Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic patients with rheumatoid arthritis without overt cardiac disease

Diastolic dysfunction in rheumatoid arthritis

https://doi.org/10.4081/monaldi.2019.1053

Authors

  • Elena Costanza dal Piaz Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
  • Giovanni Cioffi | dottcioffi@gmail.com Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Federica Ognibeni Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Andrea Dalbeni General Medicine and Hypertension Unit, Department of Medicine, University of Verona, Italy.
  • Alessandro Giollo Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Giovanni Orsolini Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Davide Gatti Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Luca Idolazzi Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Carlo Stefenelli Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
  • Maurizio Rossini Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  • Ombretta Viapiana Rheumatology Unit, Department of Medicine, University of Verona, Italy.

Abstract

Rheumatoid arthritis (RA) is associated with higher risk of heart failure. Several studies report that left ventricular (LV) diastolic dysfunction (LVDD), a silent precursor of heart failure, is widely present in RA patients. Very little is known about the factors related to the development of LVDD in this disease. In this study we assessed the incidence and the predictors of new-onset LVDD in RA patients. Two-hundred-ninety-five adults with RA without overt cardiac disease were prospectively analyzed from March 2014 to March 2015 by Doppler echocardiography. Among the 295 subjects evaluated, 217 (73.6%) had normal LV diastolic function and represented the final study population. At 1-year follow-up, 53 of 217 patients (24%) developed LVDD, which was of degree I (mild dysfunction) in all of them. By multivariate logistic regression analysis, lower E/A ratio of transmitral flow (ratio between the peak velocity of early diastolic “E†wave and late diastolic “A†wave of transmitral flow) was independently associated with new-onset LVDD [OR 0.17 (CI 0.09-0.57)], together with older age and higher systolic blood pressure. In a clinical predictive model derived from multivariate analysis, the new-onset LVDD rate event ranged from 0% (patients without any factor) to 75% (patients in whom the three predictors coexisted). A significant portion of patients with RA without overt cardiac disease develop LVDD at 1-year follow-up. This condition can be predicted by a simple clinical model which could improve the clinical management and the prognostic stratification of patients with RA.

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Published
2019-09-10
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Issue
Section
Cardiology - Original Articles
Keywords:
Left ventricular diastolic dysfunction, rheumatoid arthritis, heart failure, transthoracic Doppler echocardiography
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How to Cite
dal Piaz, Elena Costanza, Giovanni Cioffi, Federica Ognibeni, Andrea Dalbeni, Alessandro Giollo, Giovanni Orsolini, Davide Gatti, Luca Idolazzi, Carlo Stefenelli, Maurizio Rossini, and Ombretta Viapiana. 2019. “Incidence and Predictors of New Onset Left Ventricular Diastolic Dysfunction in Asymptomatic Patients With Rheumatoid Arthritis Without Overt Cardiac Disease: Diastolic Dysfunction in Rheumatoid Arthritis”. Monaldi Archives for Chest Disease 89 (3). https://doi.org/10.4081/monaldi.2019.1053.

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