OP0163 Treatment-Naïve, Early Rheumatoid Arthritis Patients Demonstrate Vascular and Myocardial Abnormalities on Cardiac MRI

Abstract

BackgroundCardiac studies of patients with rheumatoid arthritis (RA) have demonstrated abnormalities in left ventricular (LV) remodelling that is associated with development of heart failure and cardiovascular (CV) morbidity and mortality1,2. No studies to date have evaluated for changes in myocardial and vascular function in treatment-naïve early RA (ERA).ObjectivesTo evaluate whether patients with newly diagnosed, treatment-naïve ERA demonstrate myocardial and vascular changes on cardiac MRI (CMR) compared with matched controls.MethodsSixty-six ERA patients fulfilling ACR/EULAR classification criteria and with no CVD history underwent 3.0T CMR (Philips Achieva TX) at a cardiology-CMR unit. All patients had symptoms for less than 1 year, were DMARD treatment-naïve and with minimum disease activity score (DAS28) ≥3.2. Thirty healthy controls (HC) were matched by age, sex and blood pressure.Standard balanced steady state free precession cine images were acquired and LV dimensions calculated. For aortic distensibility, multi-phase SSFP cine images (50 phases) were acquired in a plane transverse to the ascending aorta at the level of the pulmonary artery bifurcation. Aortic contours were drawn by manual planimetry of the endovascular–blood pool interface at the times of minimal and maximal distension. Additional parameters measured include strain analysis and extracellular volume (results awaited). Body surface area (BSA) index values are presented.ResultsPatients in ERA and HC groups were similar mean (SD) age [49.4 (13.08) and 46.7 (11.4) respectively, p=0.33] and systolic BP [122 (23) and 126 (16) respectively, p=0.18]. Mean (SD) BSA was lower in the ERA group vs HC [(1.83 (0.22) vs 1.9 (0.21) respectively, p=0.09]. In the ERA group, median (IQR) ESR, CRP and mean (SD) DAS28 were 39.5 (28.7)mm/hr, 18.9 (27.1)mg/L and 5.65 (1.6) respectively. 54 (82%) and 48 (73%) patients were ACPA and RF positive respectively.Table 1 details CMR parameters. Aortic distensibility was significantly reduced in ERA patients compared to HC (median ± IQR, 3.19±2.16 10-3mmHg-1 versus 4.4±2.1 10-3mmHg-1, p=0.001). Other measures of arterial stiffness including aortic stiffness index, compliance and strain showed similar significant differences. Left ventricular and right ventricular end-systolic and end-diastolic volumes were all significantly lower in the ERA vs HC. A trend for lower LVmass index in the ERA group was observed and seemed to be associated with seropositivity (see table 2). Evidence for overt inflammation/fibrosis was seen in 4 patients with focal non-ischaemic patterns of LGE.ConclusionsThis first CMR study in treatment-naive ERA demonstrates abnormalities at the earliest stage of RA. Reduced vascular function, ventricular volumes, and trend change in LV geometry suggest an early cardiomyopathy. This might imply higher risk for CV morbidity and mortality at time of diagnosis. Further investigation will clarify the natural history, clinical implications and the scope to modify outcome with effective RA therapy.ReferencesGi...

First cardiovascular MRI study in individuals at risk of rheumatoid arthritis detects abnormal aortic stiffness suggesting an anti-citrullinated peptide antibody-mediated role for accelerated atherosclerosis

“…Overall, modest event rate has necessitated the use of surrogate CV abnormalities of increased CV risk including arterial stiffness. Increased arterial stiffness is well recognised in established RA,2 with early, similar reports using comprehensive and reliable cardiac MRI (CMRI) in our treatment-naïve, early onset RA cohort 3. Autopsy, histopathological and clinical studies in general population and RA cohorts with and without CV disease (CVD) suggest citrullinated proteins as a mechanism for atherosclerosis, including presence of citrullination within the atherosclerotic plaque of subjects without RA 4 5.…”

Cardiovascular MRI evidence of reduced systolic function and reduced LV mass in rheumatoid arthritis: impact of disease phenotype

“…Although Ntusi et al reported similar LVEF, they did determine reduced peak systolic circumferential strain and reduced diastolic strain rate in those with RA [8]. Similarly, smaller CMR studies have not described reduced LV mass [8,12], although our research group has reported preliminary findings of lower LV mass, in treatment-naive early RA patients (n = 66) [10]. Echocardiography studies have repeatedly reported increased LV mass in patients with RA [32], and often no difference in LVEF [11,33], although reduced LVEF has been associated with active disease [33].…”

“…The largest CMR study in RA (n = 75, some with diabetes) reported a 4.4% reduction in LV ejection fraction (LVEF), but interestingly also a 15% reduction in LV mass index (LVMI) in those with RA [9]. A preliminary CMR report of 66 patients with treatment-naive early RA also demonstrated a reduced LVMI [10]. Both of these CMR studies stand in contrast to echocardiographic data [11] and smaller CMR studies in RA [8,12] reporting no difference or increase in LV mass.…”

Using cardiovascular magnetic resonance to define mechanisms of comorbidity and to measure the effect of biological therapy: the CADERA observational study

“…These data were partly presented at the American College of Rheumatology meeting. 28 Early rheumatoid arthritis cohort: baseline to 1 year…”