Rheumatoid arthritis (RA) is associated with increased mortality and morbidity because of accelerated atherosclerosis. The study assessed the prevalence of left and right ventricle diastolic and systolic dysfunction in outpatients with RA.
Methods
The study included 93 outpatients with RA. In all patients and control group, echocardiographic conventional and tissue Doppler (TDI) studies were conducted.
Results
In the group of RA patients, we found high prevalence of left ventricular systolic and diastolic dysfunction and right diastolic dysfunction compared with controls (13.5% vs 5.5 %, 76.3% vs 48.8% and 41.9% vs 6.6%, respectively; P < 0.001).
Rheumatoid arthritis patients and controls showed significant differences about mitral, tricuspid, and pulmonary flow velocity curves; tissue Doppler curves of the lateral and the septal myocardial walls of the left ventricle; and basal myocardial free wall of the right ventricle. There were not any correlations between inflammatory and functional disease parameters and variables of systolic and diastolic function.
Conclusions
Our study shows a high prevalence of left ventricular systolic and diastolic dysfunction in a population of outpatients affected by rheumatoid arthritis.
Aviña-ZubietaJA, ChoiHK, SadatsafaviM, . Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008; 59 (12): 1690–1697.
2.
WolfeF, MichaudK. Heart failure in rheumatoid arthritis: rates, predictors and the effect of anti-tumour necrosis factor therapy. Am J Med. 2004; 116: 305–311.
3.
NicolaPJ, Maradit-KremersH, RogerVL, . The risk of congestive heart failure in rheumatoid arthritis. Arthritis Rheum. 2005; 52 (2): 412–420.
4.
BhatiaGS, SosinMD, PatelJV, . Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden?J Am Coll Cardiol. 2006; 47: 1169–1174.
5.
AlpaslanM, OnratR, EvcikD. Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis. Clin Rheumatol. 2003; 22: 84–88.
6.
LevendogluF, TemizhanA, UgurluH, . Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatol Int. 2004; 24: 141–116.
7.
MontecuccoC, GobbiG, PerliniS, . Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol. 1999; 17: 407–412.
8.
ArslanŞ, BozkurtE, SariRA, . Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease. Clin Rheumatol. 2006; 25: 294–299.
9.
ArnettFC, EdworthySM, BlochDA, . The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31: 315–324.
10.
LangRM, BierigM, DevereuxRB, . Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18 (12): 1440–1463.
11.
ZoghbiWA, Enriquez-SaranoM, FosterE, . Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16: 777–802.
12.
QuinonesMA, OttoCM, StoddardM, . Recommendations for quantification of Doppler echocardiography. A report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002; 15: 167–184.
13.
NaguehSF, AppletonCP, GillebertTC, . Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009; 22 (2): 107–133.
14.
RudskiLG, LaiWW, AfilaloJ, . Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23 (7): 685–713.
15.
TeiC, DujardinKS, HodgeDO, . New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy. J Cardiol. 1995; 26: 357–366.
16.
TeiC, DujardinK, HodgeD, . Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr. 1996; 9: 838–847.
17.
CrowsonCS, NicolaPJ, Maraddit KremersH, . How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?Arthritis Rheum. 2005; 52: 3039–3044.
ParkYB, ChoiHK, LeeSH, . Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound. Arthritis Rheum. 2003; 46: 1714–1719.
20.
Wallberg-JonssonS, CvetkovicJT, SundqvistKG. Activation of the immune system and inflammatory activity in relation to markers of atherothrombotic disease and atherosclerosis in rheumatoid arthritis. J Rheumatol. 2002; 29: 875–882.
21.
BaconP, KitasG. The inflammation may accelerate the development of atherogenesis, thrombosis, and congestive heart disease. Ann Rheum Dis. 1994; 53: 621–623.
22.
Wallberg-JonssonS, JohanssonH, OhmanML, . Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset. J Rheumatol. 1999; 26: 2562–2571.
23.
GoldenbergJ, FerrazMB, PessoaAP. Symptomatic cardiac involvement in juvenile rheumatoid arthritis. Int J Cardiol. 1992; 34: 57–62.
24.
YndestadA, DamasJK, OieE, . Role of inflammation in the progression of heart failure. Curr Cardiol Rep. 2007; 9 (3): 236–241.
25.
GilesJT, MalayeriAA, FernandesV, . Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging. Arthritis Rheum. 2010; 62 (4): 940–951.
26.
VizzardiE, CavazzanaI, FranceschiniF, . Echocardiographic evaluation of outpatients affected by rheumatoid arthritis. G Italiano Cardiol. 2008; 9 (suppl 1-12): 140–41S.
27.
OkadaT, ShiokawaY. Cardiac lesions in collagen disease. Jpn Circ J. 1975; 39: 479–484.
28.
MorelandLW, O'DellJR. Glucocorticoids and rheumatoid arthritis: back to future?Athritis Rhematoid. 2002; 46: 2553–2563.
29.
WolfeF, MichaudK. The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial infarction predictors in rheumatoid arthritis. Arthritis and Rheumatism. 2008; 58: 2612–2621.
30.
YaziciD, TokayS, AydinS, . Echocardiographic evaluation of cardiac diastolic function in patients with rheumatoid arthritis: 5 years of follow-up. Clin Rhematol. 2008; 27: 647–650.
31.
Maradit-KremersH, NicolaPJ, CrowsonCS, . Cardiovascular death in rheumatoid arthritis: a population based study. Arthiris Rheum. 2005; 52: 722–732.
32.
ZhangZ, ZhaoP, LiA, . Effects of methotrexate on plasma cytokines and cardiac remodeling and function in postmyocarditis rats. Mediators Inflamm. 2009; 2009: 389–720.
