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Early Wave Reflection and Pulse Wave Velocity Are Associated with Diastolic Dysfunction in Rheumatoid Arthritis

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Abstract

Rheumatoid arthritis (RA) impacts arterial and diastolic function. This study examined whether arterial properties can determine diastolic function in RA. In 173 RA patients, arterial function measures including carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification, and the magnitude and timing of the forward and reflected waves were measured using applanation tonometry. Diastolic function parameters including the ratio of early-to-late transmitral velocity (E/A) and ratio of E to the mean of the lateral and septal wall myocardial tissue lengthening (e’) were measured using echocardiography. The timing of the reflected wave was associated with E/A; PWV was related to E/e’. The timing of the reflected wave, forward wave magnitude, and pulse pressure amplification were associated with impaired relaxation; PWV was related to increased left ventricular (LV) filling pressure. Early wave reflection and PWV are associated with LV-impaired relaxation and increased filling pressure, respectively, in RA.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitors

Alx:

Augmentation index

ARB:

Angiotensin receptor blockers

BB:

Beta blockers

CCB:

Calcium channel blockers

cPP:

Central pulse pressure

e’:

The mean of the lateral and septal wall myocardial tissue lengthening

E:

Trans-mitral velocity in the early period of left ventricular diastolic filling

E/A:

Early-to-late transmitral velocity

LV:

Left ventricle

LVMI:

Left ventricular mass indexed to body surface area

Pb:

Backward wave pressure

Pb time:

Time to wave reflection

Pf:

Forward wave pressure

PPamp:

Pulse pressure amplification

PWV:

Pulse wave velocity

RA:

Rheumatoid arthritis

RM:

Reflection magnitude

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Acknowledgments

The authors thank the voluntary contribution of the patients in this study.

Funding

Funding for this work was provided by the National Research Foundation (Thuthuka programme) and the University of the Witwatersrand.

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Author notes

  1. Patrick H. Dessein and Aletta M. E. Millen share senior authorship.

Authors and Affiliations

  1. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Lebogang Mokotedi, Sulé Gunter, Chanel Robinson, Frederic Michel, Gavin R. Norton, Angela J. Woodiwiss, Linda Tsang, Patrick H. Dessein & Aletta M. E. Millen

  2. Department of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Ahmed Solomon

  3. Free University and University Hospital, Brussels, Belgium

    Patrick H. Dessein

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  1. Lebogang Mokotedi
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  2. Sulé Gunter
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  3. Chanel Robinson
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Correspondence to Aletta M. E. Millen.

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The authors declare that they have no conflict of interest.

Ethical Approval

This investigation was approved by the University of the Witwatersrand Human (Medical) Research Ethics Committee (approval number: M06-07-33; protocol number: M120562 renewed as M170592) and was conducted in line with the principles of the Helsinki declaration. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all participants included in the study.

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Associate Editor Ana Barac oversaw the review of this article

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Mokotedi, L., Gunter, S., Robinson, C. et al. Early Wave Reflection and Pulse Wave Velocity Are Associated with Diastolic Dysfunction in Rheumatoid Arthritis. J. of Cardiovasc. Trans. Res. 12, 580–590 (2019). https://doi.org/10.1007/s12265-019-09892-3

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