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Hellenic J Cardiol. 2019 Jan - Feb;60(1):28-35. doi: 10.1016/j.hjc.2018.01.008. Epub 2018 Jan 31.

Cardiovascular magnetic resonance characterization of myocardial and vascular function in rheumatoid arthritis patients.

Author information

1
University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK; Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
2
University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK.
3
Department of Statistics, University of Cape Town, Cape Town, South Africa.
4
First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
5
GlaxoSmithKline Clinical Imaging Centre, London, UK; Division of Brain Sciences, Department of Medicine, Imperial College, London, UK.
6
Bortnar Institute, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre and John Radcliffe Hospital, Oxford, UK.
7
University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK; First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece. Electronic address: tkaramitsos@auth.gr.

Abstract

BACKGROUND:

Rheumatoid arthritis (RA) is a multisystem, autoimmune disorder and confers one of the strongest risks for cardiovascular disease (CVD) morbidity and mortality.

OBJECTIVE:

To assess myocardial function and vascular stiffness in RA patients with and without cardiovascular risk factors (CVRFs) using cardiovascular magnetic resonance (CMR).

METHODS:

Twenty-three RA patients with no CVRFs (17 female, mean age 52 ± 13 years), 46 RA patients with CVRFs (32 female, mean age 53 ± 12), 50 normal controls (32 female, mean age 50 ± 11 years), and 13 controls with CVRFs (7 female, mean age 55 ± 7 years), underwent CMR at 1.5 Tesla, including evaluation of left ventricular (LV) ejection fraction, strain, and vascular elasticity (aortic distensibility [AD] and pulse wave velocity [PWV]). Disease activity and duration were recorded for each patient. Subjects with known symptomatic CVD were excluded.

RESULTS:

LV volumes, mass, and ejection fraction were similar in the four groups. RA patients with CVRFs showed the greatest abnormality in mid short-axis circumferential systolic strain, peak diastolic strain rate, and vascular indices. RA patients without CVRFs showed a similar degree of vascular dysfunction and deformational abnormality as controls with CVRFs. AD and total PWV correlated with myocardial strain and RA disease activity. On multivariate regression analysis, strain was related to age, RA disease activity, AD, and PWV.

CONCLUSION:

CMR demonstrates impaired myocardial deformation and vascular function in asymptomatic RA patients, worse in those with CVRFs. Subclinical cardiovascular abnormalities are frequent and appear to be incremental to those due to traditional CVRFs and likely contribute to the excess CVD in RA.

KEYWORDS:

Rheumatoid arthritis; cardiovascular magnetic resonance; left ventricular function; myocardial strain; vascular function

PMID:
29369795
DOI:
10.1016/j.hjc.2018.01.008
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