title: Tocilizumab treatment increases left ventricular ejection fraction and decreases left ventricular mass index in patients with rheumatoid arthritis without cardiac symptoms: assessed using 3.0 tesla cardiac magnetic resonance imaging.
abstract: OBJECTIVE
  The aim of our pilot study was to prospectively evaluate the effect of inhibiting interleukin 6 on the left ventricular (LV) structure and function in patients with rheumatoid arthritis (RA) without cardiac symptoms, using cardiac magnetic resonance (CMR).
  
  
  METHODS
  Female patients with RA with active disease and healthy controls were enrolled. Cardiac symptoms were absent in all subjects. Tocilizumab (TCZ; 8 mg/kg IV every 4 weeks) was prescribed for patients with RA with an inadequate clinical response to methotrexate. All subjects underwent baseline evaluation of LV function and structure measured by CMR. We compared measures of LV geometry and function between patients with RA and patients without RA controls at baseline, and changes in the same variables between baseline and after 52 weeks of treatment among the group with RA.
  
  
  RESULTS
  Twenty women with RA were compared with 20 women without RA of similar mean age. In patients with RA at baseline, ejection fraction (EF) was significantly lower (-3.7%) and LV mass index (LVMI) significantly higher (+9.2%) compared with controls. TCZ treatment resulted in a significant decrease in the Simplified Disease Activity Index (SDAI) after 52 weeks of treatment, paralleling a significant increase in EF (+8.2%) and a significant decrease in LVMI (-24.4%) over the same period. The percentage change in LVMI correlated strongly with the percentage change in SDAI (r = -0.63, p = 0.0028). LV geometry in the group with RA at baseline showed eccentric hyper-trophy compared with the group without RA, a condition that normalized after TCZ treatment.
  
  
  CONCLUSIONS
  TCZ treatment significantly increased EF and decreased LVMI associated with disease activity.
authors.affiliation: From the Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine; the Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo; the Department of Radiology and the Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan; the Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.H. Kobayashi, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, and Division of Rheumatology, Itabashi Chuo Medical Center; Y. Kobayashi, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; J.T. Giles, MD, Division of Rheumatology, Columbia University, College of Physicians and Surgeons; K. Yoneyama, MD, PhD, Division of Cardiology, St. Marianna University School of Medicine; Y. Nakajima, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; M. Takei, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: From the Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine; the Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo; the Department of Radiology and the Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan; the Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.H. Kobayashi, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, and Division of Rheumatology, Itabashi Chuo Medical Center; Y. Kobayashi, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; J.T. Giles, MD, Division of Rheumatology, Columbia University, College of Physicians and Surgeons; K. Yoneyama, MD, PhD, Division of Cardiology, St. Marianna University School of Medicine; Y. Nakajima, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; M. Takei, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine. pero1995@gmail.com.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: From the Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine; the Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo; the Department of Radiology and the Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan; the Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.H. Kobayashi, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, and Division of Rheumatology, Itabashi Chuo Medical Center; Y. Kobayashi, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; J.T. Giles, MD, Division of Rheumatology, Columbia University, College of Physicians and Surgeons; K. Yoneyama, MD, PhD, Division of Cardiology, St. Marianna University School of Medicine; Y. Nakajima, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; M. Takei, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Jon T
authors.initials: JT
authors.lastname: Giles
authors.affiliation: From the Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine; the Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo; the Department of Radiology and the Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan; the Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.H. Kobayashi, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, and Division of Rheumatology, Itabashi Chuo Medical Center; Y. Kobayashi, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; J.T. Giles, MD, Division of Rheumatology, Columbia University, College of Physicians and Surgeons; K. Yoneyama, MD, PhD, Division of Cardiology, St. Marianna University School of Medicine; Y. Nakajima, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; M. Takei, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.affiliation: From the Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine; the Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo; the Department of Radiology and the Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan; the Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.H. Kobayashi, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, and Division of Rheumatology, Itabashi Chuo Medical Center; Y. Kobayashi, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; J.T. Giles, MD, Division of Rheumatology, Columbia University, College of Physicians and Surgeons; K. Yoneyama, MD, PhD, Division of Cardiology, St. Marianna University School of Medicine; Y. Nakajima, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; M. Takei, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: From the Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine; the Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo; the Department of Radiology and the Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan; the Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.H. Kobayashi, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, and Division of Rheumatology, Itabashi Chuo Medical Center; Y. Kobayashi, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; J.T. Giles, MD, Division of Rheumatology, Columbia University, College of Physicians and Surgeons; K. Yoneyama, MD, PhD, Division of Cardiology, St. Marianna University School of Medicine; Y. Nakajima, MD, PhD, Department of Radiology, St. Marianna University School of Medicine; M. Takei, MD, PhD, Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Masami
authors.initials: M
authors.lastname: Takei
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010865:Pilot Projects; D013318:Stroke Volume / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab
keywords: CARDIAC MAGNETIC RESONANCE IMAGING; LEFT VENTRICULAR FUNCTION AND STRUCTURE; RHEUMATOID ARTHRITIS; TOCILIZUMAB