Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
In rheumatoid arthritis (RA), cardiac involvement is common and frequently subclinical. We used cardiac MRI to identify myocardial abnormalities in patients with active RA, free of symptoms and signs of cardiac disease.
Methods:
Sixty female patients with active RA under age of 70 years (31 patients with early RA awaiting the start of treatment with conventional DMARDs and 29 patients with chronic RA awaiting the start of treatment with biological therapy) and 21 sex and age-matched control subjects (10 patients with FM and 11 healthy volunteers) underwent either 1.5T or 3T cardiac MRI for analyses of T1 relaxation times, late gadolinium enhancement (LGE), volumes and function of both ventricles.
Table 1. Clinical features of RA patients
|
Early RA |
Chronic RA |
p-value |
|
|
Age, years; mean ± SD |
48 ± 15 |
48 ± 14 |
0.57 |
|
RF positivity; n (%) |
26 (84) |
23 (85) |
1.000 |
|
ACPA positivity; n (%) |
27 (87) |
26 (93) |
0.673 |
|
CRP; mean + SD |
16 + 26 |
7 + 7 |
0.076 |
|
Number of swollen joints; median (IQR)* |
8 (4-10) |
6 (2-7) |
0.037 |
|
Number of tender joints; median (IQR)* |
7 (3-12) |
6 (2-11) |
0.726 |
|
DAS28-CRP; mean ± SD |
3.7 ± 1.05 |
3.4 ± 1.15 |
0.267 |
|
Extra-articular manifestations; n (%) |
5 (16) |
14 (48) |
0.007 |
|
Erosions on radiographs; n (%) |
5 (17) |
23 (85) |
<0.001 |
|
Duration of symptoms, years; median (IQR) |
0.4 (0.3-0.8) |
13.0 (4-26) |
<0.001 |
|
BMI, kg/m2; mean ± SD |
23.7 ± 4.1 |
25.5 ± 3.6 |
0.069 |
* 66/68 joints evaluated
Results:
By using 1.5T cardiac MRI, native left ventricular (LV) septal T1 time averaged 1010 ± 45 ms in 20 RA patients v.s. 977 ± 18 ms in 11 controls (p = 0.045). With 3T cardiac MRI, the T1 time measured 1170 ± 33 ms in 29 RA patients v.s. 1047 ± 113 ms in 9 controls (p = 0.002). Myocardial LGE was detected in 55% of RA patients, but in none of FM controls. Increased likelihood of LGE was associated with increasing DAS28-CRP (OR 1.87, 95% CI 1.05 to 3.35, p=0.035) and increasing age (OR 1.05, 95% CI 1.00 to 1.09, p=0.040) in multivariate logistic regression model, but not with disease duration or ACPA positivity. Compared with controls, RA patients had impairments in systolic and diastolic function of both ventricles (Table 2). In patients with early RA, right ventricular (RV) dysfunction was more obvious (Table 3).
Table 2. Cardiac MRI findings in RA patients and controls
|
Variable |
RA patients = 60 Mean ± SD Median (IQR)
|
Controls together = 21 Mean ± SD Median (IQR) |
p-value |
|
LVEF, % |
58.9 ± 4.3 |
66.7 ± 6.8 |
<0.001 |
|
LVEDV-index, ml/m2 |
82.3 ± 11.6 |
75.1 ± 11.0 |
0.022 |
|
LVESV-index, ml/m2 |
34 (30-40) |
25 (21-29) |
<0.001 |
|
LVSV-index, ml/m2 |
47 ± 11 |
43 ± 6 |
0.24 |
|
LVPFR/EDV, 1/s |
2.95 ± 0.85 |
3.44 ± 0.70 |
0.012 |
|
LV mass-index, g/m2 |
51.3 ± 7.6 |
53.1 ± 7.2 |
0.29 |
|
RVEF, % |
59 ± 6 |
58 ± 6 |
0.65 |
|
RVEDV-index, ml/m2 |
82 ± 13 |
74 ±8 |
0.03 |
|
RVESV-index, ml/m2 |
34 ± 9 |
31 ± 6 |
0.21 |
|
RVSV-index, ml/m2 |
44 (40-45) |
48 (45-49) |
0.02 |
SD = standard deviation, IQR = interquartile range, LV = left ventricle, EF = ejection fraction, EDV = end-diastolic volume, ESV = end-systolic volume, SV = stroke volume, PFR = peak filling rate, RV = right ventricle
Table 3. Cardiac MRI findings in early and chronic RA
|
Variable |
Early RA Mean (±SD) Median (IQR) |
Chronic RA Mean (±SD) Median (IQR) |
p-value |
|
LV EF % |
57 (56-58) |
60 (59-61) |
0.05 |
|
LV EDV-index ml/m2 |
83±11 |
81±13 |
0.56 |
|
LV ESV-index ml/m2 |
35±7 |
33±6 |
0.13 |
|
LV SV-index; ml |
48±6 |
46±14 |
0.96 |
|
LV PFR/EDV; 1/s |
3.04±1.67 |
3.21±0.88 |
0.61 |
|
LV mass-index; g/m2 |
51±8 |
52±8 |
0.86 |
|
RV EF % |
57±5 |
61±6 |
0.008 |
|
RV EDV-index ml/m2 |
84±12 |
79±13 |
0.16 |
|
RV ESV-index ml/m2 |
37±8 |
32±8 |
0.02 |
|
RV SV-index ml/m2 |
47±5 |
48±7 |
0.49 |
Conclusion:
Patients with active RA show myocardial abnormality on cardiac MRI: prolonged myocardial T1 relaxation times suggesting diffuse inflammation or fibrosis and LGE indicating local myocardial scars. RA patients also had impairments of LV and RV systolic and diastolic functions. Inflammatory activity observed in patients with early RA with lower systolic ventricular functions compared to patients with chronic RA can reflect systemic inflammation.
To cite this abstract in AMA style:
Holmström M, Koivuniemi R, Tiippana-Kinnunen T, Kuuliala A, Leirisalo-Repo M, Kivistö S. Cardiac Magnetic Resonance Imaging Reveals Myocardial Damage in Patients with Active Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/cardiac-magnetic-resonance-imaging-reveals-myocardial-damage-in-patients-with-active-rheumatoid-arthritis/. Accessed .« Back to ACR/ARHP Annual Meeting 2015
ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiac-magnetic-resonance-imaging-reveals-myocardial-damage-in-patients-with-active-rheumatoid-arthritis/