Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy; National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy.
Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy.
Eur J Intern Med. 2015 May;26(4):259-67. doi: 10.1016/j.ejim.2015.02.008. Epub 2015 Mar 5.
Cardiovascular disease represents one of the most important extra-articular causes of morbidity and mortality in patients with rheumatoid arthritis (RA). Evidences showed that several cardiac structures can be affected during the course of the disease as well as abnormalities of left ventricular diastolic filling. Contrasting data are available about left ventricular mass (LVM) involvement in patients asymptomatic for cardiovascular disease. The purpose of this systematic review and meta-analysis is to summarize the effects of RA on LVM in rheumatoid arthritis patients without cardiovascular disease.
A systematic research of the current case-control studies was conducted in Medline on November 20th, 2013. Studies were included if data of measurements of LVM were reported. The pooled mean effect size estimate was calculated according to methods described by Hedges and Olkin.
Sixteen eligible studies were included in this meta-analysis. RA determines an increase of absolute and indexed LVM compared with control patients [standardized mean difference (95% CI): 0.41(0.15-0.66) and 0.47(0.32-0.62), respectively]. On the contrary, posterior wall thickness did not show a significant RA effect. Finally, a significant positive effect of RA on interventricular wall thickness was found [standardized mean difference (95% CI): 0.39 (0.07-0.71)].
Results of this meta-analysis suggest that increased absolute and indexed LVM seem to be characteristic of RA patients with a fundamental clinical significance since they are related to an increased risk of cardiovascular morbidity and mortality. Our data suggest the use of LVM as surrogate end-point for clinical trials involving RA patients.
心血管疾病是类风湿关节炎（RA）患者除关节外最重要的发病率和死亡率原因之一。有证据表明，在疾病过程中，许多心脏结构都可能受到影响，左心室舒张充盈也会出现异常。而对于无症状心血管疾病的 RA 患者的左心室质量（LVM）异常，目前的数据则存在差异。本系统回顾和荟萃分析的目的是总结 RA 对无心血管疾病的 RA 患者 LVM 的影响。
我们于 2013 年 11 月 20 日在 Medline 上进行了一项针对当前病例对照研究的系统研究。如果报告了 LVM 测量数据，则纳入研究。根据 Hedges 和 Olkin 描述的方法计算汇总平均效应大小估计值。
本荟萃分析纳入了 16 项符合条件的研究。与对照组患者相比，RA 导致 LVM 绝对值和指数增加[标准化均数差（95%CI）：0.41（0.15-0.66）和 0.47（0.32-0.62）]。相反，后壁厚度没有显示出 RA 的显著作用。最后，发现 RA 对室间隔壁厚度有显著的正效应[标准化均数差（95%CI）：0.39（0.07-0.71）]。
本荟萃分析的结果表明，增加的 LVM 绝对值和指数似乎是 RA 患者的特征，具有重要的临床意义，因为它们与心血管发病率和死亡率的增加相关。我们的数据表明，将 LVM 用作涉及 RA 患者的临床试验的替代终点。
