Cardiovascular magnetic resonance characterization of myocardial and vascular function in rheumatoid arthritis patients

• Published in: Hellenic journal of cardiology 2019-01, Vol.60 (1), p.28-35
• Main Authors: Ntusi, Ntobeko A.B., Francis, Jane M., Gumedze, Freedom, Karvounis, Haralambos, Matthews, Paul M., Wordsworth, Paul B., Neubauer, Stefan, Karamitsos, Theodoros D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiopathology; Arthritis, Rheumatoid - complications; Cardiac Volume; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; cardiovascular magnetic resonance; Female; Humans; left ventricular function; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; myocardial strain; Myocardium - pathology; Rheumatoid arthritis; Risk Factors; Stroke Volume - physiology; vascular function; Vascular Stiffness - physiology; Ventricular Function, Left - physiology; Young Adult
• ISSN: 1109-9666; 2241-5955
• DOI: 10.1016/j.hjc.2018.01.008

Rheumatoid arthritis (RA) is a multisystem, autoimmune disorder and confers one of the strongest risks for cardiovascular disease (CVD) morbidity and mortality. To assess myocardial function and vascular stiffness in RA patients with and without cardiovascular risk factors (CVRFs) using cardiovascular magnetic resonance (CMR). Twenty-three RA patients with no CVRFs (17 female, mean age 52 ± 13 years), 46 RA patients with CVRFs (32 female, mean age 53 ± 12), 50 normal controls (32 female, mean age 50 ± 11 years), and 13 controls with CVRFs (7 female, mean age 55 ± 7 years), underwent CMR at 1.5 Tesla, including evaluation of left ventricular (LV) ejection fraction, strain, and vascular elasticity (aortic distensibility [AD] and pulse wave velocity [PWV]). Disease activity and duration were recorded for each patient. Subjects with known symptomatic CVD were excluded. LV volumes, mass, and ejection fraction were similar in the four groups. RA patients with CVRFs showed the greatest abnormality in mid short-axis circumferential systolic strain, peak diastolic strain rate, and vascular indices. RA patients without CVRFs showed a similar degree of vascular dysfunction and deformational abnormality as controls with CVRFs. AD and total PWV correlated with myocardial strain and RA disease activity. On multivariate regression analysis, strain was related to age, RA disease activity, AD, and PWV. CMR demonstrates impaired myocardial deformation and vascular function in asymptomatic RA patients, worse in those with CVRFs. Subclinical cardiovascular abnormalities are frequent and appear to be incremental to those due to traditional CVRFs and likely contribute to the excess CVD in RA. [Display omitted]