title: Left ventricular function at two-year follow-up in treatment-naive rheumatoid arthritis patients is associated with anti-cyclic citrullinated peptide antibody status: a cohort study.
abstract: OBJECTIVE
  In rheumatoid arthritis (RA), the role of autoimmunity, especially anti-cyclic citrullinated peptide antibody (anti-CCP) level, and the time-course of left ventricular (LV) function is unknown. The objective was to assess LV function and the amount of coronary calcium in relation to anti-CCP levels in a cohort of treatment-naive RA patients, and to assess changes in these parameters during a 2 year follow-up period.
  
  
  METHODS
  Sixty-six steroid- and disease-modifying anti-rheumatic drug-naive RA patients were treated with methotrexate according to the Danish national guidelines. We assessed LV function by conventional echocardiography and speckle-tracking echocardiography. We estimated the amount and progression of coronary calcium by coronary computed tomography. Patients were examined at the time of diagnosis and after 2 years.
  
  
  RESULTS
  Patients with elevated anti-CCP at baseline and after 2 years, compared to those with non-persistently elevated anti-CCP, had significantly less improvement in S´ (1 ± 1.4 cm/s vs 0.2 ± 0.9 cm/s; p = 0.04) and a worsening in global longitudinal systolic strain (GLS) (0.6 ± 1.8% vs -1 ± 2.8%; p = 0.04). There was a significant correlation between ΔGLS over 2 years and anti-CCP at 2 year follow-up (r = 0.36; p = 0.006). We observed a small progression of coronary calcium score during the 2 year follow-up period. No differences in progression were found between patients with high anti-CCP titres at baseline and 2 year follow-up (n = 12) and patients with normal/low anti-CCP titres (n = 32) (23.8 ± 40.3 vs 22.6 ± 68.9; p = 0.96).
  
  
  CONCLUSIONS
  Deformation analysis by speckle-tracking echocardiography is a valuable tool to detect early development of myocardial dysfunction despite normal ejection fraction in RA.
authors.affiliation: a Department of Cardiology , Aarhus University Hospital Skejby , Aarhus , Denmark.|b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: B B
authors.initials: BB
authors.lastname: Løgstrup
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: D
authors.initials: D
authors.lastname: Masic
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: T B
authors.initials: TB
authors.lastname: Laurbjerg
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Blegvad
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Herly
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: L D
authors.initials: LD
authors.lastname: Kristensen
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: G
authors.initials: G
authors.lastname: Urbonaviciene
authors.affiliation: b Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Hedemann-Nielsen
authors.affiliation: c The Danish National Registry DANBIO , Rigshospitalet Glostrup , Glostrup , Denmark.|d Department of Rheumatology , Odense University Hospital , Odense , Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Ellingsen
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D003718:Denmark; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D016277:Ventricular Function, Left
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D008727:Methotrexate