Background/Purpose: Cardiovascular disease (CVD) is the main cause of mortality in patients with rheumatoid arthritis (RA) reflected by a higher prevalence of cardiovascular risk factors (CVRFs), a chronic systemic inflammatory state and heart failure compared to the general population. Left ventricular diastolic dysfunction (LVDD) is attributable to structural abnormalities such as hypertrophy or interstitial fibrosis and impaired myocyte relaxation resulting from ischemia and is frequently asymptomatic. The presence of LVDD could be considered as the first step to development of heart failure.

The aim of the study was to identify the association of disease activity and the presence of LVDD in RA patients.

Methods: This was a cross-sectional, observational, and comparative study of RA subjects that fulfilled the 2010 ACR/EULAR classification criteria, aged 40-75 years. A transthoracic echocardiogram was performed and reviewed by two certified echocardiographers, in all study subjects. A total of fifty-one RA patients diagnosed with LVDD according to the 2016 American Society of Echocardiography (ASE) criteria, and 51 RA patients without LVDD, matched by age, gender, and comorbidities, were included in this study. Disease activity was evaluated with the disease activity score using 28 joints-C reactive protein (DAS28-CRP). Distribution was evaluated with the Kolmogorov-Smirnov test. Chi-square test, Student’s t test and Mann-Whitney U test were used for comparations between groups. A p-value < 0.05 was considered statistically significant.

Results: There were no differences between groups regarding age, gender, and comorbidities. Patients with LVDD demonstrated a higher disease activity evaluated by DAS28-CRP (4.88 vs 3.56, p=0.004) (Table 1). It was observed that patients with LVDD had a higher prevalence of being classified in the high disease activity category compared to patients without LVDD (41.2% vs. 13.7%, p=0.002) (Figure 1). When performing a binary logistic regression, including traditional CVRFs and disease activity, it was found that a high disease activity was the only independent predictor for the presence of LVDD, with an OR 4.70, (95% CI 1.63-13.50, p=0.004).

Conclusion: Patients with RA and LVDD have higher disease activity, so emphasis should be placed on strict antirheumatic treatment to achieve disease control and therefore avoid the risk of developing a CVD and the progression to heart failure.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-disease-activity-on-left-ventricular-diastolic-dysfunction-in-rheumatoid-arthritis-patients/