Prevalence and factors associated with left ventricular diastolic dysfunction in patients with rheumatoid arthritis: A cross-sectional study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Rheumatoid arthritis (RA) (n=163). Intervention: Rheumatoid arthritis vs. Spondyloarthritis patients (n=41) and healthy volunteers (n=39). Primary outcome: Prevalence of left ventricular diastolic dysfunction (LVDD) assessed by transthoracic echocardiography (p=>0.05).

Q: What does this research mean for the field?

Left ventricular diastolic dysfunction does not occur at a significantly higher frequency in rheumatoid arthritis patients compared to spondyloarthritis patients or healthy controls, with older age and smoking history acting as the main independent predictors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Cansu Akleylek; Mehtap Üçer; Betül Cengiz Elçioğlu; Şükrü Taylan Şahin; Neslihan Yılmaz

doi:10.4274/raed.galenos.2026.87004

November 10, 2026Ulusal Romatoloji DergisiOpen Access

Prevalence and factors associated with left ventricular diastolic dysfunction in patients with rheumatoid arthritis: A cross-sectional study

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Key result

Rheumatoid arthritis shows no significant difference in LVDD prevalence versus spondyloarthritis or healthy controls.

P>0.05
n=163

Key Points

To determine the prevalence of left ventricular diastolic dysfunction (LVDD) in patients with rheumatoid arthritis (RA) and identify independent clinical factors associated with its presence.
Cross-sectional study evaluating 83 patients with RA, 41 control patients with spondyloarthritis (SpA), and 39 healthy volunteers.
Left ventricular diastolic function was assessed across all participants using transthoracic echocardiography.
Multivariate logistic regression analysis was conducted in the RA group to identify independent predictors among clinical, demographic, and disease-related variables.
Echocardiographic assessment identified LVDD in 32.5% (n=27) of patients with RA, 21.9% (n=9) of patients with SpA, and 23.1% (n=9) of healthy controls (p>0.05).
Multivariable analysis identified increasing age (OR: 1.11, 95% CI: 1.05-1.18, p<0.01) and a history of smoking (OR: 3.08, 95% CI: 1.01-9.33, p=0.04) as independent predictors of LVDD in RA.

Study Design

Type

Cross-Sectional (n=163)

Blinding

Single-blind (cardiologist blinded to clinical diagnosis)

Multicenter

No

Structured PICO

P

Population

163 adults (83 with rheumatoid arthritis, 41 with spondyloarthritis, and 39 healthy controls; mean age 47.7 years in the RA group, 81.0% female overall) without overt cardiovascular disease, diabetes, severe obesity, or age >=70 years evaluated cross-sectionally at a Turkish rheumatology clinic.

E

Exposure

Transthoracic echocardiography (two-dimensional, M-mode, pulsed-wave Doppler, and tissue Doppler imaging) to assess left ventricular diastolic dysfunction

C

Comparator

Control groups consisting of 41 patients with spondyloarthritis (27 ankylosing spondylitis, 12 psoriatic arthritis, 2 inflammatory bowel disease-associated arthritis) and 39 healthy volunteers without inflammatory rheumatic or cardiovascular disease

O

Outcome

Prevalence of left ventricular diastolic dysfunction (LVDD) assessed by integrated interpretation of multiparametric transthoracic echocardiography (transmitral inflow E and A velocities, E/A ratio, E-wave deceleration time, tissue Doppler E' velocity, E/E' ratio, and isovolumic relaxation time)surrogate

Main Result

Absolute Event Rate: 32.5% vs 23.1%

p-value: p=>0.05

Limitations

Cross-sectional design precludes establishing a causal relationship between inflammatory rheumatic diseases and LVDD.
Data on cumulative inflammatory burden, cumulative glucocorticoid exposure, and detailed smoking exposure (pack-years and duration) were unavailable.
Echocardiographic measurements were obtained at a single time point and left atrial volume index/reservoir strain were unavailable.
Relatively small sample size determined without a priori calculation may have limited statistical power to detect between-group differences (risk of type II error) and yielded a limited number of LVDD events for multivariable modeling.
Cohort predominantly had low-to-moderate disease activity and relatively well-controlled RA, limiting generalizability to patients with severe disease.
Cross-sectional design precludes establishing a causal relationship or evaluating changes in diastolic function over time
Assessment of inflammatory burden was limited to cross-sectional measures, and data on cumulative glucocorticoid exposure and detailed smoking exposure (pack-years, duration) were unavailable
Relatively small sample size determined without a priori calculation may have limited statistical power to detect between-group differences (risk of type II error) and limited the number of LVDD events for multivariable modeling
Left atrial volume index and left atrial reservoir strain were not available, preventing application of the 2025 ASE multiparametric algorithm
Cohort predominantly consisted of patients with low-to-moderate disease activity and well-controlled RA, which may limit generalizability to populations with more severe disease

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Implication

In patients with relatively well-controlled rheumatoid arthritis without overt cardiovascular disease, the prevalence of left ventricular diastolic dysfunction was not significantly different from spondyloarthritis or healthy controls, and was independently driven by traditional risk factors (older age and smoking) rather than disease-specific inflammatory variables.

Abstract

Objective Rheumatoid arthritis (RA) confers an increased risk of cardiovascular morbidity and mortality compared with the general population. Left ventricular diastolic dysfunction (LVDD) may represent an early manifestation of cardiac involvement. This study aimed to determine the frequency of LVDD in patients with RA and to identify factors associated with LVDD. Methods In this cross-sectional study, 83 patients with RA were included. The control group consisted of 41 patients with spondyloarthritis (SpA) and 39 healthy volunteers. LVDD was assessed using transthoracic echocardiography. Results Among the 83 patients with RA included in the study, the mean age was 47.7±12.3 years, and the median disease duration was 69 months (interquartile range: 42-144). There were no significant differences among the RA, SpA, and healthy control groups regarding age, hypertension, dyslipidemia, or obesity (all p>0.05). Echocardiographic assessment revealed LVDD in 32.5% (n=27) of patients with RA, 21.9% (n=9) of patients with SpA, and 23.1% (n=9) of healthy controls, with no statistically significant difference among the groups (p>0.05). In the RA cohort, multivariate logistic regression analysis showed that increasing age (p<0.01) and history of smoking (p=0.04) were independently associated with LVDD. Conclusion In this study, older age and a history of smoking were independently associated with LVDD among patients with RA. Although the frequency of LVDD was numerically higher in the RA group compared with patients with SpA and healthy controls, this difference did not reach statistical significance. Given the relatively modest sample size, larger prospective studies are warranted to better elucidate the relationship between RA and subclinical diastolic dysfunction.

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Cite This Study

Akleylek et al. (2026) conducted a cross-sectional in Rheumatoid arthritis (RA) (n=163). Rheumatoid arthritis vs. Spondyloarthritis patients (n=41) and healthy volunteers (n=39) was evaluated on Prevalence of left ventricular diastolic dysfunction (LVDD) assessed by transthoracic echocardiography (p=>0.05). Rheumatoid arthritis had a numerically higher LVDD prevalence (32.5%) than spondyloarthritis (21.9%) and healthy controls (23.1%, p>0.05), predicted by age and smoking.

synapsesocial.com/papers/6af46f437bb3da179b8502cb https://doi.org/10.4274/raed.galenos.2026.87004

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Prevalence and factors associated with left ventricular diastolic dysfunction in patients with rheumatoid arthritis: A cross-sectional study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevalence and factors associated with left ventricular diastolic dysfunction in patients with rheumatoid arthritis: A cross-sectional study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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