Five-year changes in cardiac structure and function in patients with rheumatoid arthritis compared with the general population

Davis, John M.; Lin, Grace; Oh, Jae K.; Crowson, Cynthia S.; Achenbach, Sara J.; Therneau, Terry M.; Matteson, Eric L.; Rodeheffer, Richard J.; Gabriel, Sherine E.

doi:10.1016/j.ijcard.2017.03.108

Cited by 42 publications

(44 citation statements)

References 45 publications

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“…P‐wave dispersion is considered as an electrocardiographic marker of inhomogeneous and discontinuous propagation of sinus impulses in the atrial myocardium, representing a sensitive and specific clinical predictor of AF. The left atrial volume index increased at a higher rate in the RA cohort than in the non‐RA cohort 13. In clinical studies, however, it is difficult to determine whether RA directly causes atrial remodeling or whether the observed associations are due to potential confounders.…”

Section: Discussionmentioning

confidence: 97%

“…The left atrial volume index increased at a higher rate in the RA cohort than in the non-RA cohort. 13 In clinical studies, however, it is difficult to determine whether RA directly causes atrial remodeling or whether the observed associations are due to potential confounders. Consequently, an experimental study is needed to understand the association between RA and AF.…”

Section: Relationship To Clinical Findingsmentioning

confidence: 99%

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Atrial Fibrillation Promotion in a Rat Model of Rheumatoid Arthritis

Dai

Wang

Yin

et al. 2017

JAHA

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BackgroundThe prevalence of atrial fibrillation (AF) is significantly higher in rheumatoid arthritis (RA) patients, but the underlying mechanisms remain poorly understood. The goal of this study was to assess the effects of RA on AF susceptibility and atrial arrhythmogenic remodeling in a rat model of RA.Methods and ResultsCollagen‐induced arthritis was induced in rats by immunization with type II collagen in Freund's incomplete adjuvant. Among the rats that developed arthritis, AF susceptibility and atrial remodeling were examined 8 weeks after the primary immunization. AF inducibility and duration were substantially increased in collagen‐induced arthritis rats, and AF duration was significantly and positively correlated with the serum IL‐6 and TNF‐α levels. Rats with collagen‐induced arthritis showed prolonged atrial conduction time with no changes in the atrial effective refractory period. Atrial conduction delay was accompanied by significantly increased atrial fibrosis. In addition, atrial structural and autonomic remodeling, including left atrial dilation, apoptosis and autophagy of atrial myocytes, and atrial heterogeneous sympathetic hyperinnervation, was observed. Interestingly, we found that collagen‐induced arthritis had no significant effects on connexins, Nav1.5, and the main ion channels' protein expressions in atria.ConclusionsWe demonstrated that RA increased AF susceptibility by inducing AF‐promoting atrial remodeling. This study may provide insights into mechanisms underlying RA‐induced AF and validate a model that is suitable for further mechanistic and therapeutic exploration.

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Section: Discussionmentioning

confidence: 97%

Section: Relationship To Clinical Findingsmentioning

confidence: 99%

Atrial Fibrillation Promotion in a Rat Model of Rheumatoid Arthritis

Dai

Wang

Yin

et al. 2017

JAHA

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“…140 Echocardiographic evidence of right ventricular diastolic dysfunction is common in RA, which progresses faster than in the general population, and may reflect myocardial as well as pulmonary disease. 142…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

Pulmonary Complications of Rheumatoid Arthritis

Farquhar

Vassallo

Edwards

et al. 2019

Semin Respir Crit Care Med

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Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that characteristically causes joint inflammation and damage. In addition, many patients develop extraarticular manifestations which may cause significant comorbidity and premature mortality.Some respiratory tract involvement of the upper and lower airways and parenchymal disease features are unique to RA, including cricoarytenoid arthritis and RA pulmonary nodulosis, and others, especially the interstitial parenchymal involvement, occur in many other idiopathic and autoimmune diseases. The pathophysiology of lung disease is not well understood. Rheumatoid lung disease may even predate the onset of joint disease, and could be triggered by chronic airway and alveolar epithelial injury. Chronic systemic inflammation and risk factors such as cigarette smoking, infection, host genetics, and immune dysregulation are contributors. Treatment of the respiratory disease is directed at reducing the systemic inflammation of RA. Less well understood is the management of the interstitial lung disease of RA, for which antifibrotic and immune suppressive agents may be helpful. The management of RA-related lung disease is perhaps the major remaining hurdle in reduction of the disease burden related to extraarticular manifestations of this disease.

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“…[14] ДД ЛЖ обнаружена у 48% больных ранним РА с умеренной или высокой активностью. При 5-летнем проспективном наблюдении после поправки на наличие АГ и ожирения показано, что диастолическая функция при РА ухудшается быстрее, чем в контроле [24]. Прогрессирование ДД зависело от индекса RAPID3 (инструмента оценки воспалительной активности и функционального статуса больных РА).…”

Section: эхокардиографические особенности диагностики хронической серunclassified

Chronic Heart Failure in Rheumatoid Arthritis Patients (Part II): Difficulties of Diagnosis

Новикова¹,

Udachkina²,

Kirillova³

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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Rheumatoid arthritis (RA) is characterized by a twofold increase in morbidity and mortality due to chronic heart failure (CHF). At the same time, the prevalence of CHF among RA patients is significantly underestimated. The aim of the review was to analyze the results of the main studies on the features of the clinical presentation of heart failure (HF) in RA patients, the role of visualization techniques and biomarkers in the diagnosis of HF and preclinical dysfunction of the myocardium. HF in patients with RA is characterized by a predominance of HF with a preserved left ventricular ejection fraction (LVEF). The use of clinical diagnostic criteria in RA patients can lead to both over- or underdiagnosis of CHF. Systolic dysfunction estimated by LVEF is rare in RA and does not reflect the real frequency of myocardial dysfunction. Echocardiography (ECHO-CG) with tissue Doppler echocardiography (TDE) and visualization of myocardial deformation, magnetic resonance imaging (MRI) of the heart in RA patients revealed a high frequency of HF with preserved ejection fraction, left ventricular remodeling and hypertrophy, pre-clinical systolic and diastolic dysfunction. Determination of natriuretic peptides is useful for verifying the diagnosis of HF and estimating the prognosis in this cohort, despite the possible decrease in the sensitivity and specificity of these indicators in RA patients. The review discusses the advantages of MRI of the heart, including quantitative T1 and T2 regimens, in the diagnosis of myocarditis, myocardial fibrosis, and myocardial perfusion disorders in RA patients. In order to verify the diagnosis of heart failure and detect pre-clinical myocardial dysfunction in RA patients, the determination of natriuretic peptides concentration should become part of the routine examination, beginning with the debut of the disease, along with the collection of a cardiological history, physical examination, ECHO-CT with TDE, and visualization of myocardial deformation. Evaluation of the quantitative characteristics of tissue according to MRI of the heart could improve the diagnosis of myocardial damage.

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Five-year changes in cardiac structure and function in patients with rheumatoid arthritis compared with the general population

Cited by 42 publications

References 45 publications

Atrial Fibrillation Promotion in a Rat Model of Rheumatoid Arthritis

Atrial Fibrillation Promotion in a Rat Model of Rheumatoid Arthritis

Pulmonary Complications of Rheumatoid Arthritis

Chronic Heart Failure in Rheumatoid Arthritis Patients (Part II): Difficulties of Diagnosis

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