Increased prevalence of diastolic dysfunction in rheumatoid arthritis

Abstract

Objective To compare the prevalence of left ventricular (LV) diastolic dysfunction in subjects with and without rheumatoid arthritis (RA), among those with no history of heart failure (HF), and to determine risk factors for diastolic dysfunction in RA. Methods We conducted a cross-sectional, community-based study comparing cohorts of adult RA and non-RA subjects without a history of HF. Standard 2D/Doppler echocardiography was performed in all participants. Diastolic dysfunction was defined as impaired relaxation (with or without increased filling pressures) or advanced reduction in compliance or reversible or fixed restrictive filling. Results The study included 244 RA subjects and 1448 non-RA subjects. Mean age was 60.5 years in the RA cohort (71% female) and 64.9 years (50% female) in the non-RA cohort. The vast majority (>98%) of both cohorts had preserved ejection fraction (EF≥50%). Diastolic dysfunction was more common in RA subjects at 31% compared to 26% (age and sex adjusted) in non-RA subjects (OR 1.6; 95% CI 1.2, 2.4). RA subjects had significantly lower LV mass, higher pulmonary arterial pressure, and higher left atrial volume index than non-RA subjects. RA duration and IL-6 level were independently associated with diastolic dysfunction in RA even after adjustment for cardiovascular risk factors. Conclusion Subjects with RA have a higher prevalence of diastolic dysfunction than those without RA. RA duration and IL-6 are independently associated with diastolic dysfunction suggesting the impact of chronic autoimmune inflammation on myocardial function in RA. Clinical implications of these findings require further investigation.

Targeting Inflammation in Heart Failure with Histone Deacetylase Inhibitors

“…Furthermore, there are no FDA-approved drugs for HFpEF, and current standards-ofcare for systolic heart failure provide little benefit to patients with this condition (71,72). Interestingly, patients with rheumatoid arthritis were recently shown to have increased prevalence of diastolic cardiac dysfunction, providing an additional link between inflammation and HFpEF (73). Post-MI remodeling is another indication for which efficacy of HDAC inhibitors could be addressed easily, and these trials could be patterned after the recent study of anakinra in patients with STEMI (9).…”

Artrite reumatóide e doença cardiovascular na atualidade: o que sabemos sobre essa associação e o que podemos fazer pelo paciente?

“…A mesma tendência de mortalidade também observase após 6 meses de seguimento no grupo AR (OR = 1,94, IC 95%, 1,17-3,23) 7 . Por último, pacientes com AR apresentam maior chance de desenvolverem insuficiência cardíaca com fração de ejeção de ventrículo esquerdo preservada comparado à indivíduos sem AR (OR = 2,57, IC 95%, 1,20-5,49) 7,26 . Estudo recente com seguimento médio de 25 anos mostrou que após esse período cerca de 31% dos pacientes com AR apresentavam diagnóstico de insuficiência cardíaca com fração de ejeção preservada (> 50%) em comparação à 26% dos indivíduos sem AR da mesma idade e sexo (OR = 1,6, IC 95%, 1,2-2,4).…”

“…Além disso, indivíduos com AR possuíam de maneira significativa menor índice de massa de ventrículo esquerdo, maior valor de pressão arterial pulmonar e maior volume de átrio esquerdo. O tempo de duração da AR e os níveis plasmáticos de IL-6 foram fatores independentes diretamente relacionados à maior ocorrência de insuficiência cardíaca diastólica em pacientes com AR 26 .…”

“…As atuais evidências mostram que em relação a desfechos clínicos o completo controle da atividade inflamatória parece ser mais importante que quaisquer efeitos colaterais das medicações 7 ; 10) Pacientes com AR devem ser constantemente reavaliados quanto à sintomas de insuficiência cardíaca, e tratados adequadamente quando necessário. Lembramos que na maioria dos casos a disfunção é apenas diastólica 26 .…”

Noncardiac Comorbidities in Heart Failure With Preserved Ejection Fraction – A Commonly Ignored Fact –

“…RA duration and interleukin-6 concentration are independently associated with diastolic dysfunction, suggesting the effect of chronic autoimmune inflammation on myocardial function in RA. 62 …”