University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK; Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK.
Hellenic J Cardiol. 2019 Jan-Feb;60(1):28-35. doi: 10.1016/j.hjc.2018.01.008. Epub 2018 Jan 31.
Rheumatoid arthritis (RA) is a multisystem, autoimmune disorder and confers one of the strongest risks for cardiovascular disease (CVD) morbidity and mortality.
To assess myocardial function and vascular stiffness in RA patients with and without cardiovascular risk factors (CVRFs) using cardiovascular magnetic resonance (CMR).
Twenty-three RA patients with no CVRFs (17 female, mean age 52 ± 13 years), 46 RA patients with CVRFs (32 female, mean age 53 ± 12), 50 normal controls (32 female, mean age 50 ± 11 years), and 13 controls with CVRFs (7 female, mean age 55 ± 7 years), underwent CMR at 1.5 Tesla, including evaluation of left ventricular (LV) ejection fraction, strain, and vascular elasticity (aortic distensibility [AD] and pulse wave velocity [PWV]). Disease activity and duration were recorded for each patient. Subjects with known symptomatic CVD were excluded.
LV volumes, mass, and ejection fraction were similar in the four groups. RA patients with CVRFs showed the greatest abnormality in mid short-axis circumferential systolic strain, peak diastolic strain rate, and vascular indices. RA patients without CVRFs showed a similar degree of vascular dysfunction and deformational abnormality as controls with CVRFs. AD and total PWV correlated with myocardial strain and RA disease activity. On multivariate regression analysis, strain was related to age, RA disease activity, AD, and PWV.
CMR demonstrates impaired myocardial deformation and vascular function in asymptomatic RA patients, worse in those with CVRFs. Subclinical cardiovascular abnormalities are frequent and appear to be incremental to those due to traditional CVRFs and likely contribute to the excess CVD in RA.
类风湿关节炎（RA）是一种多系统自身免疫性疾病，可导致心血管疾病（CVD）发病率和死亡率的风险最高之一。
使用心血管磁共振（CMR）评估有无心血管危险因素（CVRF）的 RA 患者的心肌功能和血管僵硬程度。
23 名无 CVRF 的 RA 患者（17 名女性，平均年龄 52±13 岁）、46 名有 CVRF 的 RA 患者（32 名女性，平均年龄 53±12 岁）、50 名正常对照者（32 名女性，平均年龄 50±11 岁）和 13 名有 CVRF 的对照者（7 名女性，平均年龄 55±7 岁）在 1.5 Tesla 磁共振仪上进行 CMR，包括评估左心室（LV）射血分数、应变和血管弹性（主动脉可扩张性[AD]和脉搏波速度[PWV]）。记录每位患者的疾病活动度和病程。排除已知有症状 CVD 的患者。
四组的 LV 容积、质量和射血分数相似。有 CVRF 的 RA 患者的中短轴圆周收缩期应变、峰值舒张应变率和血管指数异常最明显。无 CVRF 的 RA 患者的血管功能障碍和变形异常与有 CVRF 的对照组相似。AD 和总 PWV 与心肌应变和 RA 疾病活动度相关。多元回归分析显示，应变与年龄、RA 疾病活动度、AD 和 PWV 相关。
CMR 显示无症状 RA 患者存在心肌变形和血管功能障碍，有 CVRF 的患者更严重。亚临床心血管异常很常见，且似乎与传统 CVRF 相关的异常呈递增关系，并可能导致 RA 患者 CVD 发生率过高。
