Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

Midtbø, Helga; Semb, Anne Grete; Matre, Knut; Kvien, Tore K; Gerdts, Eva

doi:10.1136/annrheumdis-2016-209223

Cited by 42 publications

(48 citation statements)

References 43 publications

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“…Supporting this hypothesis, rheumatoid arthritis patients in remission (Simplified Disease Activity Index <3.3) showed improved left ventricular function as assessed by stress corrected mid-wall shortening and global longitudinal strain compared with those with low, moderate, or high disease activity 25. Differences in left ventricular function were independent of traditional cardiovascular risk factors 25.…”

Section: Mechanisms Linking Rheumatoid Arthritis and Cardiovascular Dmentioning

confidence: 87%

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

England

Thiele

Anderson

et al. 2018

BMJ

398

266

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Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.

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Section: Mechanisms Linking Rheumatoid Arthritis and Cardiovascular Dmentioning

confidence: 87%

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

England

Thiele

Anderson

et al. 2018

BMJ

398

266

View full text Add to dashboard Cite

show abstract

“…Moreover, RA has also been associated with increased arterial stiffness and endothelial dysfunction that may contribute to development of HF by increased myocardial afterload and reduced coronary flow reserve 15, 19. Also, RA has been associated with left ventricular concentric remodeling and systolic and diastolic left ventricular dysfunction, respectively 13, 14, 17, 21. Even at an early course of the disease, patients with RA are more likely to display significantly elevated levels of circulating cardiac biomarkers (eg, troponins, pro‐B‐type natriuretic peptides) that are recognized as strong predictors of cardiac diseases, including HF 48.…”

Section: Discussionmentioning

confidence: 99%

“…The proinflammatory cytokines involved in HF promote myocardial damage and other pathogenic manifestations through an array of mechanisms, including, for example, increased arterial stiffness and endothelial dysfunction 13, 14, 15, 16, 17, 18, 19…”

Section: Introductionmentioning

confidence: 99%

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Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

Khalid

Egeberg

Ahlehoff

et al. 2018

JAHA

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BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease associated with a wide range of comorbidities, including cardiovascular disease, but its association with heart failure (HF) is not fully clear. We investigated the risk of incident HF in a nationwide cohort of patients with RA.Methods and ResultsThe study comprised the entire Danish population aged ≥18 years followed from January 1, 2008 until first hospitalization for HF, emigration, December 31, 2012, or death. Information on comorbidity, medication, and socioeconomic status was identified by individual‐level linkage of administrative registers. Patients with a rheumatologist diagnosis of RA between 1978 and 2008 were included. The primary study outcome was incident HF defined as first hospital admission for HF. Incidence rates of HF per 1000 person‐years were calculated and incidence rate ratios adjusted for age, sex, calendar year, comorbidity, medications, socioeconomic status, smoking, and alcohol consumption were estimated. A total of 4 305 225 subjects with no history of HF were eligible for analysis at the study start. Of these subjects, 24 343 developed RA and 50 623 were hospitalized for HF. Overall incidence rates of incident HF were 2.43 and 6.64 for the reference population (n=49 879) and patients with RA (n=744), respectively. Correspondingly, the fully adjusted incidence rate ratio for incident HF was increased in patients with RA with incidence rate ratio 1.30 (95% confidence interval, 1.17–1.45).ConclusionsIn this cohort study, RA was associated with an increased hospitalization for HF. These findings add significantly to the existing evidence of RA as a clinically relevant risk factor for HF.

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“…We have read with interest the recent paper by Midtbø et al 1. The authors evaluated 119 patients with rheumatoid arthritis (RA), and found that patients with RA active disease (Simplified Disease Activity Index (SDAI) >3.3) compared with those in remission (SDAI<3.3) had lower left ventricular (LV) systolic myocardial function, assessed by stress-corrected mid-wall shortening (scMWS) and global longitudinal strain (GLS).…”

mentioning

confidence: 99%

Disease activity and left ventricular systolic function in rheumatoid arthritis

et al. 2016

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Disease activity and left ventricular systolic function in rheumatoid arthritisWe have read with interest the recent paper by Midtbø et al. 1The authors evaluated 119 patients with rheumatoid arthritis (RA), and found that patients with RA active disease (Simplified Disease Activity Index (SDAI) >3.3) compared with those in remission (SDAI<3.3) had lower left ventricular (LV) systolic myocardial function, assessed by stress-corrected mid-wall shortening (scMWS) and global longitudinal strain (GLS).Data from Midtbø et al are in line with our previous work, in which we demonstrated that RA per se is a condition closely related to LV systolic dysfunction (LVSD) assessed by scMWS. 2Furthermore, similar to other pathophysiological models (systemic hypertension, diabetes mellitus and aortic stenosis), we showed that the LVSD in patients with RA is closely associated with concentric geometry and increased LV mass (LVM), 2 which is inappropriately high in the two-third of them.

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Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

Abstract: Active RA is associated with lower LV systolic myocardial function despite normal ejection fraction and independent of traditional cardiovascular risk factors.

Cited by 42 publications

References 43 publications

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

Disease activity and left ventricular systolic function in rheumatoid arthritis

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