The role of inflammation, the autonomic nervous system and classical cardiovascular disease risk factors on subendocardial viability ratio in patients with RA: a cross-sectional and longitudinal study

Abstract

IntroductionEvidence indicates that rheumatoid arthritis (RA) patients have increased susceptibility to myocardial ischaemia that contributes to myocardial infarction. The subendocardial viability ratio (SEVR) can be measured using pulse wave analysis and reflects myocardial oxygen supply and demand. The objective of the present study was to examine specific predictors of SEVR in RA patients, with a specific focus on inflammation and classical cardiovascular disease (CVD) risk factors.MethodsTwo patient cohorts were included in the study; a primary cohort consisting of 220 RA patients and a validation cohort of 127 RA patients. All patients underwent assessment of SEVR using pulse wave analysis. Thirty-one patients from the primary cohort who were about to start anti-inflammatory treatment were prospectively examined for SEVR at pretreatment baseline and 2 weeks, 3 months and 1 year following treatment. Systemic markers of disease activity and classical CVD risk factors were assessed in all patients.ResultsThe SEVR (mean ± standard deviation) for RA in the primary cohort was 148 ± 27 and in the validation cohort was 142 ± 25. Regression analyses revealed that all parameters of RA disease activity were associated with SEVR, along with gender, blood pressure and heart rate. These findings were the same in the validation cohort. Analysis of longitudinal data showed that C-reactive protein (P < 0.001), erythrocyte sedimentation rate (P < 0.005), Disease Activity Score in 28 joints (P < 0.001), mean blood pressure (P < 0.005) and augmentation index (P < 0.001) were significantly reduced after commencing anti-TNFα treatment. Increasing C-reactive protein was found to be associated with a reduction in SEVR (P = 0.02) and an increase in augmentation index (P = 0.001).ConclusionThe present findings reveal that the SEVR is associated with markers of disease activity as well as highly prevalent classical CVD risk factors in RA, such as high blood pressure and diabetes. Further prospective studies are required to determine whether the SEVR predicts future cardiac events in RA.

Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

“…Low SEVR values indicate reduced subendocardial perfusion [5-7]. A low SEVR has been associated with albuminuria [8-10] and haemoglobin [11], as well as with markers of inflammation in patients with rheumatoid arthritis [12]. Hypertensive patients with reduced coronary flow reserve [13], extreme dippers [14], patients with rheumatoid arthritis [15] or peripheral artery disease [16], women with type 2 diabetes [17] and highly proteinuric CKD patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 [18] have also been associated with a lower SEVR.…”

The relationship between pulse waveform analysis indices, endothelial function and clinical outcomes in patients with peripheral artery disease treated using percutaneous transluminal angioplasty during a one-year follow-up period

“…Low SEVR has been associated with reduced coronary flow reserve in patients with low ABI [23], microalbuminuria [24,25], hypertension and cardiac autonomic neuropathy [26,27] in patients with type 1 diabetes, low fitness in obesity [28,29] and markers of inflammation in patients with rheumatoid arthritis [30]. Reduced SEVR has been shown to predict cardiovascular mortality in patients with chronic kidney disease [31] and the combined endpoint all-cause mortality and endstage renal disease in patients with type 1 diabetes [25].…”

The interrelation of endothelial function and microvascular reactivity in different vascular beds, and risk assessment in hypertension: results from the Doxazosin–ramipril study

“…Coronary microvascular function estimated by SEVR did not relate to SCORE. SEVR is a validated measure of cardiovascular health in subjects with rheumatoid arthritis, a population with a high prevalence of hypertension [ 56 ]. Accordingly, SEVR predicts cardiovascular mortality in patients at high risk [ 19 , 20 , 57 ].…”