medwireNews: Premenopausal women with rheumatoid arthritis (RA) are twice as likely as their healthy counterparts to have subclinical diastolic dysfunction, Korean study findings indicate.
Writing in Arthritis Research & Therapy, Gee Hee Kim and Yune-Jung Park, from the Catholic University of Korea in Suwon, therefore suggest “[e]arly screening of myocardial function may provide an opportunity for preventing future cardiovascular disease.”
For their study, Kim and Park screened 61 premenopausal women (mean age 48 years) with RA and no history of hypertension and 107 age-matched women without RA for the presence of grade I to III diastolic dysfunction using standard 2D/Doppler echocardiography. Grade I was defined as impaired relaxation with or without mild evidence of increased filling pressures, grade II was impaired relaxation associated with moderate elevation of filling pressures or pseudonormal filling, and grade III involved advanced reduction in compliance restrictive filling.
They found that 47% of the women with RA had diastolic dysfunction, compared with 26% of those without RA, a significant difference.
Individuals with RA also had significantly higher median left ventricular (LV) end-diastolic diameter than controls (46 vs 45 mm), as well as higher median LV mass index (151.7 vs 140.0 g/m2), LV filling pressure (9.4 vs 9.0), and transmitral A wave velocity (70.0 vs 65.8 cm/s).
Median transmitral E wave velocity (68.5 vs 72.4 cm/s), systolic tissue velocity (6.9 vs 8.0 cm/s), and early diastolic tissue velocity (8.7 vs 9.3 cm/s) were all significantly lower in the patients with RA relative to controls. There was no significant difference between the two groups in median LV ejection fraction (64.0 vs 64.6%).
In multivariate analyses, adjusted for potential confounders including age, BMI, and blood pressure, higher C-reactive protein levels were significantly associated with an increased likelihood for diastolic dysfunction in the women with RA.
In addition, the risk varied by age. The researchers observed that women with RA aged 30–49 years had a significant 3.54 higher risk for diastolic dysfunction than those of the same age without RA. However, the risk was not significantly elevated for older women with RA.
Kim and Park say: “RA patients aged 30–50 already have a risk of developing diastolic dysfunction comparable to control subjects in their 60s.
“This indicates that the risk of diastolic dysfunction in RA patients is accelerated, which is in line with the observation that patients with RA over the age of 60 experience a significantly higher incidence of [congestive heart failure] compared to those without.”
The authors conclude: “This increased risk of diastolic dysfunction at a younger age is undoubtedly one of the reasons contributing to heart failure at an older age.”
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