Patients with rheumatoid arthritis had markedly lower left ventricular (LV) mass compared with controls, a study utilizing cardiac magnetic resonance imaging found. Cardiac MRI previously has shown that increased LV mass is predictive of incident heart failure in the general population. "We hypothesized that the prevalence of increased LV mass and of enlarged LV chamber volumes, which are myocardial parameters typically associated with progression to clinical [heart failure], would be higher in [rheumatoid arthritis] patients compared with controls," the investigators said. Their finding that LV volume was lower, rather than higher, was unexpected, they acknowledged. "Although the etiology and implications of our finding of a lower LV mass in [rheumatoid arthritis] patients are not readily apparent, it is tempting to speculate that the lower LV mass . . . could be related to chronic myocarditis and/or microvascular hypoperfusion resulting in myocyte loss and/or fibrosis," Giles and colleagues wrote. Their study included 75 patients with rheumatoid arthritis and 225 matched controls whose mean age was 59. Slightly more than half were women. Patients had higher mean systolic and diastolic blood pressure and heart rate compared with controls, and they had higher median levels of interleukin 6. C-reactive protein levels did not differ between patients and controls, nor did the frequency of smoking, diabetes, or the presence of coronary calcium. A total of 88% of patients were receiving nonbiologic disease-modifying drugs and 49% were receiving biologic agents. In all but one case the biologic drug used was a tumor necrosis factor inhibitor. Univariate analysis determined that LV mass in both patients and controls was positively associated with male sex, higher body mass index and body surface area, diabetes, hypertension, smoking, exercise, and coronary calcification. An inverse association was found with age, heart rate, and HDL cholesterol.
Adjusted mean LV mass was 119 g in rheumatoid arthritis patients compared with 145 g in controls (P<0.001), according to Jon T. Giles, MD, of Johns Hopkins University, and colleagues.
This represented an 18% difference, the researchers reported in the April Arthritis & Rheumatism.
Heart failure is a major contributor to the excess cardiovascular mortality in patients with rheumatoid arthritis, but little is known about the natural history of myocardial dysfunction in these patients.
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