Rheumatology International

, Volume 28, Issue 6, pp 513–519 | Cite as

Diastolic heart function in RA patients

  • M. Wislowska
  • B. Jaszczyk
  • M. Kochmański
  • S. Sypuła
  • M. Sztechman
Original Article
First Online:
Received:
Accepted:

Abstract

The results of some epidemiological studies point to the presence of an increased risk of cardiovascular disease (CVD), particularly atherosclerosis and congestive heart failure (CHF) in rheumatoid arthritis (RA). At least 50% of abnormalities remained asymptomatic. Pathological conditions contributing to myocardial dysfunction such as high serum levels of IL-6, C-reactive protein (CRP) and TNF alpha are present both in RA and CHF patients. The most common pathological mechanism leading to the development of heart failure is left ventricular (LV) diastolic dysfunction, which remains clinically asymptomatic for a long time. The aim of this study was to assess the systolic and diastolic functions of the LV in RA patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Our purpose was also to estimate whether there is a correlation between the duration and severity of RA and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the RA group and control group, which constituted healthy volunteers. Left ventricular mass index in RA group was significantly greater than in the control group (105.2 ± 32.6 vs. 87.9 ± 16.8; p < 0.05) so were the interventricular septum end-diastolic thickness (1.01 ± 0.33 vs. 0.86 ± 0.12; p < 0.05), the LV posterior wall end-diastolic thickness (0.94 ± 0.08 vs. 0.83 ± 0.11; p < 0.0001) and the aortic root diameter (3.18 ± 0.31 vs. 3.10 ± 0.63, p < 0.001). The ejection fraction in RA group was significantly lower than in the control group (64.4 ± 1.3 vs. 66.3 ± 1.3; p < 0.0001). The assessment of diastolic function parameters revealed significantly longer isovolumetrc relaxation time (IVRT) and shorter deceleration time (DT) in RA patients compared to the control group. Patients in stage II or III revealed significantly lower LV mass index (99 ± 17 vs. 131 ± 42; p < 0.05) and the interventricular septum end-diastolic thickness (0.94 ± 0.10 vs. 1.28 ± 0.5; p < 0.05) than those in stage IV. Mean aortic diameter was significantly greater in individuals in stages III and IV (3.73 ± 0.28) than in the stage II of the disease (2.77 ± 0.21), p < 0.05. No differences in echocardiographic parameters’ values were observed between seropositive, seronegative, nodule-present and nodule-absent persons. Echocardiographic examination revealed valvular heart disease in 24 (80%) RA and 6 (20%) control patients (p < 0.0001).

Keywords

Rheumatoid arthritis Diastolic function of heart Doppler echocardiography 
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References

  1. 1.
    del Rincon ID, Wiliams K, Stern MP et al (2001) High incidence of cardiovascular events in rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44:2737–2745PubMedCrossRefGoogle Scholar
  2. 2.
    Walberg-Jonsson S, Johansson H, Obman ML et al (1999) Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset. J Rheumatol 26:2562–2571Google Scholar
  3. 3.
    Wolfe F, Freundlich B, Strauss WL (2003) Increase in cardiovascular and celebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 30:36–40PubMedGoogle Scholar
  4. 4.
    Cathcard ES, Spodick DH (1962) Rheumatoid heart disease: a study of the incidence and nature of cardiac lesion in rheumatoid arthritis. New Engl J Med 266:959–964CrossRefGoogle Scholar
  5. 5.
    Lebowitz WB (1963) Heart in rheumatoid arthritis (rheumatoid disease): a clinical and pathological study of 62 cases. Ann Intern Med 58:102–123PubMedGoogle Scholar
  6. 6.
    Sokoloff L (1964) Cardiac involvement in rheumatoid arthritis and allied disorders: current concepts. Mod Concepts Cardiovasc Dis 32:847–850Google Scholar
  7. 7.
    Giles JT, Fernandes V, Lima JA et al (2005) Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis. Arthritis Res Ther 7:195–207PubMedCrossRefGoogle Scholar
  8. 8.
    Solomon DH, Karlson EW, Rimm EB et al (2003) Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107:1303–1307PubMedCrossRefGoogle Scholar
  9. 9.
    Guedes C, Bianchi-Fior P, Cormier B et al (2001) Cardiac manifestation of rheumatoid arthritis: A case-control transesophageal echocardiography study in 30 patients. Arthritis Rheum 45:129–135PubMedCrossRefGoogle Scholar
  10. 10.
    Turesson C, Jacobsson LTH (2004) Epidemiology of extra-articular manifestations in rheumatoid arthritis. Scand J Rheumatol 33:65–72PubMedCrossRefGoogle Scholar
  11. 11.
    Roubenoff R, Roubenoff RA, Cannon JG et al (1994) Rheumatoid cachexia: Cytokinne-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest 93:2379–2386PubMedCrossRefGoogle Scholar
  12. 12.
    Nicola PJ, Maradit-Kremers H, Roger VL et al (2005) The risk of congestive heart failure in rheumatoid arthritis: A population-based study over 40 years. Arthritis Rheum 52:412–420PubMedCrossRefGoogle Scholar
  13. 13.
    Turner LW, Lansbury J (1954) Low diastolic pressure as a clinical feature of rheumatoid arthritis and its possible etiologic significance. Am J Med. Sci 227:503–508PubMedCrossRefGoogle Scholar
  14. 14.
    McEntegart A, Capell HA, Creran D et al (2001) Cardiovascular risk factors including thrombotic variables, in a population with rheumatoid arthritis. Rheumatology (Oxford) 40:640–644CrossRefGoogle Scholar
  15. 15.
    Pope JE, Anderson JJ, Felson DT (1993) A metaanalysis of the effects of nonsteroidal antiinflammatory drugs on blood-pressure. Arch Intern Med 153:477–484PubMedCrossRefGoogle Scholar
  16. 16.
    Vasan RS, Sullivan LM, Roubenoff R et al (2003) Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: The Framingham heart study. Circulation 107:1486–1491PubMedCrossRefGoogle Scholar
  17. 17.
    Cesari M, Penninx BWJH, Newman AB et al (2003) Inflammatory markers and onset of cardiovascular events: Results from the Health ABC study. Circulation 108:2317–2322PubMedCrossRefGoogle Scholar
  18. 18.
    Vasan RS, Larson MG, Benjamin EJ et al (1999) Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 33:1948–1955PubMedCrossRefGoogle Scholar
  19. 19.
    Philbin EF, Rocco TA, Lindenmuth NW et al (2000) Systolic versus diastolic heart failure in community practice: clinical features, outcomes and the use of angiotensin-converting enzyme inhibitors. Am J Med 109:605–613PubMedCrossRefGoogle Scholar
  20. 20.
    Vasan RS (2003) Diastolic heart failure. BMJ 327:1181–1182PubMedCrossRefGoogle Scholar
  21. 21.
    Lapu-Bula R, Ofili E (2004) Diastolic heart failure: the forgotten manifestation of hypertensive heart disease. Curr Hypertention Rep 6:164–170CrossRefGoogle Scholar
  22. 22.
    De Simone G, Greco R, Mereddu G et al (2000) Relation of left ventricular diastolic properties to systolic function in arterial hypertension. Circulation 101:152–157PubMedGoogle Scholar
  23. 23.
    Lapu-Bula R, Robert A, De Kock M et al (1998) Risk stratification in patients with dilated cardiomyopathy: contribution of Doppler-derived left ventricular filling. Am J Cardiol 82:779–785PubMedCrossRefGoogle Scholar
  24. 24.
    Arnett FC (1989) Revised criteria for the classification of rheumatoid arthritis. Bul Rheum Dis 38:1–6Google Scholar
  25. 25.
    Steinbrocker O, Treger H, Cornelius H (1949) Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662Google Scholar
  26. 26.
    Fegenbaum H (1994) Echocardiography, 5th edn. Lea and Febiger, Philadelphia 143–147Google Scholar
  27. 27.
    Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 55:613–618Google Scholar
  28. 28.
    Devereux RB, Alonsoo DR, Lutas EM et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458PubMedCrossRefGoogle Scholar
  29. 29.
    Liv H, Bjorn A (1985) Diagnosis and assessment of various heart lesions. Valve regurgitation. In: Doppler ultrasound in cardiology. Physical principles and clinical applications. Lea and Febiger, Philadelphia, pp 153–188Google Scholar
  30. 30.
    Robert R, Sokal F, Rohlf J (1986) Biometry. Freeman, New York, pp 354–359, 691–721Google Scholar
  31. 31.
    Mustonen J, Laakso M, Hirvonen T et al (1993) Abnormalities in left-ventricular diastolic function in male-patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur J Clin Invest 23:246–253PubMedCrossRefGoogle Scholar
  32. 32.
    Corrao S, Salli L, Arnone S et al (1996) Echo-Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur J Clin Invest 26:293–297PubMedCrossRefGoogle Scholar
  33. 33.
    Wislowska M, Sypula S, Kowalik I (1998) Echocardiographic findings, 24-hour electrocardiographic Holter monitoring in patients with rheumatoid arthritis according to Steinbrocker’s criteria, functional index, value of Waaler-Rose titre and duration of disease. Clin Rheumatol 17:369–377PubMedCrossRefGoogle Scholar
  34. 34.
    Montecucco C, Gobbi G, Perlini S et al (1999) Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 17:407–412PubMedGoogle Scholar
  35. 35.
    Alpaslan M, Onrat E, Evcik D (2003) Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis. Clin Rheumatol 22:84–88PubMedCrossRefGoogle Scholar
  36. 36.
    Di Franco M, Paradiso M, Mammarella A et al (2000) Diastolic function abnormalities in rheumatoid arthritis. Evaluation by echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease. Ann Rheum Dis 59:227–229PubMedCrossRefGoogle Scholar
  37. 37.
    Levendoglu F, Temizhan A, Ugurlu H et al (2004) Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatol Int 24: 141–146PubMedCrossRefGoogle Scholar
  38. 38.
    Gonzalez-Juanatey C, Testa A, Garcia-Castelo A et al (2004) Echocardiographic and Doppler findings in long-term treated rheumatoid arthritis patients without clinically evident cardiovascular disease. Semin Arthritis Rheum 33: 231–238PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • M. Wislowska
    • 1
  • B. Jaszczyk
    • 1
  • M. Kochmański
    • 2
  • S. Sypuła
    • 2
  • M. Sztechman
    • 2
  1. 1.Department of RheumatologyCentral Clinical HospitalWarsawPoland
  2. 2.Department of CardiologyCentral Clinical HospitalWarsawPoland

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