Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose: Patients with rheumatoid arthritis (RA) suffer an increased risk of heart failure not explained by traditional cardiovascular risk factors. Previously, we have shown that these patients have a high prevalence of abnormal left ventricular (LV) diastolic dysfunction and altered ventricular geometry. The objective of this study was to evaluate longitudinal changes in LV structure and function in patients with RA.
Methods: A prospective longitudinal study of patients with RA from our community population-based inception cohort was performed. RA was defined according to the 1987 classification criteria. Patients were seen at study baseline (2007 – 2009) and approximately 5 years later (2012 – 2014). For each participant, a registered diagnostic cardiac sonographer performed pulse wave and tissue Doppler echocardiography according to a standardized research protocol. LV diastolic function parameters were analyzed according to guidelines and criteria of the American Society of Echocardiography. Medical records were reviewed to ascertain demographics, cardiovascular risk factors, and RA disease characteristics. Changes in the echo parameters between baseline and 5 years were tested using paired t-tests.
Results: A total of 137 patients to date have been studied at the 5-year time point. The mean age was 58.4 years, disease duration 9.6 years, and 76% were female. The E/e’ ratio increased from 8.7 to 10.9 (p<0.001), consistent with increasing filling pressures of the left ventricle (Table). The left atrial volume index increased from 25.6 to 34.3 (p <0.001). The LV mass index and relative wall thickness decreased over time. On average, there was no biologically relevant change in the ejection fraction over time.
|
Measurement |
Baseline Mean (SD) |
5 Years Mean (SD) |
Mean Difference |
P-value |
|
LV ejection fraction, % |
62.0 (5.8) |
61.2 (4.6) |
-0.8 (6.3) |
0.13 |
|
E velocity, m/s |
0.69 (0.17) |
0.7 (0.17) |
0.01 (0.17) |
0.53 |
|
A velocity , m/s |
0.43 (0.1) |
0.71 (0.21) |
0.28 (0.25) |
<0.001 |
|
Tissue Doppler e’, m/s |
0.08 (0.02) |
0.07 (0.02) |
-0.02 (0.02) |
<0.001 |
|
E/A ratio |
1.7 (0.4) |
1.1 (0.4) |
-0.6 (0.6) |
<0.001 |
|
E/e’ ratio |
8.7 (2.9) |
10.9 (3.9) |
2.2 (3.4) |
<0.001 |
|
Left atrial volume index, mL/m2 |
25.6 (5.4) |
34.3 (8.7) |
8.6 (7.9) |
<0.001 |
|
LV mass index, gm/m2 |
80.7 (14.9) |
77.3 (18.4) |
-3.4 (17.5) |
0.06 |
|
Relative wall thickness |
0.40 (0.07) |
0.36 (0.07) |
-0.04 (0.08) |
<0.001 |
Conclusion: In this sample of patients with RA, clinically significant worsening in cardiac structure and function occurred during 5 years of follow-up, including progression of diastolic dysfunction. Additionally, decline in the LV mass index was observed, which contrasts the expected increased LV mass associated with diastolic dysfunction (hypertrophy). Future work is necessary to compare these findings to age-related changes in the general population in order to better understand the significance of the results with respect to the risk of future heart failure.
Disclosure:
J. M. Davis III,
None;
G. Lin,
None;
J. Oh,
None;
C. S. Crowson,
None;
T. M. Therneau,
None;
E. L. Matteson,
None;
S. E. Gabriel,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/five-year-changes-in-myocardial-structure-and-function-in-patients-with-rheumatoid-arthritis/