title: Prevalence and Factors Associated with Subclinical Left Ventricular Systolic Dysfunction Evaluated by Mid-Wall Mechanics in Rheumatoid Arthritis.
abstract: OBJECTIVE
  Patients with rheumatoid arthritis (RA) have an increased cardiovascular event rate, mainly due to the arterial stiffness which leads to coronary atherosclerosis and concentric left ventricular (LV) geometry. These conditions predispose to LV systolic dysfunction (LVSD), which can be detected by stress-corrected mid-wall shortening (sc-MS), an early prognosticator of cardiovascular events in asymptomatic patients with arterial hypertension and/or diabetes. In these subjects, sc-MS is frequently impaired even though LV ejection fraction (LVEF) is preserved. In this study, we analyzed the prevalence and the factors associated with asymptomatic LVSD measured by sc-MS among patients with RA and verified whether RA per se was independently related to LVSD.
  
  
  METHODS
  We prospectively recruited 198 outpatients with RA without overt cardiac disease between January and June 2014 and compared them to 198 controls matched for age, gender, body mass index, and prevalence of hypertension and diabetes. sc-MS was taken as index of LVSD and considered impaired if <86.5%.
  
  
  RESULTS
  Impaired sc-MS was detected in 110 (56%) RA patients and in 30 (15%) controls (P < 0.001), whereas LVEF was impaired (value <50%) in six (3%) RA patients and in two (1%) controls (P = ns). Multiple logistic regression analysis revealed that RA was independently associated with impaired sc-MS (Exp β 2.01 [CI 1.12-3.80], P = 0.02) together with increased LV mass and concentric geometry.
  
  
  CONCLUSIONS
  More than half RA patients without overt cardiac disease have LVSD detectable by sc-MS. RA emerges as a condition closely related to LVSD. These findings might explain the high risk for adverse cardiovascular events in RA patients.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, 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: Elena
authors.initials: E
authors.lastname: Fracassi
authors.affiliation: Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giollo
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: 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: Cardiovascular Center, Health Authority no 1, University of Trieste, Trieste, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Cardiovascular Center, Health Authority no 1, University of Trieste, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Faganello
authors.affiliation: Cardiovascular Center, Health Authority no 1, University of Trieste, Trieste, Italy.
authors.forename: Andrea Di
authors.initials: AD
authors.lastname: 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 / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D058070:Asymptomatic Diseases / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: cardiovascular risk; left ventricular function; mid-wall shortening; primary prevention; rheumatoid arthritis