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Schau T, Gottwald M, Arbach O, Seifert M, Schöpp M, Neuß M, Butter C, Zänker M. Increased Prevalence of Diastolic Heart Failure in Patients with Rheumatoid Arthritis Correlates with Active Disease, but Not with Treatment Type. J Rheumatol 2015; 42:2029-37. [PMID: 26373561 DOI: 10.3899/jrheum.141647] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Although heart failure (HF) is a major cause of premature mortality, there is little information regarding its prevalence and associated risk factors in patients with rheumatoid arthritis (RA). In this study, we evaluated the prevalence of HF in a community-based RA cohort. Further, we investigated the effect of RA activity and present treatment on HF rate and cardiac structure. METHODS A diagnostic workup for HF according to the European Society of Cardiology recommendations was performed in 157 patients with RA fulfilling the American College of Rheumatology/European League Against Rheumatism criteria (68% women, age 61 ± 13 yrs) from our outpatient clinic and in 77 age- and sex-matched controls. RESULTS The prevalence of HF in patients with RA (24%) was unexpectedly high and differed significantly from the control sample (6%, p = 0.001). Diastolic HF was the dominant type (23% vs 6%), and clinical symptoms alone were of low diagnostic value. Active RA (28-joint Disease Activity Score ≥ 2.6: OR 3.4, 95% CI 1.3-9.8) was an independent risk factor of HF, as well as systemic inflammation (erythrocyte sedimentation rate > 16 mm/h: OR 5.4, 95% CI 2.1-16; C-reactive protein > 10 mg/l: OR 2.6, 95% CI 0.8-8.0) and RA duration > 10 years (OR 2.6, 95% CI 1.2-5.8). HF in RA was associated with concentric hypertrophy (48% vs 17%, p < 0.001) and reduced longitudinal strain (-17.2% vs -19.7%, p < 0.001). However, the prevalence of HF was equivalent between the treatment groups [conventional synthetic disease-modifying antirheumatic drugs (DMARD) 25%, tumor necrosis factor inhibitors 22%, other biological DMARD 27%]. CONCLUSION Recognition of all diastolic HF in RA requires a complex diagnostic approach. Active rather than inactive RA places patients at a higher risk for HF, whereas influence of RA treatment on HF risk needs to be elucidated in further studies.
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Affiliation(s)
- Thomas Schau
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Michael Gottwald
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Olga Arbach
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Martin Seifert
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Maren Schöpp
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Michael Neuß
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Christian Butter
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Michael Zänker
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
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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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