POS0553 IMPACT OF RHEUMATOID ARTHRITIS ON LEFT VENTRICULAR REMODELING

Abstract

Background:Patients with Rheumatoid Arthritis (RA) have a higher prevalence of cardiovascular diseases (1) and a strong association with abnormalities in the left ventricle (LV) geometry. Both concentric and eccentric remodeling have been determined as an independent factor for sudden cardiac arrest in the general population with normal or slightly decreased ventricular function (2) but there is still controversy about the factors involved and the pathophysiology in patients with RA.Objectives:The aim of the study is to determine the characteristics of LV geometry and the impact of RA.Methods:A cross-sectional, observational, and comparative study of fifty-two RA patients that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Controls were included and matched by age, gender, and comorbidities. Subjects were evaluated using a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. Ventricular geometry was evaluated with indexed left ventricular mass and relative wall thickness. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A logistic binary regression was performed with the traditional cardiovascular risk factors (CVRFs), age and RA diagnosis. A p value <0.05 was considered statistically significant.Results:No significant differences were found in the traditional CVRFs (type 2 diabetes mellitus, dyslipidemia, active smoking, and hypertension) (Table 1). Most of the subjects reported normal geometry in both groups (55.8% for RA group vs 64.0% for controls). A higher prevalence of eccentric hypertrophy was found in the RA group, 13 (25%) subjects versus 3 (6%) in the control group, p = 0.009. The binary regression showed that the diagnosis of RA was the only independent risk factor for the presence of eccentric hypertrophy, OR 7.22 95% CI (1.68-31.02, p = 0.008).Table 1.Demographic characteristics and echocardiographic findings.RA(n=52)Control(n=50)pAge, years ± DE51.4 ±6.251.1 ± 5.5NSWomen, n (%)51 (98.1)49 (98.0)NSActive smoking, n (%)8 (15.4)8 (16.0)NSDyslipidemia, n (%)11 (21.2)13 (26.0)NSType 2 Diabetes Mellitus, n (%)5 (9.6)5 (10.0)NSHTN, n (%)8 (15.4)10 (20.0)NSBMI kg/m2, median (p25-p75)27.8 (24.5-31.4)28.3 (25.4-30.3)NSBSA, median (p25-p75)1.7 (1.6-1.8)1.8 (1.6-1.9)0.003Systolic blood pressure, mmHg (p25-p75)119.5 (110.0-127.5)120.0 (110.7-130.0)NSEchocardiography findingsLVPWTd, median (p25-p75)0.9 (0.8-1.0)0.9 (0.8-1.0)NSLVIDd, median (p25-p75)4.8 (4.3-5.2)4.6 (4.5-4.9)NSLV mass, median (p25-p75)131.2 (119.5-155.7)131.2 (113.2-154.3)NSLV mass index, median (p25-p75)78.6 (69.7-95.6)76.0 (66.7-84.6)NSRWT, mean ± SD0.4 ± 0.090.4 ± 0.07NSNS, no significant; BMI, body mass index; BSA, body surface area; LVPWTd, left ventricular posterior wall thickness at end-diastole; LVIDd, left ventricular internal dimension at end-diastole; RWT, relative wall thickness.Conclusion:There is a higher prevalence of eccentric remodeling in patients with RA independently of traditional CVRF. The diagnosis of RA is an independent risk factor for the presence of eccentric hypertrophy that is associated with higher mortality. Treatment of cardiovascular comorbidities should be intensified in those patients with abnormalities in LV geometry in order to prevent cardiovascular diseases such as heart failure.References:[1]You S, Cho CS, Lee I, et al. A systems approach to rheumatoid arthritis. PLoS One 2012;7(12):e51508. doi: 10.1371/journal.pone.0051508[2]Pascale V, Finelli R, Giannotti R, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Sci Rep 2018;8(1):5867. doi: 10.1038/s41598-018-24323-0Disclosure of Interests:None declared