Five-year changes in cardiac structure and function in patients with rheumatoid arthritis compared with the general population.
Five-year changes in cardiac structure and function in patients with rheumatoid arthritis compared with the general population.
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DOI：
10.1016/j.ijcard.2017.03.108
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发表时间：
2017-08-01
影响因子：
3.5
通讯作者：
Gabriel SE
中科院分区：
文献类型：
--
作者：
Davis JM 3rd;Lin G;Oh JK;Crowson CS;Achenbach SJ;Therneau TM;Matteson EL;Rodeheffer RJ;Gabriel SE
射血分数保留的类风湿性关节炎（RA）患者发生心力衰竭的风险增加。临床心力衰竭发病前左心室功能障碍的发生和进展尚不清楚。本研究的目的是评估 RA 患者与普通人群相比心脏结构和功能的纵向变化。对 160 名 RA 患者的人群队列和 1,391 名非 RA 患者的人群队列（非 RA 队列）进行了一项前瞻性纵向研究。每个参与者在基线和 4 至 5 年的随访后均接受了二维脉冲波组织多普勒超声心动图检查。使用年龄和性别调整的线性回归模型来测试 RA 和非 RA 队列之间超声心动图参数年化变化率的差异。 RA 患者的二尖瓣 A 速度比非 RA 患者增加得更快（年龄和性别调整后的参数估计值，0.030；P<.001）。相应地，RA 队列的平均二尖瓣流入 E/A 比值比非 RA 队列下降得更快（调整后的参数估计值，-0.096；P<.001）。 RA 队列中左心房容积指数的增加速度高于非 RA 队列（调整参数估计值，0.150；P<.001）。这种超声心动图结果证实了之前的横断面研究，并表明 RA 患者舒张功能的亚临床变化在 5 年内发生得比一般人群更快。有必要进一步研究这些患者心肌疾病的机制以及与疾病活动性和治疗的关系。
Patients with rheumatoid arthritis (RA) have increased risk of heart failure with preserved ejection fraction. The development and progression of left ventricular dysfunction before onset of clinical heart failure are unknown. The objective of this study was to evaluate longitudinal changes in cardiac structure and function of patients with RA compared with persons in the general population. A prospective longitudinal study of a population-based cohort of 160 patients with RA and a population-based cohort of 1,391 persons without RA (non-RA cohort) was performed. Each participant underwent 2-dimensional, pulsed-wave tissue Doppler echocardiography at baseline and after 4 to 5 years of follow-up. Age- and sex-adjusted linear regression models were used to test for differences between the RA and non-RA cohorts in annualized rates of change for echocardiographic parameters. Mitral A velocity increased more rapidly among the patients with RA than the non-RA cohort (age- and sex-adjusted parameter estimate, 0.030; P<.001). Correspondingly, the mean mitral inflow E/A ratio decreased faster in the RA cohort than the non-RA cohort (adjusted parameter estimate, −0.096; P<.001). The left atrial volume index increased at a higher rate in the RA cohort than the non-RA cohort (adjusted parameter estimate, 0.150; P<.001). This pattern of echocardiographic findings confirms previous cross-sectional studies and indicates that subclinical changes in diastolic function occur more rapidly over 5 years in RA patients than in the general population. Further research into the mechanisms of myocardial disease in these patients and the relationship with disease activity and treatment is warranted.