title: Increased Prevalence of Diastolic Heart Failure in Patients with Rheumatoid Arthritis Correlates with Active Disease, but Not with Treatment Type.
abstract: OBJECTIVE
  Although heart failure (HF) is a major cause of premature mortality, there is little information regarding its prevalence and associated risk factors in patients with rheumatoid arthritis (RA). In this study, we evaluated the prevalence of HF in a community-based RA cohort. Further, we investigated the effect of RA activity and present treatment on HF rate and cardiac structure.
  
  
  METHODS
  A diagnostic workup for HF according to the European Society of Cardiology recommendations was performed in 157 patients with RA fulfilling the American College of Rheumatology/European League Against Rheumatism criteria (68% women, age 61 ± 13 yrs) from our outpatient clinic and in 77 age- and sex-matched controls.
  
  
  RESULTS
  The prevalence of HF in patients with RA (24%) was unexpectedly high and differed significantly from the control sample (6%, p = 0.001). Diastolic HF was the dominant type (23% vs 6%), and clinical symptoms alone were of low diagnostic value. Active RA (28-joint Disease Activity Score ≥ 2.6: OR 3.4, 95% CI 1.3-9.8) was an independent risk factor of HF, as well as systemic inflammation (erythrocyte sedimentation rate > 16 mm/h: OR 5.4, 95% CI 2.1-16; C-reactive protein > 10 mg/l: OR 2.6, 95% CI 0.8-8.0) and RA duration > 10 years (OR 2.6, 95% CI 1.2-5.8). HF in RA was associated with concentric hypertrophy (48% vs 17%, p < 0.001) and reduced longitudinal strain (-17.2% vs -19.7%, p < 0.001). However, the prevalence of HF was equivalent between the treatment groups [conventional synthetic disease-modifying antirheumatic drugs (DMARD) 25%, tumor necrosis factor inhibitors 22%, other biological DMARD 27%].
  
  
  CONCLUSIONS
  Recognition of all diastolic HF in RA requires a complex diagnostic approach. Active rather than inactive RA places patients at a higher risk for HF, whereas influence of RA treatment on HF risk needs to be elucidated in further studies.
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schau
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Michael
authors.initials: M
authors.lastname: Gottwald
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Olga
authors.initials: O
authors.lastname: Arbach
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Martin
authors.initials: M
authors.lastname: Seifert
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Maren
authors.initials: M
authors.lastname: Schöpp
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Michael
authors.initials: M
authors.lastname: Neuß
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
authors.forename: Christian
authors.initials: C
authors.lastname: Butter
authors.affiliation: From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg. m.zaenker@immanuel.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Zänker
mesh_terms: D017677:Age Distribution; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005858:Germany; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: CARDIOVASCULAR RISK; CONCENTRIC HYPERTROPHY; DIASTOLIC HEART FAILURE; DISEASE ACTIVITY; GLOBAL LONGITUDINAL STRAIN; RHEUMATOID ARTHRITIS