The Features of Systolic Function and Remodelation of the Left Ventricle in Patients with Rheumatoid Arthritis in Combination with Arterial Hypertension

Abstract

Recent studies have shown that heart disease in patients with rheumatoid arthritis occurs according to various data in 20-100% of cases. Hypertension is often the first objectively detectable marker of cardiovascular pathology in patients with rheumatoid arthritis. Hypertension in patients with rheumatoid arthritis usually becomes an active initiator and accelerator of the progression of atherosclerosis and remodeling of the left ventricle. Cardiac remodeling in patients with hypertension and in patients with rheumatoid arthritis, combined with hypertension is a significant factor that affects to the quality of life and prognosis and requires careful study of this problem. The purpose of the work was to study the systolic function and morphological parameters of the left ventricle in patients with rheumatoid arthritis in combination with hypertension and to establish indicators associated with high cardiovascular risk. Material and methods. The main group of patients consisted of 93 patients with rheumatoid arthritis of moderate activity in combination with hypertension stage II. The second group included 45 patients with essential hypertension stage II. The control group had 31 almost healthy people. An ultrasound examination of the heart was performed with studying of systolic function and the main morphological parameters of the left ventricle. Results and discussion. We found a significant increase in the left ventricle myocardial mass index by 11.97% in patients with rheumatoid arthritis in combination with hypertension compared to the patients with essential hypertension and by 30.1% compared to the control group. We also detected the significant increase of the interventricular septum thickness by 9.02%, the posterior wall of left ventricle – by 5.51%, and the relative wall thickness of left ventricle – by 6.0% in patients with rheumatoid arthritis in combination with hypertension compared to the patient with essential hypertension. There was a significant increase in end-diastolic volume by 8.64%; end-systolic volume – by 12.95%; and a decrease of ejection fraction by 2.5% in patients with rheumatoid arthritis in combination with hypertension with m SCORE >4 points compared to the corresponding indicators of patients with m SCORE ≤4 points. The study showed that the most common type of left ventricle remodeling was concentric left ventricle hypertrophy (79% of patients) in patients with rheumatoid arthritis with hypertension. In addition, the subgroup of patients with m SCORE >4 points left ventricle myocardial mass and left ventricle myocardial mass index were by 15.01% and 14.86% significantly higher than the corresponding indicators in the subgroup of patients with m SCORE ≤4 points. Conclusion. The patients with rheumatoid arthritis in combination with hypertension showed an association between increasing of the left atrium size and the volume parameters of the left ventricle, and the presence of fluid in the pericardial cavity. This was manifested by the left atrium size increase by 10.65%, end-diastolic volume – by 8.62%, end-systolic volume – by 12.2% and the ejection fraction decrease by 2.23% in patients with fluid versus to a subgroup of patients without fluid in the pericardium