Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction.
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.


CONCLUSIONS
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.
Rudominer
Rebecca L
RL
Weill Cornell Medical College, New York, New York 10021, USA.
Roman
Mary J
MJ
Devereux
Richard B
RB
Paget
Stephen A
SA
Schwartz
Joseph E
JE
Lockshin
Michael D
MD
Crow
Mary K
MK
Sammaritano
Lisa
L
Levine
Daniel M
DM
Salmon
Jane E
JE
D000328:Adult; D017677:Age Distribution; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume