severity of disease activity.
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Affiliation(s)
- Abhishek Sharma
- Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun, Uttarakhand , India
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Adlan AM, Panoulas VF, Smith JP, Fisher JP, Kitas GD. Association between corrected QT interval and inflammatory cytokines in rheumatoid arthritis. J Rheumatol 2015; 42:421-8. [PMID: 25593223 DOI: 10.3899/jrheum.140861] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Corrected QT (QTc) interval predicts all-cause and cardiovascular mortality and may contribute to the increased mortality risk in rheumatoid arthritis (RA). Animal experiments have shown that proinflammatory cytokines [tumor necrosis factor (TNF)-α and interleukin 1 (IL-1)] can prolong cardiomyocyte action potential. We sought to determine whether elevations in circulating inflammatory cytokines were independently associated with QTc prolongation in patients with RA. METHODS One hundred twelve patients [median age 62 (interquartile range 17) yrs; 80 women (71%)] from a well-characterized RA cohort underwent baseline 12-lead electrocardiograms for QT interval measurement and contemporary blood sampling to assess concentrations of inflammatory markers including C-reactive protein (CRP), TNF-α, and interleukins (IL-1α, IL-1β, IL-6, IL-10). QTc was calculated using the Bazett (QTBAZ = QT ÷ √RR) and Framingham Heart Study (QTFHS = QT + 0.154 × [1 - RR]) heart rate correction formulas. RESULTS Inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-10) were positively correlated with QTBAZ (Spearman rank correlation coefficient rho = 0.199, 0.210, 0.222, 0.333; all p < 0.05). In multivariable regression analysis, these associations were all confounded by age except IL-10, where higher tertile groups were independently and positively associated with QTBAZ (β = 0.202, p = 0.023) and QTFHS (β = 0.223, p = 0.009) when compared to the lower tertile. CRP (per unit increase) was independently associated with QTBAZ (β = 0.278, p = 0.001), but not QTFHS. CONCLUSION To our knowledge, ours is the first study demonstrating a contemporary link between inflammatory cytokines and QT interval in humans. Our results suggest that a lower inflammatory burden may protect against QTc prolongation in patients with RA. However, further studies are required to confirm the effects of pro- and antiinflammatory cytokines on QTc interval.
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Affiliation(s)
- Ahmed M Adlan
- From the College of Life and Environmental Sciences, University of Birmingham, Birmingham; Imperial College London, National Heart and Lung Institute, South Kensington Campus, London; and the Department of Rheumatology, Dudley Group of Hospitals National Health Service (NHS) Trust, Russells Hall Hospital, Dudley, UK.A.M. Adlan, MBBS, MRCP, College of Environmental Sciences; J.P. Fisher, BSc (Hons), PhD, College of Life and Environmental Sciences, University of Birmingham; V.F. Panoulas, MD, PhD, Imperial College London, National Heart and Lung Institute, Department of Rheumatology, Dudley Group of Hospitals NHS Trust; J.P. Smith, BSc (Hons), MSc; G.D. Kitas, MD, PhD, FRCP, Department of Rheumatology, Dudley Group of Hospitals NHS Trust.
| | - Vasileios F Panoulas
- From the College of Life and Environmental Sciences, University of Birmingham, Birmingham; Imperial College London, National Heart and Lung Institute, South Kensington Campus, London; and the Department of Rheumatology, Dudley Group of Hospitals National Health Service (NHS) Trust, Russells Hall Hospital, Dudley, UK.A.M. Adlan, MBBS, MRCP, College of Environmental Sciences; J.P. Fisher, BSc (Hons), PhD, College of Life and Environmental Sciences, University of Birmingham; V.F. Panoulas, MD, PhD, Imperial College London, National Heart and Lung Institute, Department of Rheumatology, Dudley Group of Hospitals NHS Trust; J.P. Smith, BSc (Hons), MSc; G.D. Kitas, MD, PhD, FRCP, Department of Rheumatology, Dudley Group of Hospitals NHS Trust
| | - Jacqueline P Smith
- From the College of Life and Environmental Sciences, University of Birmingham, Birmingham; Imperial College London, National Heart and Lung Institute, South Kensington Campus, London; and the Department of Rheumatology, Dudley Group of Hospitals National Health Service (NHS) Trust, Russells Hall Hospital, Dudley, UK.A.M. Adlan, MBBS, MRCP, College of Environmental Sciences; J.P. Fisher, BSc (Hons), PhD, College of Life and Environmental Sciences, University of Birmingham; V.F. Panoulas, MD, PhD, Imperial College London, National Heart and Lung Institute, Department of Rheumatology, Dudley Group of Hospitals NHS Trust; J.P. Smith, BSc (Hons), MSc; G.D. Kitas, MD, PhD, FRCP, Department of Rheumatology, Dudley Group of Hospitals NHS Trust
| | - James P Fisher
- From the College of Life and Environmental Sciences, University of Birmingham, Birmingham; Imperial College London, National Heart and Lung Institute, South Kensington Campus, London; and the Department of Rheumatology, Dudley Group of Hospitals National Health Service (NHS) Trust, Russells Hall Hospital, Dudley, UK.A.M. Adlan, MBBS, MRCP, College of Environmental Sciences; J.P. Fisher, BSc (Hons), PhD, College of Life and Environmental Sciences, University of Birmingham; V.F. Panoulas, MD, PhD, Imperial College London, National Heart and Lung Institute, Department of Rheumatology, Dudley Group of Hospitals NHS Trust; J.P. Smith, BSc (Hons), MSc; G.D. Kitas, MD, PhD, FRCP, Department of Rheumatology, Dudley Group of Hospitals NHS Trust
| | - George D Kitas
- From the College of Life and Environmental Sciences, University of Birmingham, Birmingham; Imperial College London, National Heart and Lung Institute, South Kensington Campus, London; and the Department of Rheumatology, Dudley Group of Hospitals National Health Service (NHS) Trust, Russells Hall Hospital, Dudley, UK.A.M. Adlan, MBBS, MRCP, College of Environmental Sciences; J.P. Fisher, BSc (Hons), PhD, College of Life and Environmental Sciences, University of Birmingham; V.F. Panoulas, MD, PhD, Imperial College London, National Heart and Lung Institute, Department of Rheumatology, Dudley Group of Hospitals NHS Trust; J.P. Smith, BSc (Hons), MSc; G.D. Kitas, MD, PhD, FRCP, Department of Rheumatology, Dudley Group of Hospitals NHS Trust
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Abbate A, Arena R, Abouzaki N, Van Tassell BW, Canada J, Shah K, Biondi-Zoccai G, Voelkel NF. Heart failure with preserved ejection fraction: Refocusing on diastole. Int J Cardiol 2015; 179:430-40. [PMID: 25465302 DOI: 10.1016/j.ijcard.2014.11.106] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/08/2014] [Accepted: 11/13/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA.
| | - Ross Arena
- University of Illinois Chicago, Department of Physical Therapy, Chicago, IL, USA
| | - Nayef Abouzaki
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin W Van Tassell
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA; Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Justin Canada
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Keyur Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Giuseppe Biondi-Zoccai
- Sapienza University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Norbert F Voelkel
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
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