Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
The rheumatoid arthritis (RA) population demonstrate a significantly increased incidence of cardiac events. Cardiac dysfunction in RA may occur as a result of impaired filling during diastole, or as contractile insufficiency (systolic dysfunction). Chronic systemic inflammation may be the underlying cause of cardiac alterations, and also impact significantly on traditional cardiovascular risk profiles. Apelin is an endogenous peptide known for its vasoactive effects, inotropic action and general cardioprotective function. Apelin may prove to be particularly beneficial within the RA population.
This study aimed to determine the association of apelin concentrations with measures of cardiac geometry, systolic and diastolic function, independent of traditional risk factors and inflammation in RA patients.
186 RA patients where included, where demographic, anthropometric and RA disease characteristics were recorded. Cardiac structure and function was assessed using two-dimensional directed M-mode echocardiography, Pulsed Doppler, and tissue Doppler imaging. Circulating cytokine concentrations were determined using immunoturbidimetric methods. Apelin-13 concentrations were quantified using a solid-phase sandwich ELISA technique. The association of apelin concentrations with stroke volume, ejection fraction, endocardial and midwall fractional shortening, relative wall thickness, left ventricular mass, mitral inflow (E/A), lateral and septal e’, left ventricular filling pressures (E/e’), and left atrial volume index (LAVI) were determined in comprehensively adjusted multivariate and backward regression analyses.
Apelin concentrations were not independently associated with cardiac geometry, diastolic or systolic function (p>0.05) in all patients. Body mass index impacted on apelin-ejection fraction and apelin-fractional shortening relations (interaction p=0.02, for both), and hypertension impacted on apelin-E/A ratio, apelin-stroke volume, apelin-ejection fraction, apelin-endocardial fractional shortening and apelin-midwall fractional shortening relations (interaction p=0.03, p=0.01, p=0.02, p=0.01 and p=0.03, respectively). In stratified analyses, apelin was associated with improved ejection fraction and endocardial fractional shortening in patients with a BMI ≥ 25kg/m2, but not in those with a BMI < 25 kg/m2. Apelin concentrations were associated with an improved E/A ratio (partial r=0.31; p=0.04), stroke volume (partial r=0.29; p=0.03), ejection fraction (partial r=0.39; p=0.01), endocardial fractional shortening (partial r=0.40; p=0.003) and midwall fractional shortening (partial r=0.31; p=0.02) in hypertensive but not normotensive patients.
Apelin concentrations are associated with improved active relaxation in hypertensive patients only. The inotropic effects of apelin is paradoxically increased in the presence of adverse metabolic risk factors. The vasoactive and cardioprotective effects of apelin may be particularly beneficial in those with adverse cardiometabolic risk profiles.
To cite this abstract in AMA style:Gunter S, Mokotedi L, Gomez M, Tsang L, Millen A, Dessein P. Cardiometabolic Risk Factors Impact on the Cardioprotective Effect of Apelin on Systolic and Diastolic Function, in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/cardiometabolic-risk-factors-impact-on-the-cardioprotective-effect-of-apelin-on-systolic-and-diastolic-function-in-patients-with-rheumatoid-arthritis/. Accessed October 23, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiometabolic-risk-factors-impact-on-the-cardioprotective-effect-of-apelin-on-systolic-and-diastolic-function-in-patients-with-rheumatoid-arthritis/