Prevalence of cardiac dysfunction in rheumatoid arthritis and axial spondyloarthritis: A comparative echocardiographic study of inflammatory arthritis

Abstract Background Chronic inflammatory diseases, including rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA), are associated with an increased prevalence of cardiac risk factors and dysfunction. However, the mechanisms underlying this increased risk remain unclear, and direct comparisons of cardiac imaging findings between RA, axSpA, and controls are limited. Purpose To compare echocardiographic measures of cardiac structure and function between patients with inflammatory arthritis (IA), including RA and axSpA, and matched controls. Methods In a prospective cohort study, 1,272 patients with a clinical diagnosis of IA (RA: 914; axSpA: 358) were included. Echocardiography was performed, and all patients were compared 1:1 to age- and sex-matched individuals from the general population without IA. Systolic dysfunction was defined as global longitudinal strain 16% or left ventricular ejection fraction 50%. Diastolic dysfunction was defined in accordance with 2016 guidelines. Finally, right heart dysfunction was defined as tricuspid annular plane systolic excursion 18 mm. Total cardiac dysfunction was defined as the presence of any systolic, diastolic, or right heart dysfunction. Results Of the 1,272 participants, the mean age was 60 ± 13 years, and 36% were male. Patients with RA were older (63 ± 12 vs. 51 ± 13 years, p 0.001) and a lower proportion were male (24% vs. 66%, p 0.001) compared with axSpA patients. RA patients also had a higher prevalence of hypertension (38% vs. 26%, p 0.001), ischemic heart disease (6.9% vs. 3.6%, p = 0.027), and atrial fibrillation (7.1% vs. 3.1%, p 0.001) compared with axSpA patients. Echocardiographic measures showed a higher mean left ventricular mass index (LVMI) in RA (75.9 ± 16.9 vs. 72.1 ± 18.2 g/m², p 0.001), and increased filling pressure (E/e’: 7.6 ± 3.0 vs. 6.4 ± 2.2, p 0.001), but a similar prevalence of total cardiac dysfunction between RA and axSpA (28.7% vs. 27.7%, p = 0.72). In a multivariable model adjusting for age, sex, and cardiovascular risk factors and diseases, LVMI remained significantly different, but E/e’ did not. Compared with controls, patients with IA had a higher prevalence of total cardiac dysfunction, 361 (28.4%) vs. 203 (16.0%), p 0.001. This difference remained significant in the multivariable model and after stratifying by IA disease type (Figure). Conclusion In a large cohort of patients with IA, we found that the overall prevalence of cardiac dysfunction was similar between RA and axSpA. However, compared with controls, IA patients had a significantly higher prevalence of cardiac dysfunction even after adjusting for cardiovascular risk factors. These findings suggest that RA and axSpA may share inflammatory pathways that contribute to cardiac dysfunction beyond traditional risk factors.Prevalence of cardiac dysfunction