Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction
Rebecca L. Rudominer
Weill Cornell Medical College, New York, New York
Search for more papers by this authorCorresponding Author
Mary J. Roman
Weill Cornell Medical College, New York, New York
Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021Search for more papers by this authorRichard B. Devereux
Weill Cornell Medical College, New York, New York
Search for more papers by this authorStephen A. Paget
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Dr. Paget has received consulting fees, speaking fees, and/or honoraria from Pfizer, Genentech, Abbott, RiGEN, Medarex, and Amgen (less than $10,000 each).
Search for more papers by this authorMichael D. Lockshin
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorMary K. Crow
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorLisa Sammaritano
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorDaniel M. Levine
Weill Cornell Medical College, New York, New York
Search for more papers by this authorJane E. Salmon
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorRebecca L. Rudominer
Weill Cornell Medical College, New York, New York
Search for more papers by this authorCorresponding Author
Mary J. Roman
Weill Cornell Medical College, New York, New York
Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021Search for more papers by this authorRichard B. Devereux
Weill Cornell Medical College, New York, New York
Search for more papers by this authorStephen A. Paget
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Dr. Paget has received consulting fees, speaking fees, and/or honoraria from Pfizer, Genentech, Abbott, RiGEN, Medarex, and Amgen (less than $10,000 each).
Search for more papers by this authorMichael D. Lockshin
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorMary K. Crow
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorLisa Sammaritano
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorDaniel M. Levine
Weill Cornell Medical College, New York, New York
Search for more papers by this authorJane E. Salmon
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
Search for more papers by this authorAbstract
Objective
Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with premature atherosclerosis, vascular stiffening, and heart failure. This study was undertaken to investigate whether RA is associated with underlying structural and functional abnormalities of the left ventricle (LV).
Methods
Eighty-nine RA patients without clinical cardiovascular disease and 89 healthy matched controls underwent echocardiography, carotid ultrasonography, and radial tonometry to measure arterial stiffness. RA patients and controls were similar in body size, hypertension and diabetes status, and cholesterol level.
Results
LV diastolic diameter (4.92 cm versus 4.64 cm; P < 0.001), mass (136.9 gm versus 121.7 gm; P = 0.004 or 36.5 versus 32.9 gm/m2.7; P = 0.01), ejection fraction (71% versus 67%; P < 0.001), and prevalence of LV hypertrophy (18% versus 6.7%; P = 0.023) were all higher among RA patients versus controls. In multivariate analysis, presence of RA was an independent correlate of LV mass (P = 0.004). Furthermore, RA was independently associated with presence of LV hypertrophy (odds ratio 4.14 [95% confidence interval 1.24, 13.80], P = 0.021). Among RA patients, age at diagnosis and disease duration were independently related to LV mass. RA patients with LV hypertrophy were older and had higher systolic pressure, damage index scores, C-reactive protein levels, homocysteine levels, and arterial stiffness compared with those without LV hypertrophy.
Conclusion
The present results demonstrate that RA is associated with increased LV mass. Disease duration is independently related to increased LV mass, suggesting a pathophysiologic link between chronic inflammation and LV hypertrophy. In contrast, LV systolic function is preserved in RA patients, indicating that systolic dysfunction is not an intrinsic feature of RA.
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