Session Information
Date: Sunday, November 5, 2017
Title: Rheumatoid Arthritis – Clinical Aspects I: Cardiac Comorbidities
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose:
Patients with RA are prone to develop myocardial dysfunction, in which chronic inflammation is suggested to play an important role. We have previously shown myocardial abnormalities on cardiac MRI (cMRI) in active RA.
Methods:
We collected 2 RA groups: a) patients with untreated active early RA (ERA; n=30) starting conventional synthetic DMARDs (csDMARDs, n=28) or biological DMARDs (bDMARDs, n=2) and b) patients with CRA (n=28) with active RA and were candidates for bDMARDs. Patients with coronary artery disease, diabetes or smoking, and aged >70 years were excluded. Before and after one-year DMARD therapy, the patients (n=58) underwent cMRI. Sex and age-matched 22 FM patients and 35 healthy volunteers underwent cMRI once. cMRI (1.5T or 3T) included analyses of T1 relaxation times, late gadolinium enhancement (LGE), and cardiac functions.
Results:
Of ERA patients, 77% used csDMARDs combinations (60% used MTX-SSZ-HCQ combination). Of CRA patients, 86% used anti-TNF therapy. In RA patients, LGE was detected as frequently at baseline as at follow-up (67%). None of FM patients had LGE. Over time, DAS28-crp (mean+SD) declined in ERA (3.7+1.0 vs 2.0+1.0; p<0.001) and in CRA (3.3+1.1 vs 2.6+0.9; p=0.002). At baseline, cardiac function was impaired in RA patients compared with FM patients or healthy volunteers. In RA patients, cardiac function improved over study-period (Table 1). ERA patients experienced improvement in LV TPFR (496+96 mms vs 445+126; p=0.010) and in RV ESV (36+8 ml/m2 vs 34+7; p=0.043). In CRA, no significant improvement was observed in cardiac functions. T1 time did not improve in ERA patients, but it improved in nine CRA patients who underwent 3.0 T cMRI (1168+21 ms vs 1125+67; p=0.044).
Table1. Cardiac MRI in RA patients (n=58) over study-period
|
Baseline mean+SD |
Follow-up mean+SD |
p-value |
|
|
LV EF% |
59+4 |
59+5 |
0.477 |
|
LV ESV, ml/m2 |
34+6 |
33+8 |
0.449 |
|
LV EDV, ml/m2 |
82+11 |
81+11 |
0.645 |
|
LV TPFR, ms |
472+99 |
445+106 |
0.035 |
|
LV mass (mg/m2) |
52+11 |
54+17 |
0.568 |
|
SV index, ml/ m2 |
48+6 |
48+6 |
0.929 |
|
RV EF% |
59+6 |
60+6 |
0.065 |
|
RV ESV, ml/m2 |
34+9 |
32+8 |
0.006 |
|
RV EDV, ml/m2 |
81+12 |
78+11 |
0.022 |
|
T1 relaxation time (1.5T cMRI) (n=22) |
1038+90 |
1047+76 |
0.274 |
|
T1 relaxation time (3.0T cMRI) (n=28) |
1122+81 |
1113+81 |
0.395 |
LV= left ventricle, RV=right ventricle, ESV = end-systolic volume, EDV=end-diastolic volume, SV=stroke volume, EF = ejection fraction, TPFR = time to peak filling rate
Conclusion:
Patients with active RA show myocardial abnormality on cMRI at baseline: prolonged myocardial T1 relaxation times suggesting diffuse inflammation or fibrosis, LGE indicating local myocardial scars, and impairments of myocardial functions. After 1-year treatment, targeting to remission, myocardial functions improved in early RA patients in parallel with decreasing RA activity. In some CRA patients, T1 time improved. Active rheumatological inflammation seems to be deleterious to the myocardium.
To cite this abstract in AMA style:
Koivuniemi R, Holmström M, Kuuliala A, Kivistö S, Leirisalo-Repo M. Myocardial Abnormalities Improve in RA Patients Treated Actively – a Cardiac MRI Follow-up Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/myocardial-abnormalities-improve-in-ra-patients-treated-actively-a-cardiac-mri-follow-up-study/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/myocardial-abnormalities-improve-in-ra-patients-treated-actively-a-cardiac-mri-follow-up-study/