From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.
W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work.
J Rheumatol. 2018 Aug;45(8):1078-1084. doi: 10.3899/jrheum.170770. Epub 2018 Apr 15.
The prevalence of heart failure is increased 2-fold in patients with rheumatoid arthritis (RA); this is not explained by ischemic heart disease or other risk factors for heart failure. We hypothesized that in patients with RA without known heart disease, cardiac magnetic resonance imaging (cMRI) would detect altered cardiac structure, function, and fibrosis.
We performed 1.5-T cMRI in 59 patients with RA and 56 controls frequency-matched for age, race, and sex, and compared cMRI indices of structure, function, and fibrosis [late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV)] using Mann-Whitney U tests and linear regression, adjusting for age, race, and sex.
Most patients with RA had low to moderate disease activity [28-joint count Disease Activity Score-C-reactive protein median 3.16, interquartile range (IQR) 2.03-4.05], and 49% were receiving anti-tumor necrosis factor agents. Left ventricular (LV) mass, LV end-diastolic and -systolic volumes indexed to body surface area, and LV ejection fraction and left atrial size were not altered in RA compared to controls (all p > 0.05). Measures of fibrosis were not increased in RA: LGE was present in 2 patients with RA and 1 control subject; native T1 mapping was similar comparing RA and control subjects, and ECV (median, IQR) was lower (26.6%, 24.7-28.5%) in patients with RA compared to control subjects (27.5%, 25.4-30.4%, p = 0.03).
cMRI measures of cardiac structure and function were not significantly altered, and measures of fibrosis were similar or lower in RA patients with low to moderate disease activity compared to a matched control group.
类风湿关节炎（RA）患者心力衰竭的患病率增加了 2 倍；这不能用缺血性心脏病或心力衰竭的其他危险因素来解释。我们假设，在没有已知心脏病的 RA 患者中，心脏磁共振成像（cMRI）将检测到心脏结构、功能和纤维化的改变。
我们对 59 例 RA 患者和 56 例年龄、种族和性别相匹配的对照患者进行了 1.5-T cMRI 检查，并使用 Mann-Whitney U 检验和线性回归比较了 cMRI 结构、功能和纤维化指标（延迟钆增强（LGE）、原生 T1 映射和细胞外容积（ECV）），调整了年龄、种族和性别。
大多数 RA 患者的疾病活动度较低至中度[28 关节计数疾病活动评分-C 反应蛋白中位数 3.16，四分位距（IQR）2.03-4.05]，49%接受肿瘤坏死因子拮抗剂治疗。与对照组相比，RA 患者的左心室（LV）质量、LV 舒张末期和收缩末期容积与体表面积的比值以及 LV 射血分数和左心房大小均无改变（均 p > 0.05）。纤维化的测量值在 RA 中没有增加：2 例 RA 患者和 1 例对照患者存在 LGE；RA 患者和对照组的原生 T1 映射相似，RA 患者的 ECV（中位数，IQR）（26.6%，24.7-28.5%）低于对照组（27.5%，25.4-30.4%，p = 0.03）。
在低至中度疾病活动度的 RA 患者中，心脏结构和功能的 cMRI 测量值没有明显改变，纤维化的测量值相似或更低。
