title: Rheumatoid arthritis affects left ventricular mass: Systematic review and meta-analysis.
abstract: BACKGROUND
  Cardiovascular disease represents one of the most important extra-articular causes of morbidity and mortality in patients with rheumatoid arthritis (RA). Evidences showed that several cardiac structures can be affected during the course of the disease as well as abnormalities of left ventricular diastolic filling. Contrasting data are available about left ventricular mass (LVM) involvement in patients asymptomatic for cardiovascular disease. The purpose of this systematic review and meta-analysis is to summarize the effects of RA on LVM in rheumatoid arthritis patients without cardiovascular disease.
  
  
  METHODS
  A systematic research of the current case-control studies was conducted in Medline on November 20th, 2013. Studies were included if data of measurements of LVM were reported. The pooled mean effect size estimate was calculated according to methods described by Hedges and Olkin.
  
  
  RESULTS
  Sixteen eligible studies were included in this meta-analysis. RA determines an increase of absolute and indexed LVM compared with control patients [standardized mean difference (95% CI): 0.41(0.15-0.66) and 0.47(0.32-0.62), respectively]. On the contrary, posterior wall thickness did not show a significant RA effect. Finally, a significant positive effect of RA on interventricular wall thickness was found [standardized mean difference (95% CI): 0.39 (0.07-0.71)].
  
  
  CONCLUSIONS
  Results of this meta-analysis suggest that increased absolute and indexed LVM seem to be characteristic of RA patients with a fundamental clinical significance since they are related to an increased risk of cardiovascular morbidity and mortality. Our data suggest the use of LVM as surrogate end-point for clinical trials involving RA patients.
authors.affiliation: Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy; National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy. Electronic address: s.corrao@tiscali.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.affiliation: Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy.
authors.forename: Christiano
authors.initials: C
authors.lastname: Argano
authors.affiliation: National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pistone
authors.affiliation: Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Messina
authors.affiliation: Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Calvo
authors.affiliation: Department of Experimental and Clinical Medicine, "G. Salvatore" University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
mesh_terms: D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D003971:Diastole; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans
keywords: Echocardiography; Interventricular septum thickness; Left ventricular mass; Left ventricular posterior wall thickness; Rheumatoid arthritis