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Abstract Number: 508

Non-Invasive Evaluation of Left Atrial Pressure in Hispanic Patients with Rheumatoid Arthritis: A Case-Control Study

José R. Azpiri-López1, Dionicio A. Galarza-Delgado2, Iris J. Colunga-Pedraza3, Jose A. Davila-Jimenez4, Estefania E. Abundis-Marquez4, Andres H. Guillen-Lozoya4, Francisco J. Torres-Quintanilla4, Aldo Valdovinos-Bañuelos4, Ray Ramos-Cázares4, Raymundo Vera-Pineda4, Jesus A. Cardenas-de la Garza4, Rosa I. Arvizu-Rivera4 and Adrián Martínez-Moreno4, 1Cardiology, Hospital Universitario, UANL, Monterrey, Mexico, 2Chief of Rheumatology, Hospital Universitario, UANL, Monterrey, Mexico, 3Rheumatology, Hospital Universitario, UANL, Monterrey, Mexico, 4Hospital Universitario, UANL, Monterrey, Mexico

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: , , ,

Session Information

Date: Sunday, October 21, 2018

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.

  1. 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.
  2. Maloberti A, et al. Association Between Atrial, Ventricular and Vascular Morphofunctional Alterations in RA. High Blood Press Cardiovasc Prev. 2018;25(1):97–104.

Table 1. Demographic and Clinical characteristics

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

Table 2. Echocardiographic findings

RA

Control

P

(n=80)

(n=54)

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

LAP – Left atrial pressure, LV – Left ventricle, NS – Non-significant

Disclosure: J. R. Azpiri-López, None; D. A. Galarza-Delgado, None; I. J. Colunga-Pedraza, None; J. A. Davila-Jimenez, None; E. E. Abundis-Marquez, None; A. H. Guillen-Lozoya, None; F. J. Torres-Quintanilla, None; A. Valdovinos-Bañuelos, None; R. Ramos-Cázares, None; R. Vera-Pineda, None; J. A. Cardenas-de la Garza, None; R. I. Arvizu-Rivera, None; A. Martínez-Moreno, None.

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 9). https://acrabstracts.org/abstract/non-invasive-evaluation-of-left-atrial-pressure-in-hispanic-patients-with-rheumatoid-arthritis-a-case-control-study/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/non-invasive-evaluation-of-left-atrial-pressure-in-hispanic-patients-with-rheumatoid-arthritis-a-case-control-study/