Clinical InvestigationCardiac Involvement in Systemic DiseasesCombined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction in Patients with Rheumatoid Arthritis without Overt Cardiac Disease
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Study Population
The design of the study was prospective. Patients >18 years of age with diagnoses of rheumatoid arthritis ascertained by clinical and laboratory examination underwent echocardiographic, clinical, and laboratory evaluations. All subjects were free of symptoms and clinical signs attributable to some cardiac disease. Exclusion criteria were a history of myocardial infarction, myocarditis, or HF; coronary heart disease diagnosed by clinical or electrocardiographic evaluation at rest and by
Prevalence and Predictors of Combined C&L LVSD
The 198 patients with rheumatoid arthritis enrolled in this study had histories of disease lasting a mean of 14 ± 10 years and a mean number of joints involved at baseline evaluation of 10 ± 3, 5% of them had extra-articular manifestations of rheumatoid arthritis, and disease activity was high in 17%. Their main clinical and echocardiographic characteristics are shown in Table 1.
Combined C&L LVSD was found in 56 patients (28% of the rheumatoid arthritis study population). The distribution of
Discussion
The present study makes evident several original findings. In patients with rheumatoid arthritis without clinical evidence of heart disease, (1) the condition of combined C&L LVSD is frequent, detectable in more than one fourth of subjects; (2) these patients have comparable clinical and laboratory characteristics with those without combined C&L LVSD but exhibit remarkable concentric LV geometry and increased LV mass; (3) rheumatoid arthritis is an independent factor associated with combined
Conclusions
In a large sample of patients with asymptomatic rheumatoid arthritis without histories of cardiac disease, the presence of combined C&L LVSD is common. This condition is associated with unfavorable changes in LV geometry and might be thought as a pathophysiologic model of compensated and asymptomatic chronic HF. Rheumatoid arthritis per se is powerfully related to combined C&L LVSD. These findings may be clinically useful for identifying a subgroup of patients with rheumatoid arthritis at very
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