title: Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis. A prospective tissue Doppler echocardiography study.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) have a high risk for cardiovascular disease due to a chronic inflammatory state, accelerated atherosclerosis, and changes in left ventricular (LV) geometry. These conditions predispose patients to LV systolic dysfunction (LVSD). In this study we assessed whether RA is a condition associated with LVSD, and analyzed the prevalence and factors associated with LVSD in patients with RA.
  
  
  METHODS
  Echocardiographic and clinical data from 198 patients with RA without presence or history of symptoms of cardiac disease were compared with 198 non-RA controls matched for cardiovascular risk factors. LVSD was identified with tissue Doppler echocardiography (TDE) when mitral annular peak systolic velocity (S') was < 9.0 cm/s.
  
  
  RESULTS
  Patients with RA were 61 ± 12 years old and 71 % were female (disease duration 14 ± 10 years). LVSD was found in 89 patients with RA (45 %). By multiple regression analysis including both RA patients and controls, RA emerged as an independent condition associated with LVSD (exp β 3.89; CI: 1.87-8.08) together with higher E/E' ratio (index of LV diastolic function) and diabetes mellitus. For the 198 patients with RA, the variables associated with LVSD were higher E/E' ratio and systolic blood pressure.
  
  
  CONCLUSIONS
  Almost half of asymptomatic RA patients without history of cardiac disease have subclinical LVSD easily detectable with TDE. RA is closely related to LVSD. A higher degree of LV diastolic dysfunction and systolic blood pressure are associated with LVSD in these patients, whose risk for cardiovascular events could be better defined using such information in the asymptomatic stage of cardiac disease.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, via Piave 78, 38100, Trento, Italy. gcioffi@villabiancatrento.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Viapiana
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ognibeni
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dalbeni
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gatti
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Faganello
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Andre
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
mesh_terms: D017677:Age Distribution; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology*; D058070:Asymptomatic Diseases / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data*; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Cardiovascular risk; Left ventricular systolic dysfunction; Longitudinal function; Primary prevention; Rheumatoid arthritis