Anti-CCP antibodies and rheumatoid factor inversely predict ejection fraction, indicating subclinical cardiac dysfunction in rheumatoid arthritis patients.
Are immunoinflammatory markers associated with echocardiographic signs of subclinical cardiac dysfunction in patients with rheumatoid arthritis?
In patients with rheumatoid arthritis, elevated anti-CCP antibodies and rheumatoid factor are independently associated with reduced ejection fraction, highlighting their potential utility in identifying subclinical cardiac dysfunction.
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Abstract Background Heart failure is one of the leading causes of morbidity and mortality in patients with rheumatoid arthritis (RA). Chronic systemic inflammation promotes mechanisms such as oxidative stress, fibrosis, and coronary microvascular dysfunction, which contribute to cardiac remodelling and diastolic dysfunction. Subclinical cardiac dysfunction often goes unrecognised. Understanding the interaction between echocardiographic findings and immunoinflammatory markers is crucial for identifying patients at an early stage and improving outcomes. Purpose This study aims to describe the association between echocardiographic parameters of cardiac function and structural remodeling with immunoinflammatory markers in patients with rheumatoid arthritis, in order to identify predictive indicators of subclinical cardiac dysfunction. Methods A descriptive retrospective study conducted in patients with rheumatoid arthritis treated at a national medical centre during the year 2024. Demographic data, immunoinflammatory markers, and cardiac morphofunctional variables were collected. Descriptive univariate analyses and Kendall's tau correlation tests were performed. Significant associations were assessed using a multivariate linear regression model adjusted for age, sex, and body mass index, using STATA v13. Results Our cohort was predominantly composed of women, with a median age in the sixth decade of life and normal weight. Although most patients did not have known heart failure, hypertension and smoking were the most common comorbidities. In the correlational analysis, an inverse relationship was found between rheumatoid factor (RF) levels and ejection fraction (EF) (tau = -0.553, p = 0.05). Anti-CCP antibodies were positively associated with the LVMI (tau = 0.505, p = 0.009) and RWT (tau = 0.502, p = 0.037), and negatively with EF (tau = -0.604, p = 0.039). Furthermore, both C-reactive protein and erythrocyte sedimentation rate showed a direct relationship with proBNP (tau = 0.507, p = 0.001; tau = 0.490, p = 0.001), as well as with LAVI (tau = 0.463, p = 0.038). The linear regression model revealed significant and independent inverse associations between EF and anti-CCP antibodies (CNE = -0.025 95% CI: -0.044, -0.005) and RF (CNE = -0.017 95% CI: -0.035, -0.001). The probability of heart failure with preserved ejection fraction (HFpEF) was estimated using the H2FPEF and HFA-PEFF scores. Conclusions We found that anti-CCP antibodies and RF have an inverse and moderately robust predictive capacity for EF in patients with rheumatoid arthritis. The low rate of previous HFpEF diagnosis, compared to the high probability estimated by the scores, suggests underdiagnosis in this population. The HFA-PEFF score appears to be more sensitive for risk stratification in patients with rheumatoid arthritis.
Zambrano et al. (Sat,) reported a other. Anti-CCP antibodies and rheumatoid factor inversely predict ejection fraction, indicating subclinical cardiac dysfunction in rheumatoid arthritis patients.