Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland.
Wojewódzki Zespół Specjalistyczny, Rzeszów, Poland.
Clin Rheumatol. 2019 Apr;38(4):1131-1137. doi: 10.1007/s10067-018-4369-7. Epub 2018 Dec 12.
INTRODUCTION/OBJECTIVES: Patients with rheumatoid arthritis (RA) are at increased risk for congestive heart failure (CHF) and left ventricular diastolic dysfunction (LVDD), as compared to the general population. High disease activity is to be associated with higher incidence of cardiovascular disease (CVD), CHF, and mortality in RA patients. LVDD is not anticipated in RA patients without CVD symptoms and may be underdiagnosed especially in those with low disease activity.
The study group consisted of 70 RA patients (54 women, 16 men) with no CVD and 33 healthy controls, of comparable age. All RA patients had low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. Laboratory and imaging assessments included metabolic, RA-related, and cardiovascular parameters. Echocardiographic and Doppler studies were conducted in patients and controls with assessment of ejection fraction (EF) and diastolic dysfunction (assessed as E/A ratio).
The mean E/A ratio did not differ significantly between RA patients and healthy controls (1.08 (0.28) vs 0.99 (0.21), NS); comparable numbers of patients and controls had abnormal E/A (< 1.0) (26 (37.1%) vs 10 (30.3%), NS). Patients with decreased E/A were significantly older and had higher disease duration, activity, and presence of bone erosions than their RA counterparts with normal E/A. The mean EF was not significantly different in patients and controls.
The prevalence of DD as expressed by E/A ratio in RA patients with continued low disease activity was not different from that of controls. Higher disease duration and severity may predispose to DD occurrence in patients with preserved EF.
简介/目的：与普通人群相比，类风湿关节炎（RA）患者发生充血性心力衰竭（CHF）和左心室舒张功能障碍（LVDD）的风险增加。疾病活动度高与 RA 患者心血管疾病（CVD）、CHF 和死亡率的发生率增加相关。RA 患者无 CVD 症状时不预期发生 LVDD，尤其是疾病活动度低的患者，LVDD 可能被漏诊。
研究组包括 70 名 RA 患者（54 名女性，16 名男性）和 33 名健康对照者，年龄相当。所有 RA 患者的疾病活动度均较低（DAS28≤3.2），持续 2-7 年。实验室和影像学评估包括代谢、与 RA 相关和心血管参数。对患者和对照者进行超声心动图和多普勒研究，评估射血分数（EF）和舒张功能障碍（以 E/A 比值评估）。
RA 患者和健康对照者的平均 E/A 比值无显著差异（1.08（0.28）比 0.99（0.21），NS）；异常 E/A（<1.0）的患者和对照者数量相当（26 名[37.1%]比 10 名[30.3%]，NS）。E/A 降低的患者明显比 E/A 正常的 RA 患者年龄更大，疾病持续时间、活动度和骨侵蚀程度更高。患者和对照者的平均 EF 无显著差异。
在持续低疾病活动度的 RA 患者中，E/A 比值表示的 DD 患病率与对照者无差异。较长的疾病持续时间和严重程度可能使 EF 正常的患者更容易发生 DD。
