Background/Purpose: Disturbances of diastolic function precede systolic heart failure and, although clinically silent, represent the earliest sign of cardiac involvement. Diastolic dysfunction is associated with age, female, and hypertension. However, little is known about the age-specific incidence rates and risk factors for diastolic dysfunction 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 (mean [±SD] age, 48.1±7.9 years) and 107 healthy subjects (47.3±9.4 years). All participants were premenopausal women with no history of hypertension. Diastolic dysfunction was defined as impaired relaxation with or without increased filling pressures.

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%). Diastolic dysfunction was more common in patients with RA at 47% compared with 26% in the controls (P=0.004). Women with RA in the 30- to 49- year age group were over 3.5 times more likely to have diastolic dysfunction 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 diastolic dysfunction even after adjustment for cardiovascular risk factors (P=0.009).

Conclusion: In premenopausal women with RA, diastolic dysfunction is much more common and the age at onset is reduced. Early screening of myocardial function may provide an opportunity for preventing future cardiovascular disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/accelerated-diastolic-dysfunction-in-premenopausal-women-with-rheumatoid-arthritis/