Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Abnormal Concentric Ventricular Remodeling in Rheumatoid Arthritis.
Davis III, John M., Roger, Veronique L., Crowson, Cynthia S., Therneau, Terry M., Matteson, Eric L., Gabriel, Sherine E.
Patients with rheumatoid arthritis (RA) are at increased risk for heart failure (HF). Pre-clinical left ventricular (LV) diastolic dysfunction is more frequent in RA patients than the general population, suggesting a distinct pathogenesis of HF in these patients. The purpose of this study was to provide new insights into myocardial disease in RA by evaluating LV geometry in RA and non-RA subjects without HF.
A cross-sectional, community-based study was conducted among adult subjects (age >=50 yrs) without HF, 210 with RA and 1446 without RA (non-RA). Participants had an echocardiogram and completed a questionnaire. Data collection included demographics, cardiovascular (CV) risk factors, and RA disease characteristics. Two-dimensional & Doppler echocardiography was performed by a registered diagnostic cardiac sonographer and interpreted by an expert cardiologist. LV geometry was classified into four categories based on relative wall thickness (RWT) and sex-specific cutoffs for LV mass index (LVMI): concentric remodeling, concentric hypertrophy, eccentric hypertrophy, or normal geometry. Sex-specific proportions of subjects with RA vs. non-RA in each category of LV geometry were compared. Logistic regression models were used to identify predictors of abnormal LV geometry (concentric remodeling, concentric hypertrophy, or eccentric hypertrophy) as compared to normal geometry, and separately among patients with abnormal LV geometry, to identify predictors of concentric remodeling as compared to concentric or eccentric hypertrophy. Candidate predictors included RA, disease characteristics, and CV risk factors.
The mean ages of the 210 RA and 1446 non-RA subjects without HF were similar among the females (64.2 ± 10.1 and 65.2 ± 9.5 yrs for RA and non-RA, respectively; p=0.13) whereas male RA subjects were slightly older (67.6 ± 9.3 vs. 64.7 ± 9.4 yrs; p=0.018). Systolic blood pressure was higher in RA women (130 ± 17 vs. 125 ± 20 mm Hg) and RA men (136 ± 19 vs. 127 ± 17 mm Hg) than their non-RA counterparts. LVMI was lower in RA women (80.9 ± 13.9 vs. 87.8 ± 20.0; p=0.001); a trend to lower LVMI was also seen in RA men (94.3 ± 15.7 vs. 99.4 ± 21.6; p=0.26). RWT was higher in both RA females (0.43 ± 0.07 vs. 0.39 ± 0.09; p<0.001) and RA males (0.44 ± 0.07 vs. 0.39 ± 0.06; p<0.001). RA subjects were 26% more likely to have abnormal LV geometry though this was not statistically significant (OR 1.26; 95% CI: 0.89, 1.76; p=0.18). Among those with abnormal LV geometry, RA subjects were 6.5 times more likely to have concentric LV remodeling (OR: 6.5; 95% CI: 3.7, 11.5; p<0.001). After adjusting for age, sex, CV risk factors, and RA characteristics; higher disability (OR: 1.74; 0.97, 3.12; p=0.062) and methotrexate use (OR 2.17; 95% CI 1.11, 4.23; p=0.023) were associated with abnormal LV geometry. RA characteristics were not significantly associated with concentric LV remodeling.
RA is strongly associated with abnormal concentric LV remodeling. These findings suggest that RA disease-related factors promote myocardial injury, remodeling, and ultimately myocardial dysfunction. The biological mechanisms underlying these changes warrant further investigation.
To cite this abstract, please use the following information:
Davis III, John M., Roger, Veronique L., Crowson, Cynthia S., Therneau, Terry M., Matteson, Eric L., Gabriel, Sherine E.; Abnormal Concentric Ventricular Remodeling in Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :761