Use of B‐type natriuretic peptide as a screening tool for left ventricular diastolic dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease

Abstract

Objective. Patients with rheumatoid arthritis (RA) are at an increased risk for heart failure and left ventricular diastolic dysfunction (LVDD). B-type natriuretic peptide (BNP) may be useful to screen for LVDD in the general population. We compared the effectiveness of BNP as a screening tool for LVDD in RA and non-RA subjects without cardiovascular disease (CVD). Methods. Study subjects were recruited from population-based samples with and without RA, excluding subjects with CVD. LVDD was assessed by 2-dimensional and Doppler echocardiography and categorized as none, mild, moderate/ severe, or indeterminate. Linear regression and proportional odds models evaluated the association between LVDD and BNP, adjusting for age, sex, and body mass index. Results. Among 231 RA and 1,730 non-RA subjects without CVD, BNP was significantly higher in subjects with moderate/severe LVDD compared to those with no or mild LVDD (P ‫؍‬ 0.02 for RA and P < 0.001 for non-RA subjects). More RA subjects had elevated BNP than non-RA subjects (16% versus 9%; P < 0.001). Positive predictive value (25% in RA and 18% in non-RA subjects) and sensitivity (40% in RA and 26% in non-RA subjects) were similarly low in both cohorts, but specificity was significantly lower in RA than in non-RA subjects (89% versus 94%; P ‫؍‬ 0.02). Conclusion. While RA subjects were more likely to have elevated BNP, few RA patients with elevated BNP actually have LVDD. Also, normal BNP levels are less likely to rule out LVDD in RA than in non-RA subjects. Therefore, BNP may be less effective for screening in RA subjects compared to the general population.

Comprehensive Functional Assessment of Right‐Sided Heart Using Speckle Tracking Strain for Patients with Pulmonary Hypertension

“…The RA reservoir function implies the ability of the right atrium to fill during ventricular systole, the RA conduit function corresponds to the passive RV filling in the early diastole and diastasis phases, and the RA contractile or booster pump function corresponds to the active atrial emptying at end‐diastole. It has further been reported that the right atrium performs an important function in terms of mechanical pumping, electrical regulation of heart and endocrine regulation . Impaired left atrial function or left atrial enlargement is generally considered to be proven prognostic parameters for patients with chronic left‐sided heart failure, but it remains unclear whether the same applies to the right atrium of PH patients.…”

Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography

“…While it has been demonstrated that patients with RA have a higher prevalence of LV diastolic dysfunction as measured by echocardiography compared with age- and gender-matched subjects without RA,23–32 the mechanism underlying this observation remains unclear 18. Plasma markers such as BNP have been shown to be less effective for CVD screening in RA 5. These reports indicate a need for better strategies for evaluating patients with RA for subclinical CVD.…”

“…Patients with RA who develop clinical HF often have impaired left ventricular (LV) diastolic function with preserved LV ejection fraction (EF), and may present with relatively fewer signs and symptoms than patients with HF without RA 4 5. However, screening patients with RA for CVD remains controversial, and the best method for evaluation of subclinical disease remains unclear.…”

Cardiovascular Comorbidity in Rheumatic Diseases

“…Patients with RA with abnormal BNP are more likely to have LVDD compared with those with normal BNP, but the specificity compared with non-RA patients (89% vs 94%, P = .02) and the positive predictive value (25%) of elevated BNP in patients with RA is low (25%) and is, therefore, not a good screening tool. 77 The duration of RA and CRP levels is independently associated with N-terminal proBNP. 78 …”