Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo, Spain; Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN Del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.
Atherosclerosis. 2018 Apr;271:214-222. doi: 10.1016/j.atherosclerosis.2018.03.004. Epub 2018 Mar 2.
Cardiovascular (CV) morbidity is increased in inflammatory joint diseases (IJD), as rheumatoid (RA) and psoriatic arthritis (PsA). Whereas increased prevalence of subclinical atherosclerosis has been reported in these conditions, whether an early myocardial functionality is also impaired remains unknown. The aim of this study was to evaluate the myocardial functionality by speckle-tracking echocardiography (STE) in recent onset RA and PsA patients and its potential associations with the levels of circulating CD34 cells, vitamin D, and with disease activity.
STE was used to assess the myocardial functionality in patients with very early RA (n = 41) and PsA (n = 35) without traditional CV risk factors, and 58 matched healthy controls (HC). Global longitudinal and circumferential strain (GLS and GCS) was estimated. Pulse wave velocity (PWV) and carotid intima-media thickness (cIMT) were measured as surrogate markers of atherosclerosis. Circulating CD34 counts were evaluated by flow cytometry and vitamin D levels were quantified by HPLC. Disease activity was assessed by Disease Activity Score-28 (DAS28).
RA patients exhibited impaired GLS and GCS (both p < 0.001) as compared to HC, GLS being also altered in PsA (p = 0.020 vs. HC). DAS28 was correlated to GLS (r = 0.908, p < 0.001) and GCS (r = 0.868, p < 0.001) in RA, these findings being confirmed by multivariate regression analyses adjusted for confounders and Principal Component Analyses. GLS and GCS were impaired in PsA patients with high disease activity as compared to HC, and GLS was found to be a predictor of cIMT in this condition. On the other hand, vitamin D was negatively associated with cIMT in HC (r = -0.308, p = 0.026) but not in PsA or RA, although decreased levels were observed (both p < 0.001). Vitamin D was an independent predictor of decreased CD34 levels in PsA and RA. CD34 counts negatively correlated DAS28, GLS and GCS in RA.
Subclinical myocardial dysfunction is observed in IJD patients with preserved left-ventricular function and without traditional CV risk factors. Subclinical myocardial dysfunction was found to be a very early event in IJD. Disease activity was the main predictor of myocardial strain impairment. Interestingly, myocardial function was altered and associated with cIMT also in PsA patients with high disease activity.
心血管（CV）发病率在炎性关节疾病（IJD）中增加，如类风湿关节炎（RA）和银屑病关节炎（PsA）。尽管这些疾病中已经报道了亚临床动脉粥样硬化的患病率增加，但早期心肌功能是否也受损仍不清楚。本研究的目的是通过斑点追踪超声心动图（STE）评估近期发作的 RA 和 PsA 患者的心肌功能及其与循环 CD34 细胞水平、维生素 D 和疾病活动的潜在相关性。
使用 STE 评估无传统 CV 危险因素的早期 RA（n=41）和 PsA（n=35）患者以及 58 名匹配的健康对照者（HC）的心肌功能。估计整体纵向应变（GLS）和整体圆周应变（GCS）。脉搏波速度（PWV）和颈动脉内膜中层厚度（cIMT）被测量为动脉粥样硬化的替代标志物。通过流式细胞术评估循环 CD34 计数，通过 HPLC 定量维生素 D 水平。通过疾病活动评分 28（DAS28）评估疾病活动。
与 HC 相比，RA 患者的 GLS 和 GCS 均受损（均 p<0.001），而 PsA 患者的 GLS 也受损（p=0.020 与 HC 相比）。RA 患者的 DAS28 与 GLS（r=0.908，p<0.001）和 GCS（r=0.868，p<0.001）相关，这些发现通过调整混杂因素和主成分分析的多元回归分析得到证实。与 HC 相比，高疾病活动的 PsA 患者的 GLS 和 GCS 受损，并且在这种情况下，GLS 被发现是 cIMT 的预测因子。另一方面，维生素 D 与 HC 中的 cIMT 呈负相关（r=-0.308，p=0.026），但在 PsA 或 RA 中并非如此，尽管观察到水平降低（均 p<0.001）。维生素 D 是 PsA 和 RA 中 CD34 水平降低的独立预测因子。CD34 计数与 RA 中的 DAS28、GLS 和 GCS 呈负相关。
在无传统 CV 危险因素且左心室功能正常的 IJD 患者中观察到亚临床心肌功能障碍。亚临床心肌功能障碍是 IJD 的早期事件。疾病活动是心肌应变损伤的主要预测因子。有趣的是，在高疾病活动的 PsA 患者中，心肌功能也发生改变，并与 cIMT 相关。
