Session Information
Date: Sunday, October 21, 2018
Session Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster I: Comorbidities
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
In the last several years a higher prevalence of heart failure has been described in Rheumatoid arthritis (RA) patients, particularly heart failure with preserved ejection fraction (HFpEF). Elevated left atrial pressure (LAP) may not only be a pathophysiologic substrate of symptoms in patients with HFpEF, it may also be direct prognostic markers.(1) Several studies have emphasized the importance of left atrial function in RA-patients. (2) Objective: to compare the LAP and diastolic left ventricle (LV) filling patterns between RA-patients and controls.
Methods:
A case-control study with RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and matching controls were included. Exclusion criteria: poor acoustic window, prior atherosclerotic cardiovascular (CV) disease and overlap syndromes. Patients were matched using age, sex and CV comorbidities. Transthoracic echocardiogram was performed by a board-certified cardiologist, and reviewed by two cardiologists. LAP was estimated using the Nagueh-formula [1.24 * (E/E’) + 1.9] and ASE’s guidelines were used to define elevated LAP and diastolic LV filling patterns.
Results:
A total of 80 RA-patients and 54 matched controls were included. Demographic and clinical characteristics are shown in Table 1. As shown in Table 2, the mean LAP was not significantly higher in RA-patients than controls (12.9 ± 3.6 vs 12.2 ± 2.5, P=0.18). The difference between elevated LAP prevalence was not significant among both groups (8.8% vs 5.6%, P=0.49). Abnormal diastolic LV filling pattern was more prevalent in RA-patients compared to controls. LAP showed null correlation with disease duration (r= 0.06 P= 0.64) and DAS 28-CRP (r=0.01 P=0.93).
Conclusion:
Left atrial pressure values were not different in Hispanic RA-patients evaluated when compared to controls and did not correlate with disease activity and duration. RA-patients had abnormal relaxation more frequently than controls.
- Hasenfuss G, et al. Rationale and Design of the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure Trial. J Card Fail. 2015;21(7):594–600.
- Maloberti A, et al. Association Between Atrial, Ventricular and Vascular Morphofunctional Alterations in RA. High Blood Press Cardiovasc Prev. 2018;25(1):97–104.
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Table 1. Demographic and Clinical characteristics |
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|
RA |
Control |
P |
|
|
(n=80) |
(n=54) |
||
|
Age, mean ± SD |
55.3 ± 8.6 |
53.5 ± 6.3 |
0.182 (NS) |
|
Women, n (%) |
78 (97.5) |
49 (90.7) |
0.085 (NS) |
|
Disease duration, mean ± SD |
10.5 ± 8.5 |
– |
– |
|
DAS 28-CRP, mean ± SD |
3.3 ± 1.31 |
– |
– |
|
DM type 2, n (%) |
7 (8.8) |
7 (13) |
0.434 (NS) |
|
Hypertension, n (%) |
28 (35) |
11 (20.4) |
0.067 (NS) |
|
Smoking, n (%) |
6 (7.5) |
6 (11.1) |
0.473 (NS) |
|
DAS 28-CRP – DAS 28 using C reactive protein, DM type 2 – Diabetes mellitus type 2, NS – Non-significant |
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Table 2. Echocardiographic findings |
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|
RA |
Control |
P |
||
|
(n=80) |
(n=54) |
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|
LAP (mmHg), mean ± SD |
12.9 ± 3.6 |
12.2 ± 2.5 |
0.178 (NS) |
|
|
Elevated LAP, n (%) |
7 (8.8) |
3 (5.6) |
0.490 (NS) |
|
|
E/E’, mean ± SD |
8.88 ± 2.87 |
8.3 ± 2.06 |
0.206 (NS) |
|
|
E/A, mean ± SD |
1.05 ± 0.29 |
1.06 ± 0.32 |
0.855 (NS) |
|
|
Diastolic LV filling pattern |
Normal, n (%) |
66 (82.5) |
51 (94.4) |
0.042 |
|
Impaired relaxation, n (%) |
10 (12.5) |
2 (3.7) |
0.08 (NS) |
|
|
Pseudonormal, n (%) |
4 (5) |
1 (1.9) |
0.346 (NS) |
|
|
Restrictive, n (%) |
0 (0) |
0 (0) |
NS |
|
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LAP – Left atrial pressure, LV – Left ventricle, NS – Non-significant |
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To cite this abstract in AMA style:
Azpiri-López JR, Galarza-Delgado DA, Colunga-Pedraza IJ, Davila-Jimenez JA, Abundis-Marquez EE, Guillen-Lozoya AH, Torres-Quintanilla FJ, Valdovinos-Bañuelos A, Ramos-Cázares R, Vera-Pineda R, Cardenas-de la Garza JA, Arvizu-Rivera RI, Martínez-Moreno A. Non-Invasive Evaluation of Left Atrial Pressure in Hispanic Patients with Rheumatoid Arthritis: A Case-Control Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/non-invasive-evaluation-of-left-atrial-pressure-in-hispanic-patients-with-rheumatoid-arthritis-a-case-control-study/. Accessed July 2, 2020.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/non-invasive-evaluation-of-left-atrial-pressure-in-hispanic-patients-with-rheumatoid-arthritis-a-case-control-study/