Infliximab, an anti-TNF-alpha agent, improves left atrial abnormalities in patients with rheumatoid arthritis: preliminary results : cardiovascular topic

Abstract

SummaryBackgroundRheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study, we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further, we tried to demonstrate the effects of infliximab, an anti-TNFalpha agent, on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction.MethodsWe compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further, we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment, this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE), and (2) electrocardiographic P-wave changes.ResultsThe values of C-reactive protein (CRP), isovolumic relaxation time (IVRT), A wave, and deceleration time (DT) were significantly higher in RA patients compared to the control group (p < 0.05), whereas E/E′ and E/A values were found to be lower (p < 0.05) in RA patients. E/E′ values were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). After three months of infliximab and prednisolone treatment, CRP and disease activity score (DAS 28) values decreased in both groups (p < 0.05), and Duke activity status index (DASI) increased (p < 0.05). Maximal left atrial volume index (LAVImax), pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p < 0.05), whereas LA global strain was found to be lower (p < 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E′, LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p < 0.05). At baseline in both treatment groups, E/E′ and LA global late diastolic strain rate were lower in prednisolone-compared to infliximab-treated patients (p < 0.05).ConclusionThere was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by electrocardiography. Infliximab therapy for a period of three months improved LA abnormality.

The Impact of Biologics and Tofacitinib on Cardiovascular Risk Factors and Outcomes in Patients with Rheumatic Disease: A Systematic Literature Review

“…Data on patients with RA treated with infliximab were obtained from four RCTs (three full-length articles [ 54 – 56 ] and two conference abstracts [ 57 , 58 ]), 11 PCs (11 full-length articles [ 35 , 59 – 68 ] and one conference abstract [ 69 ]), and five RCs (four full-length articles [ 38 , 49 , 51 , 70 ] and one conference abstract [ 19 ]). Data from several studies showed that treatment with infliximab resulted in significant increase in TC [ 54 , 57 – 63 , 65 , 67 , 68 , 70 ], HDL-C [ 57 – 65 ], and TG [ 61 , 63 , 65 , 70 ]. Results with LDL-C and atherogenic index were mixed.…”

“…Results with LDL-C and atherogenic index were mixed. In three PC studies, there was significant increase in LDL-C for at least the first 12 weeks [ 60 , 61 , 64 ], whereas data from two RCTs [ 54 , 57 , 58 ] and two PC studies [ 65 , 67 , 68 ] showed no significant change. Significant improvement in atherogenic index was reported in one RCT [ 57 , 58 ], but significant worsening was reported in three PC studies [ 61 , 63 , 65 ], and no significant change was reported in one RCT [ 56 ] and two PC studies [ 59 , 60 ].…”

“…Significant improvement in atherogenic index was reported in one RCT [ 57 , 58 ], but significant worsening was reported in three PC studies [ 61 , 63 , 65 ], and no significant change was reported in one RCT [ 56 ] and two PC studies [ 59 , 60 ]. Several studies reported significant reduction in inflammation as determined by decreased CRP levels [ 56 , 60 , 64 , 67 , 68 , 70 ]. In one RCT [ 55 ], AIx worsened in response to infliximab treatment but showed no significant change in another [ 56 ].…”

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

“…It has been reported that radial-to-femoral systolic pressure gradient was observed during the first 10 minutes after CPB in pediatric cardiac surgery. [48] Therefore, it is expected that femoral dP/dt max may more reliably reflect the dP/dt max of central artery, and relationship between femoral and Ao dP/dt max may be different from radial-Ao dP/dt max relationship. In addition, we could not examine changes in the relationship between Ao and radial dP/dt max before and after CPB, because we have recorded only radial arterial waveforms before CPB.…”

Possible relationship between certolizumab pegol and arrhythmias: report of two cases

“…Murine models have shown that TNFa may promote exercise-induced atrial remodeling and favor the occurrence of AF, both of which can be prevented by the use of etanercept (16). Moreover, the use of infliximab in RA patients seems to improve echocardiographic findings of diastolic dysfunction and left atrial volumes within the first three months of treatment (17). A recent review of arrhythmic events in RA patients found an increased risk of sudden cardiac death (often related to malignant ventricular arrhythmias, a prolonged QT interval frequently associated with increased CRP levels, and AF) in comparison with the general population; some of these anomalies may be normalized by treatment with the biological agent tocilizumab (18).…”