Background/Purpose:   The impairment of left ventricular (LV) relaxation and passive filling, known as diastolic dysfunction, undergirds the development of heart failure in patients with rheumatoid arthritis (RA). Little is known about factors that contribute to the progression of diastolic dysfunction over time in these patients. The objective of this study was to identify predictors of progression of LV diastolic dysfunction over five years in patients with RA.

Methods:   A prospective longitudinal study of a population-based cohort of patients with RA was performed. Patients participated in research study visits at baseline and 5 years later. Clinical evaluation included the Rapid Assessment of Patient Index Data-3 (RAPID-3), Health Assessment Questionnaire (HAQ) disability index, use of disease-modifying antirheumatic drugs (DMARDs), biologics and prednisone, and measurement of C-reactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (anti-CCP). At baseline and 5 years, participants underwent pulse-wave and tissue Doppler echocardiography, according to a standardized research protocol. Spearman methods were used to determine the age- and sex-adjusted correlations between the 5-year changes in echocardiographic parameters and baseline clinical variables.

Results:   A total of 160 patients with RA were included in this study. The mean age at baseline was 58.5 years, and 76.3% were female. The mean (SD) values of the RAPID-3, HAQ and CRP were 6.4 (5.8), 0.47 (0.55) and 4.2 (6.3) mg/L, respectively. Previous analyses demonstrated that RA is associated with increasing mitral A velocity and decreasing E/A ratio over 5 years. The present analysis demonstrated statistically significant correlations between the 5-year increases in the mitral A velocity and higher baseline values of the RAPID-3 (r = 0.24, p = 0.003), the HAQ disability index (r = 0.21, p = 0.011), CRP (r = 0.21, p = 0.011), and baseline prednisone use (r = 0.17, p = 0.039). Similarly, 5-year decreases in the E/A ratio correlated with higher baseline values of RAPID-3 (r = -0.17, p = 0.041), HAQ disability index (r = -0.19, p = 0.019), and CRP (r = -0.16, p = 0.047). Increases in the e’ velocity correlated only with higher values of CRP (r = 0.19, p = 0.021) while increases in the E/e’ ratio correlated with higher values of RAPID-3 (r = 0.19, p = 0.018). There was no evidence of any significant correlations between echocardiographic parameters and RF, anti-CCP or DMARD/biologic use.

Conclusion:   Higher disease activity and severity at baseline are predictive of progressive changes over time in key parameters of LV diastolic function among patients with RA. The findings suggest that disease activity is a determinant of future myocardial disease in patients with RA. Echocardiographic monitoring of LV diastolic function should be considered as an outcome measure in future clinical trials of treat-to-target strategies for RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diastolic-dysfunction-in-patients-with-rheumatoid-arthritis-predictors-of-longitudinal-progression-over-five-years/