Sharma Abhishek, Kaushik Reshma, Kaushik Rajeev Mohan, Kakkar Rajesh
Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun, Uttarakhand , India.
Mod Rheumatol. 2015 Jul;25(4):552-7. doi: 10.3109/14397595.2014.998404. Epub 2015 Feb 11.
To assess left ventricular diastolic dysfunction (LVDD) and its predictors in rheumatoid arthritis (RA).
This cross-sectional case-control study assessed 100 RA patients and 100 healthy controls for LVDD by M-mode, two-dimensional, colour Doppler echocardiography.
RA patients had higher prevalence of LVDD than controls (43% vs. 14%; p < 0.001). LVDD had significant association with duration (p = 0.033), severity of disease activity (p < 0.0001), Steinbrocker stage and functional class (p < 0.0001 each) and non-adherence to treatment (p = 0.047). Peak of late diastolic (A) mitral flow velocity and isovolumic relaxation time (IVRT) were higher (p < 0.05 each), whereas left ventricular ejection fraction, peak of early diastolic (E) mitral flow velocity and E/A ratio were lower (p < 0.05 each) in RA patients than in controls. Deceleration time (DT) was not significantly different in the two groups (p = 0.623). E/A ratio had significant correlation with anti-cyclic citrullinated peptide antibody (ACPA) (r = 0.233, p = 0.019) and age (r = 0.203, p = 0.042). IVRT had significant negative correlation with ACPA (r = -0.196, p = 0.044), while DT had significant correlation with Disease Activity Score with 28-joint (DAS28) counts (r = 0.244, p = 0.014). ACPA was an independent predictor of E/A ratio (p = 0.031). DAS28 was the only independent predictor of LVDD (odds ratio [OR] = 6.01; p = 0.007).
LVDD occurred commonly in RA patients and depended on severity of disease activity.
评估类风湿关节炎（RA）患者的左心室舒张功能障碍（LVDD）及其预测因素。
本横断面病例对照研究通过M型、二维、彩色多普勒超声心动图对100例RA患者和100例健康对照者进行LVDD评估。
RA患者LVDD的患病率高于对照组（43%对14%；p<0.001）。LVDD与病程（p = 0.033）、疾病活动严重程度（p<0.0001）、Steinbrocker分期和功能分级（各p<0.0001）以及治疗依从性差（p = 0.047）显著相关。RA患者的舒张晚期（A）二尖瓣血流速度峰值和等容舒张时间（IVRT）较高（各p<0.05），而左心室射血分数、舒张早期（E）二尖瓣血流速度峰值和E/A比值较低（各p<0.05）。两组的减速时间（DT）无显著差异（p = 0.623）。E/A比值与抗环瓜氨酸肽抗体（ACPA）（r = 0.233，p = 0.019）和年龄（r = 0.203，p = 0.042）显著相关。IVRT与ACPA显著负相关（r = -0.196，p = 0.044），而DT与28个关节疾病活动评分（DAS28）计数显著相关（r = 0.244，p = 0.014）。ACPA是E/A比值的独立预测因素（p = 0.031）。DAS28是LVDD的唯一独立预测因素（比值比[OR]=6.01；p = 0.007）。
LVDD在RA患者中常见，且取决于疾病活动的严重程度。
