Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Arthritis Res Ther. 2021 Sep 24;23(1):247. doi: 10.1186/s13075-021-02629-1.
Disturbances of diastolic function precede systolic heart failure and, although clinically silent, represent the earliest sign of cardiac involvement. Diastolic dysfunction (DD) is associated with age, gender (female), and hypertension. However, little is known about the age-specific incidence rates and risk factors for DD in patients with rheumatoid arthritis (RA).
We used standard two-dimensional/Doppler echocardiography to screen for the presence of diastolic dysfunction in 61 patients with RA and 107 healthy subjects. All participants were premenopausal women with no history of hypertension. DD includes an impaired relaxation with or without increased left ventricular (LV) filling pressures, pseudonormal filling, and restrictive filling based on parameters measured using echocardiography.
The two groups were similar with respect to age (P=0.269). Patients with RA had significantly higher LV mass index, LV filling pressure, and lower E/A velocity than controls. All patients had preserved ejection fraction (EF ≥50%). DD was more common in patients with RA at 47% compared to 26% in the controls (P=0.004). Women with RA in the 30- to 49-year age range were over 3.5 times more likely to have DD than those of similar age in the control group (OR=3.54; 95% CI 1.27 to 9.85). Among patients with RA, high CRP levels were independently associated with DD even after adjustment for cardiovascular risk factors (P=0.009).
In premenopausal women with RA, DD is much more common and the age of onset is reduced. Early screening of myocardial function may provide an opportunity for preventing future cardiovascular disease.
舒张功能障碍先于收缩性心力衰竭发生，尽管临床上无症状，但它代表了心脏受累的最早迹象。舒张功能障碍（DD）与年龄、性别（女性）和高血压有关。然而，对于类风湿关节炎（RA）患者中，DD 的年龄特异性发病率和危险因素知之甚少。
我们使用标准的二维/多普勒超声心动图筛查 61 例 RA 患者和 107 例健康对照者是否存在舒张功能障碍。所有参与者均为绝经前女性，无高血压病史。DD 包括舒张期松弛功能障碍，伴或不伴左心室（LV）充盈压升高、假性正常充盈和限制性充盈，这些参数是通过超声心动图测量得出的。
两组在年龄方面相似（P=0.269）。RA 患者的 LV 质量指数、LV 充盈压显著高于对照组，E/A 速度较低。所有患者的射血分数（EF≥50%）均正常。RA 患者的 DD 发生率为 47%，明显高于对照组的 26%（P=0.004）。30-49 岁年龄组的 RA 女性发生 DD 的可能性是对照组同龄女性的 3.5 倍以上（OR=3.54；95%CI 1.27 至 9.85）。在 RA 患者中，即使在调整心血管危险因素后，高 CRP 水平仍与 DD 独立相关（P=0.009）。
在绝经前的 RA 女性中，DD 更为常见，发病年龄更早。早期心肌功能筛查可能为预防未来心血管疾病提供机会。
