Session Type: Abstract Submissions (ACR)
Background/Purpose: Left ventricular (LV) dysfunction in rheumatoid arthritis (RA) may result, at least in part, from inflammation that may be regional and global. Therefore, therapies that reduce inflammation (anti-IL-6 therapy) may delay onset and/or slow progression of LV dysfunction. Cardiac magnetic resonance imaging (CMR) is a sensitive technique for assessing subclinical LV dysfunction. The overall goal of this pilot study was to prospectively evaluate the effect of inhibition of IL-6 on LV function and structure in patients with RA without cardiac symptoms as assessed by using CMR at 3.0 T.
Methods: Consecutive RA patients (pts) with active disease and healthy controls were enrolled. All subjects had no history or clinical findings of hypertension, cardiovascular disease, diabetes mellitus, or dyslipidemia. The RA pts who each had inadequate clinical response to methotrexate were prescribed tocilizumab (TCZ; 8 mg/kg IV every 4 wks). All subjects underwent baseline evaluation of LV function and structure, as measured by non-contrast CMR at 3.0 T. The following parameters were measured: global LV function (LV ejection fraction, end-systolic volume, end-diastolic volume, stroke volume, and cardiac output); and LV hypertrophy (absolute LV mass, LV mass index [mass/BSA]). After the baseline (BL) CMR, treatment with TCZ was initiated and pts were followed for 52 wks. Pts underwent follow-up CMR evaluation at 52 wks of treatment with TCZ. We examined differences in LV structure and function between control subjects and RA pts. We compared RA pts at BL and at 52 wks, and determined the association of LV structure and function with disease activity and severity measures.
Results: All RA pts received TCZ treatment for 52 wks. We compared 20 RA pts (100% female; mean age 53.4±10.2 y) at BL and at 52 wks, with 20 non-RA controls (100% female; mean age 54.0±4.6 y). DAS28-ESR, SDAI and swollen joint count were significantly lower in RA pts at 52 wks than at BL (p<0.0001, p<0.0001, p<0.0001, respectively). In RA pts at BL, ejection fraction (EF) was significantly lower than in controls (p=0.04), and LV mass Index was also significantly higher than in controls (p=0.05). Median EF at BL was 60.5% (25th and 75th percentiles 56.1% and 63.4%, respectively), and TCZ treatment resulted in a significant increase of EF at 52 wks (median value 64.3%; 25th and 75th percentiles 61.6% and 69.0%; p<0.0001). Median LV mass index at BL was 59.4 gm/m2 (25th and 75th percentiles 54.3 gm/m2 and 63.0 gm/m2, respectively), and TCZ treatment also resulted in a significant decrease in mass index at 52 wks (median value 48.0 gm/m2; 25th and 75th percentiles 44.1 gm/m2 and 52.1 gm/m2; p=0.0013). Percentage change in LV mass index in RA pts was significantly associated with percentage change in SDAI (r=–0.63, p=0.0028).
Conclusion: TCZ treatment contributed significantly to increasing LVEF and decreasing LV mass. Furthermore, we found a significant relationship between disease activity and measures of LV structure and function. TCZ may reduce progression of LV dysfunction and improve LV structure in association with reduced disease activity. These findings suggest that RA itself may be an important contributor to functional and structural abnormalities of LV.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tocilizumab-treatment-increases-left-ventricular-ejection-fraction-and-decreases-left-ventricular-mass-index-in-rheumatoid-arthritis-patients-without-cardiac-symptoms-assessment-by-cardiac-magnetic/