What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatoid arthritis (n=300). Intervention: Rheumatoid arthritis vs. Non-RA control subjects. Primary outcome: Mean left ventricular mass (26 gm lower, p=<0.001).

January 28, 2010Open Access

Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging

Q: What are the key findings of this study?

Rheumatoid arthritis was associated with a 26 gm (18%) lower mean left ventricular mass compared with non-RA controls (P<0.001).

Resultado clave

Rheumatoid arthritis was associated with a 26 gm (18%) lower mean left ventricular mass compared with non-RA controls (P<0.001).

Diseño del estudio

Tipo

Cohort (n=300)

PICO estructurado

Does rheumatoid arthritis alter left ventricular structure and function compared to non-RA controls?

Población

300 subjects, comprising 75 men and women with rheumatoid arthritis (RA) from the ESCAPE RA cohort and 225 frequency-matched non-RA controls from the MESA cohort.

Comparador

Non-RA control subjects

Resultado

Measures of myocardial structure and function (left ventricular mass, ejection fraction, cardiac output, stroke volume, end systolic and end diastolic volumes) assessed by cardiac magnetic resonance imagingsurrogate

Rheumatoid arthritis is associated with reduced left ventricular mass and modestly lower systolic function, suggesting that progression to heart failure in this population may occur through myocardial mass reduction rather than hypertrophy.

Resultado numérico

Estimación del efecto: 26 gm lower

valor p: p=<0.001

Resumen

OBJECTIVE: Heart failure is a major contributor to cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA), but little is known about myocardial structure and function in this population. This study was undertaken to assess the factors associated with progression to heart failure in patients with RA. METHODS: With the use of cardiac magnetic resonance imaging, measures of myocardial structure and function were assessed in men and women with RA enrolled in the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis study, a cohort study of subclinical cardiovascular disease in patients with RA, in comparison with non-RA control subjects from a cohort enrolled in the Baltimore Multi-Ethnic Study of Atherosclerosis. RESULTS: Measures of myocardial structure and function were compared between 75 patients with RA and 225 frequency-matched controls. After adjustment for confounders, the mean left ventricular mass was found to be 26 gm lower in patients with RA compared with controls (P < 0.001), an 18% difference. In addition, the mean left ventricular ejection fraction, cardiac output, and stroke volume were modestly lower in the RA group compared with controls. The mean left ventricular end systolic and end diastolic volumes did not differ between the groups. In patients with RA, higher levels of anti-cyclic citrullinated peptide (anti-CCP) antibodies and current use of biologic agents, but not other measures of disease activity or severity, were associated with significantly lower adjusted mean values for the left ventricular mass, end diastolic volume, and stroke volume, but not with ejection fraction. The combined associations of anti-CCP antibody level and biologic agent use with myocardial measures were additive, without evidence of interaction. CONCLUSION: These findings suggest that the progression to heart failure in RA may occur through reduced myocardial mass rather than hypertrophy. Both modifiable and nonmodifiable factors may contribute to lower levels of left ventricular mass and volume.

Me gusta

Guardar

Ver artículo completo