Prospective changes in diastolic function in patients with rheumatoid arthritis
Abstract Background Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-022-02864-0 |
| _version_ | 1811315496203583488 |
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| author | Elizabeth Park Kazato Ito Rabia Iqbal Isabelle Amigues Sabahat Bokhari Jennifer Van Eyk Christopher Depender Jon T. Giles Joan Bathon |
| author_facet | Elizabeth Park Kazato Ito Rabia Iqbal Isabelle Amigues Sabahat Bokhari Jennifer Van Eyk Christopher Depender Jon T. Giles Joan Bathon |
| author_sort | Elizabeth Park |
| collection | DOAJ |
| description | Abstract Background Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic function and its associated RA and cardiovascular (CV) predictors. Methods In this study, 158 RA patients without clinical CV disease (CVD) were enrolled and followed up at 4 to 6 years, undergoing baseline and follow-up echocardiography to assess for DD, as well as extensive characterization of RA disease activity and CV risk factors. Novel measures of myocardial inflammation and perfusion were obtained at baseline only. Using baseline and follow-up composite DD (E/e′, Left Atrial Volume Index (LAVI) or peak tricuspid regurgitation (TR) velocity; ≥ 1 in top 25%) as the outcome, multivariable regression models were constructed to identify predictors of DD. Results DD was prevalent in RA patients without clinical heart failure (HF) (40.7% at baseline) and significantly progressed on follow-up (to 57.9%). Baseline composite DD was associated with baseline RA disease activity (Clinical Disease Activity Index; CDAI) (OR 1.39; 95% CI 1.02–1.90; p=0.034). Several individual diastolic parameters (baseline E/e′ and LAVI) were associated with troponin-I and brain natriuretic peptide (BNP). Baseline and follow-up composite DD, however, were not associated with myocardial inflammation, myocardial microvascular dysfunction, or subclinical atherosclerosis. Conclusions DD is prevalent in RA patients without clinical HF and increases to >50% over time. Higher RA disease activity at baseline predicted baseline composite DD. Future longitudinal studies should explore whether adverse changes in diastolic function lead to clinical HF and are attenuated by disease-modifying antirheumatic drugs (DMARDs). |
| first_indexed | 2024-04-13T11:31:17Z |
| format | Article |
| id | doaj.art-e3f0124f1e4446f5bf82d30723e9a464 |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-04-13T11:31:17Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthritis Research & Therapy |
| spelling | doaj.art-e3f0124f1e4446f5bf82d30723e9a4642022-12-22T02:48:34ZengBMCArthritis Research & Therapy1478-63622022-08-0124111110.1186/s13075-022-02864-0Prospective changes in diastolic function in patients with rheumatoid arthritisElizabeth Park0Kazato Ito1Rabia Iqbal2Isabelle Amigues3Sabahat Bokhari4Jennifer Van Eyk5Christopher Depender6Jon T. Giles7Joan Bathon8Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian HospitalDivision of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian HospitalDivision of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian HospitalDivision of Rheumatology, National Jewish HealthLehigh Valley Heart and Vascular InstituteDepartment of Biomedical Sciences, Cedars-Sinai Medical CenterDivision of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian HospitalDivision of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian HospitalDivision of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian HospitalAbstract Background Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic function and its associated RA and cardiovascular (CV) predictors. Methods In this study, 158 RA patients without clinical CV disease (CVD) were enrolled and followed up at 4 to 6 years, undergoing baseline and follow-up echocardiography to assess for DD, as well as extensive characterization of RA disease activity and CV risk factors. Novel measures of myocardial inflammation and perfusion were obtained at baseline only. Using baseline and follow-up composite DD (E/e′, Left Atrial Volume Index (LAVI) or peak tricuspid regurgitation (TR) velocity; ≥ 1 in top 25%) as the outcome, multivariable regression models were constructed to identify predictors of DD. Results DD was prevalent in RA patients without clinical heart failure (HF) (40.7% at baseline) and significantly progressed on follow-up (to 57.9%). Baseline composite DD was associated with baseline RA disease activity (Clinical Disease Activity Index; CDAI) (OR 1.39; 95% CI 1.02–1.90; p=0.034). Several individual diastolic parameters (baseline E/e′ and LAVI) were associated with troponin-I and brain natriuretic peptide (BNP). Baseline and follow-up composite DD, however, were not associated with myocardial inflammation, myocardial microvascular dysfunction, or subclinical atherosclerosis. Conclusions DD is prevalent in RA patients without clinical HF and increases to >50% over time. Higher RA disease activity at baseline predicted baseline composite DD. Future longitudinal studies should explore whether adverse changes in diastolic function lead to clinical HF and are attenuated by disease-modifying antirheumatic drugs (DMARDs).https://doi.org/10.1186/s13075-022-02864-0Rheumatoid arthritisHeart failureDiastolic dysfunctionDisease activity |
| spellingShingle | Elizabeth Park Kazato Ito Rabia Iqbal Isabelle Amigues Sabahat Bokhari Jennifer Van Eyk Christopher Depender Jon T. Giles Joan Bathon Prospective changes in diastolic function in patients with rheumatoid arthritis Arthritis Research & Therapy Rheumatoid arthritis Heart failure Diastolic dysfunction Disease activity |
| title | Prospective changes in diastolic function in patients with rheumatoid arthritis |
| title_full | Prospective changes in diastolic function in patients with rheumatoid arthritis |
| title_fullStr | Prospective changes in diastolic function in patients with rheumatoid arthritis |
| title_full_unstemmed | Prospective changes in diastolic function in patients with rheumatoid arthritis |
| title_short | Prospective changes in diastolic function in patients with rheumatoid arthritis |
| title_sort | prospective changes in diastolic function in patients with rheumatoid arthritis |
| topic | Rheumatoid arthritis Heart failure Diastolic dysfunction Disease activity |
| url | https://doi.org/10.1186/s13075-022-02864-0 |
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