Subendocardial viability ratio in patients with rheumatoid arthritis: comparison with healthy controls and identification of prognostic factors

Abstract

Cardiac involvement is common in rheumatoid arthritis. Subendocardial viability ratio (SEVR) is a non-invasive measure of microvascular coronary perfusion, yet it remains unclear whether it is affected in rheumatoid arthritis patients. We additionally sought predictors of SEVR in rheumatoid arthritis among a wide range of disease-related parameters, cardiac and hemodynamic factors, and markers of atherosclerosis, arteriosclerosis, and endothelial dysfunction. SEVR was estimated in rheumatoid arthritis patients and healthy controls by applanation tonometry, which was also used to evaluate arterial stiffness (pulse wave velocity and augmentation index). In the rheumatoid arthritis group, carotid intima-media thickness (cIMT) was additionally estimated by ultrasound, cardiac and hemodynamic parameters by impedance cardiography, and endothelial dysfunction by measurement of asymmetric dimethylarginine (ADMA). In a total of 122 participants, SEVR was lower among 91 patients with rheumatoid arthritis compared to 31 controls (141.4 ± 21.9 vs 153.1 ± 18.7%, p = 0.009) and remained so among 29 rheumatoid arthritis patients without hypertension, diabetes, or cardiovascular diseases, compared to the control group (139.7 ± 21.7 vs 153.1 ± 18.7%, p = 0.013). SEVR did not significantly correlate with arterial stiffness, cIMT, ADMA, or disease-related parameters. Multivariate analysis revealed gender (p = 0.007), blood pressure (p = 0.028), heart rate (p = 0.025), cholesterol levels (p = 0.008), cardiac index (p < 0.001) and left ventricular ejection time (p = 0.004) as independent predictors of SEVR among patients with rheumatoid arthritis. Patients with rheumatoid arthritis exhibit lower values of SEVR compared to healthy individuals. Cardiac and hemodynamic parameters, rather than functional indices of endothelial and macrovascular dysfunction, may be useful as predictors of myocardial perfusion in rheumatoid arthritis.

Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk

“…It is perceived that the atherogenic process triggered by RA is not only limited to plaque formation in large conduit arteries, but is also associated with generalized microvascular dysfunction that subsequently affects myocardial perfusion and induces myocardial ischemia . Indeed, patients with RA most frequently die of cardiac involvement, while impaired myocardial perfusion has been reported even among patients without cardiovascular comorbidities . Notably, patients with RA are less likely to exhibit typical symptoms and signs, and more likely to exhibit sudden death as the initial manifestation of cardiac disease compared to non‐RA subjects .…”

Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

“…A low SEVR has been associated with albuminuria [8-10] and haemoglobin [11], as well as with markers of inflammation in patients with rheumatoid arthritis [12]. Hypertensive patients with reduced coronary flow reserve [13], extreme dippers [14], patients with rheumatoid arthritis [15] or peripheral artery disease [16], women with type 2 diabetes [17] and highly proteinuric CKD patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 [18] have also been associated with a lower SEVR. Recently, a reduced SEVR was shown to predict cardiovascular mortality in CKD patients [19] and combined endpoint all-cause mortality and end-stage renal disease in patients with type 1 diabetes [10].…”

Urinary albumin excretion in rheumatoid arthritis is not associated with markers of vasculopathy in distal microvascular beds

“…In the present study, we studied for the first time the association of UAE with markers of microvascular injury in distal microvascular beds, in a population of RA patients. We included subtle markers indicative of microvascular injury in the coronary artery network, in the retinal microvasculature, and the dermal capillary network, which have been previously shown to be impaired in patients with RA, even in the absence of overt cardiovascular disease . By contrast, neither UAE nor the prevalence of microalbuminuria differed in the present cohort of RA patients, compared to the control group (Table ).…”

“…The strengths of this study include the reliable evaluation of UAE with the gold standard 24‐hour urine collection, and the meticulous assessment of distinct microvascular beds, which are important either in terms of functionality (coronary microcirculation) or accessibility (retina, dermal capillary network), using methodology that has been previously applied in RA patients and other populations . An important limitation of our study concerns the relatively small sample size.…”

“…9 It is postulated that these proatherogenic effects mediated by RA are not only limited in large conduit arteries with the formation of atheromatous plaques, but may also manifest as a state of generalized microvascular dysfunction that involves the coronary vessels. 10 We have previously shown that RA is associated with diffuse microvascular injury, evidenced by decreased myocardial perfusion, 11 altered retinal microvascular morphology, 12 and pronounced dermal capillary rarefaction, 13 even in the absence of overt cardiovascular disease.…”