Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA.
Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, USA.
Arthritis Res Ther. 2022 Aug 5;24(1):184. doi: 10.1186/s13075-022-02864-0.
Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic function and its associated RA and cardiovascular (CV) predictors.
In this study, 158 RA patients without clinical CV disease (CVD) were enrolled and followed up at 4 to 6 years, undergoing baseline and follow-up echocardiography to assess for DD, as well as extensive characterization of RA disease activity and CV risk factors. Novel measures of myocardial inflammation and perfusion were obtained at baseline only. Using baseline and follow-up composite DD (E/e', Left Atrial Volume Index (LAVI) or peak tricuspid regurgitation (TR) velocity; ≥ 1 in top 25%) as the outcome, multivariable regression models were constructed to identify predictors of DD.
DD was prevalent in RA patients without clinical heart failure (HF) (40.7% at baseline) and significantly progressed on follow-up (to 57.9%). Baseline composite DD was associated with baseline RA disease activity (Clinical Disease Activity Index; CDAI) (OR 1.39; 95% CI 1.02-1.90; p=0.034). Several individual diastolic parameters (baseline E/e' and LAVI) were associated with troponin-I and brain natriuretic peptide (BNP). Baseline and follow-up composite DD, however, were not associated with myocardial inflammation, myocardial microvascular dysfunction, or subclinical atherosclerosis.
DD is prevalent in RA patients without clinical HF and increases to >50% over time. Higher RA disease activity at baseline predicted baseline composite DD. Future longitudinal studies should explore whether adverse changes in diastolic function lead to clinical HF and are attenuated by disease-modifying antirheumatic drugs (DMARDs).
与普通人群相比，类风湿关节炎（RA）患者的舒张功能障碍（DD）更为普遍。然而，其随时间的演变及其重要的临床预测因素仍不明确。我们报告了舒张功能的基线和前瞻性变化及其与 RA 和心血管（CV）预测因素的关系。
本研究纳入了 158 例无临床 CV 疾病（CVD）的 RA 患者，并进行了 4 至 6 年的随访，进行了基线和随访超声心动图检查以评估 DD，并对 RA 疾病活动度和 CV 危险因素进行了广泛的特征描述。仅在基线时获得了心肌炎症和灌注的新测量值。使用基线和随访的复合 DD（E/e'、左心房容积指数（LAVI）或峰值三尖瓣反流（TR）速度；≥前 25%）作为结局，构建多变量回归模型以确定 DD 的预测因素。
RA 患者无临床心力衰竭（HF）时 DD 患病率较高（基线时为 40.7%），且在随访期间明显进展（至 57.9%）。基线复合 DD 与基线 RA 疾病活动度（临床疾病活动指数；CDAI）相关（OR 1.39；95%CI 1.02-1.90；p=0.034）。几个单独的舒张参数（基线 E/e'和 LAVI）与肌钙蛋白 I 和脑利钠肽（BNP）相关。然而，基线和随访的复合 DD 与心肌炎症、心肌微血管功能障碍或亚临床动脉粥样硬化无关。
RA 患者无临床 HF 时 DD 患病率较高，且随时间推移增加至>50%。基线 RA 疾病活动度较高预测了基线复合 DD。未来的纵向研究应探讨舒张功能的不良变化是否导致临床 HF，并通过疾病修饰抗风湿药物（DMARDs）来减轻。
