Session Type: Abstract Submissions (ACR)
Patients with rheumatoid arthritis (RA) experience an excess risk of congestive heart failure (CHF), but effects of disease-modifying anti-rheumatic drugs (DMARDs) on cardiac structure and function are uncertain. Cardiac magnetic resonance imaging (CMR) has been used to identify early functional and structural changes in the left ventricle (LV) before development of clinically overt CHF. We evaluated LV function and structure using a CMR in RA patients (pts) without cardiac symptoms, and determined the impact of non-biologic and biologic DMARDs (bDMARDs).
Consecutive RA pts and healthy control without a history or clinical findings of hypertension, cardiovascular disease, diabetes, or dyslipidemia were enrolled. RA pts received biologic or non-biologic DMARDs (nbDMARDs). All subjects underwent evaluation of LV function and structure using non-contrast CMR. LV function was based on LV ejection fraction (EF), end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), and cardiac output (CO). LV hypertrophy was measured by absolute LV mass (LVM) and LV mass index (LVMI) determined by LVM/body surface area. Subjects were classified into four categories based on LVMI and LVM/EDV of control subjects, with the mean + 2 SD of each measure defined as elevated LVMI and LVM/EDV.
We compared 90 female RA pts (mean age, 55.9±7.1 years) with a matched 20-patient control group (mean age, 52.7±4.6 years). 46 RA pts received nbDMARDs [43, methotrexate (MTX) (8.1±2.1mg); 3, other drugs)] and 44 RA pts received bDMARDs [(18, infliximab (3 mg/kg); 26, tocilizumab (8 mg/kg) plus MTX (8.0±1.4 mg)]. Among the RA groups, there were no significant differences in characteristics such as age, cardiovascular risk factors, RA duration, MTX dose, and proportion of corticosteroid users. The Simplified Disease Activity Index (SDAI) was significantly higher in the nbDMARDs group than in the bDMARDs group (22.3±1.5, 5.6±1.9. p=0.002). Compared to the control group, the nbDMARDs group showed significantly higher LVMI and lower EF (p<0.001, p=0.003, respectively). There were no significant differences in LVMI and EF between the control and the bDMARDs groups. LV structure was classified as (1) concentric remodeling (LVMI<66.9 and LVM/EDV>1.02); (2) concentric hypertrophy (LVMI>66.9 and LVM/EDV>1.02); (3) eccentric hypertrophy (LVMI>66.9 and LVM/EDV <1.02); and (4) normal geometry (LVMI<66.9 and LVM/EDV<1.02). Among those with abnormal LV geometry, 32% of RA patients in the nbDMARDs group showed eccentric hypertrophy. 98% of RA patients in the bDMARDs group showed normal geometry. LVMI and EF were significantly associated with SDAI (r=0.567, p<0.001; r=-0.312, p=0.003, respectively). Mass/EDV tended to be associated with SDAI (p=0.07). Adjustment for ESR did not modify the association of SDAI with EF and LVMI (p=0.017, p=0.005, respectively).
Our results showed that increased LV mass Index and decreased EF were associated with SDAI. Biologics treatment may reduce progression of subclinical LV abnormalities in association with the reduction in disease activity. It can be presumed that disease activity may be an important contributor to the development of LV abnormalities in RA.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-left-ventricular-mass-index-and-decreased-ejection-fraction-are-associated-with-disease-activity-in-rheumatoid-arthritis-patients-without-cardiac-symptoms-comparison-between-non-biolog/