Disease severity affects myocardial functions in patients with treatment‐naive early rheumatoid arthritis

Abstract

Objectives The cross‐sectional study aimed to assess myocardial functions using global longitudinal strain (GLS) echocardiography and arrhythmia parameters with treatment naive newly diagnosed rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). Methods Seventy seven newly diagnosed treatment‐naive RA patients were enrolled. Disease severity was evaluated according to rheumatoid factor (RF) and anti‐citrullinated protein antibodies (ACPA) positivity, and Disease Activity Score 28 C‐reactive protein (DAS28 CRP). Myocardial functions were assessed using conventional echocardiography and GLS technique and electrocardiogram parameters cQT and Tp‐e/cQT. Results Twenty three patients had severe disease while 54 patients were non‐severe. The Left Ventricle GLS (17.98 ± 1.24 vs 21.29 ± 1.03, P < .001), cQT (428.71 ± 9.05 vs 394.61 ± 17.83, P < .001), Tp‐e/cQT (0.19 ± 0.02 vs 0.16 ± 0.01, P < .001) for severe RA patients was reduced compared to RA non‐severe patients. Penalized maximum likelihood estimation logistic regression analysis revealed LVGLS as the only significantly independent predictor of severe RA disease (OR 0.70, CI 95% 0.52‐0.92, P = .001). Receiver operating characteristic (ROC) curves of the LVGLS was revealed 19.9 as GLS discriminative value with 88.8% positive predictive value for predicting severity. Severe RA risk increases when log‐odds value was over 0, corresponds to LVGLS value less than 18 by partial effect plots. Conclusion RA severity was associated with lower LV systolic myocardial function and increased arrhythmia parameters. Only LVGLS was significantly independent predictor of RA disease severity.

Cardiovascular comorbidity in rheumatic and musculoskeletal diseases: Where we are and how can we move forward?

“…By far the largest body of evidence about this association comes from work in the prototypic chronic inflammatory rheumatic disease, rheumatoid arthritis (RA) and the association between high‐grade inflammation and accelerated atherosclerosis. In their work, Cakmak et al 3 suggest that disease severity in treatment‐naïve patients with early RA associated with lower left ventricular function and higher arrhythmia parameters, supporting the notion that more work is needed with regard to heart failure and to sudden death in patients with RA. In their meta‐analysis of population‐based studies, Kim and Choi 4 demonstrated that patients with spondyloarthropathies (SpA) have a significantly higher risk of myocardial infarction (MI) and stroke compared to the general population; this is not as well‐documented in SpA as it is in RA but this work concurs with the continuously enlarging body of evidence that CVD is a core comorbidity across the whole spectrum of systemic inflammatory RMDs.…”

Increased Risk of Cardiovascular Diseases in Rheumatoid Arthritis: A Systematic Review

“…Rheumatologic markers can also be used to assess the severity of RA and consequently the risk of HF. This was confirmed by Çakmak et al who measured RF, anti-citrullinated protein antibodies, and DAS28 with creactive protein and concluded that lower left ventricular systolic myocardial function and higher arrhythmia measures were related to the severity of RA [36]. Left ventricular myocardial dysfunction in RA patients was also studied by Cioffi et al whose study was applied to normotensive RA patients [25].…”