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Subendocardial viability ratio in patients with rheumatoid arthritis: comparison with healthy controls and identification of prognostic factors

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Abstract

Cardiac involvement is common in rheumatoid arthritis. Subendocardial viability ratio (SEVR) is a non-invasive measure of microvascular coronary perfusion, yet it remains unclear whether it is affected in rheumatoid arthritis patients. We additionally sought predictors of SEVR in rheumatoid arthritis among a wide range of disease-related parameters, cardiac and hemodynamic factors, and markers of atherosclerosis, arteriosclerosis, and endothelial dysfunction. SEVR was estimated in rheumatoid arthritis patients and healthy controls by applanation tonometry, which was also used to evaluate arterial stiffness (pulse wave velocity and augmentation index). In the rheumatoid arthritis group, carotid intima–media thickness (cIMT) was additionally estimated by ultrasound, cardiac and hemodynamic parameters by impedance cardiography, and endothelial dysfunction by measurement of asymmetric dimethylarginine (ADMA). In a total of 122 participants, SEVR was lower among 91 patients with rheumatoid arthritis compared to 31 controls (141.4 ± 21.9 vs 153.1 ± 18.7%, p = 0.009) and remained so among 29 rheumatoid arthritis patients without hypertension, diabetes, or cardiovascular diseases, compared to the control group (139.7 ± 21.7 vs 153.1 ± 18.7%, p = 0.013). SEVR did not significantly correlate with arterial stiffness, cIMT, ADMA, or disease-related parameters. Multivariate analysis revealed gender (p = 0.007), blood pressure (p = 0.028), heart rate (p = 0.025), cholesterol levels (p = 0.008), cardiac index (p < 0.001) and left ventricular ejection time (p = 0.004) as independent predictors of SEVR among patients with rheumatoid arthritis. Patients with rheumatoid arthritis exhibit lower values of SEVR compared to healthy individuals. Cardiac and hemodynamic parameters, rather than functional indices of endothelial and macrovascular dysfunction, may be useful as predictors of myocardial perfusion in rheumatoid arthritis.

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Authors and Affiliations

  1. 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 564 29, Thessaloniki, Greece

    Panagiota Anyfanti, Areti Triantafyllou, Eugenia Gkaliagkousi, Georgios Triantafyllou, Nikolaos Koletsos, Panagiotis Panagopoulos, Ioannis Botis & Stella Douma

  2. Rheumatology Department–2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Sophia Chatzimichailidou & Spyros Aslanidis

Authors
  1. Panagiota Anyfanti
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  2. Areti Triantafyllou
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  3. Eugenia Gkaliagkousi
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  4. Georgios Triantafyllou
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Correspondence to Areti Triantafyllou.

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Anyfanti, P., Triantafyllou, A., Gkaliagkousi, E. et al. Subendocardial viability ratio in patients with rheumatoid arthritis: comparison with healthy controls and identification of prognostic factors. Clin Rheumatol 36, 1229–1236 (2017). https://doi.org/10.1007/s10067-017-3659-9

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  • DOI: https://doi.org/10.1007/s10067-017-3659-9

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