Treatment-na•ve,
early rheumatoid arthritis patients demonstrate abnormalities of vascular and
myocardial function on cardiac MRI

B Erhayiem, A McDiarmid, PP Swoboda, A Kidambi, DP Ripley, TA
Musa, LE Dobson, P Garg, S Horton, R Dumitru, J Andrews, JP Greenwood, P Emery, S Plein, MH Buch

Background/Purpose:Cardiac studies of
patients with rheumatoid arthritis (RA) have demonstrated abnormalities in left
ventricular (LV) remodelling that is associated with development of heart
failure and cardiovascular morbidity/mortality. No studies have evaluated
changes in LV myocardial and vascular function in treatment-na•ve early RA
(ERA). We evaluated whether patients with treatment-na•ve
ERA demonstrate myocardial and vascular changes on cardiac MRI (CMR) compared
with matched controls.

Methods: Eighty ERA patients (ACR/EULAR classification
criteria) without CVD history underwent 3.0T CMR at a dedicated cardiology-CMR
unit. Patient eligibility: symptoms for less than 1 year, DMARD treatment-na•ve,
minimum disease activity score (DAS28) ³ 3.2. Thirty healthy controls were
matched by age, sex and blood pressure. CMR protocol determined aortic distensibility (AD), LV dimensions, ventricular performance,
strain analysis and extracellular volume (ECV; associated with diffuse
myocardial fibrosis).

Results: Patients
in ERA and control groups were of similar mean(SD) age [49.4(13.08) and 50(15)
respectively, p=0.67] and systolic BP [123(16) and 120(13) respectively, p=0.43].
Median(IQR) ESR, CRP and mean(SD) DAS28 were 31(31)mm/hr, 8(23)mg/L and 5.6(1.5) respectively. 66(85%) and
59(76%) patients were ACPA and RF positive respectively. 17(21%) and 4913%)
were current smokers in the ERA and control groups respectively.

Table 1 details CMR parameters. Aortic distensibility
was significantly reduced in ERA patients compared to controls (median±IQR, 3.3±2.15 10^-3mmHg^-1 versus
4.7±2.0 10^-3mmHg^-1, p<0.001). Other measures of
arterial stiffness showed similar significant differences. Significant change in
LV geometry was observed with lower LVmass index in
the ERA group compared with controls. Significantly greater ECV and lower T1 were
also recorded in the ERA group. Evidence for overt inflammation/fibrosis was
seen in 6 patients with areas of focal non-ischaemic patterns of LGE.

Conclusion: This is a first CMR study on treatment-naive ERA patients that demonstrates abnormalities in vascular
function, myocardial tissue composition and LV geometry; associated with poorer
outcomes. These observations highlight presence of CV risk at the earliest
stages of RA. Further investigation will determine the natural history
including whether effective therapy can modulate these abnormalities.

Table 1: CMR
findings between RA patients and controls. Data
presented as mean±SD
unless otherwise stated. ECV=extra-cellular volume, EDV=End-diastolic volume,
EF=Ejection fraction, LGE=Late-gadolinium enhancement, LV=Left ventricle