Prevalence of abnormal left ventricular geometry and predictors of left ventricular hypertrophy in patients with rheumatoid arthritis

Abstract

Background Rheumatoid arthritis (RA) patients have an excess risk of cardiovascular morbidity and mortality. Left ventricular hypertrophy (LVH) is generally considered a target organ damage of hypertensive patients, but it is an overlooked condition in the RA. In addition, LVH is one-sixth prevalence in RA patients and reflects a greater risk of cardiovascular events. Purpose We aimed to study the prevalence of LVH in patients with RA without symptomatic cardiovascular disease and explore the associated factors of LVH. Methods A cross-sectional study was conducted among adult RA patients and a retrospectively review of echocardiography from the database in non-RA participants. LVH was defined as LV mass index greater than 115 g/m2 in males or 95 g/m2 in females. The prediction model for LVH was constructed by stepwise logistic regression. The prediction model's performance on the test data is evaluated using receiver operator characteristic (ROC) curves to predict the presence of LVH and optimal cut-off point determined by the Youden index. Results This study included 109 RA patients and 119 age- and sex-matched non-RA participants. RA participants showed a significantly greater CV risk factor profile; hypertension, diabetes, and dyslipidemia than non-RA participants. Fifty two of 109 (47.7%) RA patients had abnormal LV geometry; eccentric hypertrophy, concentric remodeling, and concentric hypertrophy were 8/109 (7.3%), 28/109 (25.7%), and 16/109 (14.7%), respectively. The prevalence of LVH in RA patients was comparable to non-RA participants 24/109 (22%) and 28/119 (23.5%), p=0.91, respectively. However, there was significantly higher relative wall thickness in RA than non-RA participants 0.4±0.1 and 0.3±0.1, p<0.001, respectively. The diagnostic performance of the score prediction [(0.025×systolic blood pressure) + (non-steroidal anti-inflammatory drug × (0 or 1)) + (0.141×Troponin T level) ≥3.948] was to predict LVH in RA patients showed 91% sensitivity and 39% specificity (AUC = 0.689, 95% CI 0.564–0.814). Conclusion RA was associated with higher abnormal LV geometry compared to the non-RA participant. LVH is not uncommon in RA patients, and we could consider it as a target organ damage despite no obvious cardiovascular risk factors. The risk predictor score may be applied for fundamental screening tool for LVH in RA patients before sending the patients for echocardiography. Funding Acknowledgement Type of funding sources: None.