Giles Jon T, Malayeri Ashkan A, Fernandes Veronica, Post Wendy, Blumenthal Roger S, Bluemke David, Vogel-Claussen Jens, Szklo Moyses, Petri Michelle, Gelber Allan C, Brumback Lyndia, Lima João, Bathon Joan M
Johns Hopkins University, Baltimore, Maryland 21224, USA.
Arthritis Rheum. 2010 Apr;62(4):940-51. doi: 10.1002/art.27349.
Heart failure is a major contributor to cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA), but little is known about myocardial structure and function in this population. This study was undertaken to assess the factors associated with progression to heart failure in patients with RA.
With the use of cardiac magnetic resonance imaging, measures of myocardial structure and function were assessed in men and women with RA enrolled in the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis study, a cohort study of subclinical cardiovascular disease in patients with RA, in comparison with non-RA control subjects from a cohort enrolled in the Baltimore Multi-Ethnic Study of Atherosclerosis.
Measures of myocardial structure and function were compared between 75 patients with RA and 225 frequency-matched controls. After adjustment for confounders, the mean left ventricular mass was found to be 26 gm lower in patients with RA compared with controls (P < 0.001), an 18% difference. In addition, the mean left ventricular ejection fraction, cardiac output, and stroke volume were modestly lower in the RA group compared with controls. The mean left ventricular end systolic and end diastolic volumes did not differ between the groups. In patients with RA, higher levels of anti-cyclic citrullinated peptide (anti-CCP) antibodies and current use of biologic agents, but not other measures of disease activity or severity, were associated with significantly lower adjusted mean values for the left ventricular mass, end diastolic volume, and stroke volume, but not with ejection fraction. The combined associations of anti-CCP antibody level and biologic agent use with myocardial measures were additive, without evidence of interaction.
These findings suggest that the progression to heart failure in RA may occur through reduced myocardial mass rather than hypertrophy. Both modifiable and nonmodifiable factors may contribute to lower levels of left ventricular mass and volume.
心力衰竭是类风湿关节炎（RA）患者心血管疾病发病率和死亡率的主要促成因素，但对于该人群的心肌结构和功能知之甚少。本研究旨在评估与RA患者发生心力衰竭进展相关的因素。
在类风湿关节炎亚临床心血管疾病评估及事件预测研究（一项针对RA患者亚临床心血管疾病的队列研究）中，使用心脏磁共振成像对纳入研究的RA男性和女性患者的心肌结构和功能进行评估，并与参加巴尔的摩多民族动脉粥样硬化研究队列中的非RA对照受试者进行比较。
比较了75例RA患者和225例频率匹配的对照者的心肌结构和功能指标。在对混杂因素进行调整后，发现RA患者的平均左心室质量比对照组低26克（P < 0.001），差异为18%。此外，RA组的平均左心室射血分数、心输出量和每搏输出量均略低于对照组。两组间的平均左心室收缩末期和舒张末期容积无差异。在RA患者中，抗环瓜氨酸肽（抗CCP）抗体水平较高和当前使用生物制剂，但不是其他疾病活动或严重程度指标，与左心室质量、舒张末期容积和每搏输出量的调整后平均值显著降低相关，但与射血分数无关。抗CCP抗体水平和生物制剂使用与心肌指标的联合关联是相加的，没有相互作用的证据。
这些发现表明，RA患者发生心力衰竭的进展可能是通过心肌质量降低而非肥厚。可改变和不可改变的因素都可能导致左心室质量和容积降低。
