Імунно-запальні предиктори розвитку діастолічної дисфункції лівого шлуночка у хворих на ревматоїдний артрит в поєднанні з артеріальною гіпертензією

Abstract

Hypertension is the most common concomitant disease in patients with rheumatoid arthritis. Diastolic dysfunction of left ventricle is an important predictor of chronic heart failure, which can be asymptomatic for a long time. Therefore, it is advisable to detect diastolic dysfunction of left ventricle as early as possible, which can slow the progression of chronic heart failure. The purpose of the study was to determine the value of lipid peroxidation, endothelial function and systemic inflammatory response markers for diagnostic of diastolic dysfunction of left ventricle and for diagnostic of pericardial effusion in patients with rheumatoid arthritis combined with hypertension. Materials and methods. 93 patients with rheumatoid arthritis in combination with stage II hypertension were studied. The ultrasound examination of heart was performed. The serum laboratory markers of lipid peroxidation, concentration of pro-inflammatory cytokines, markers of endothelial function were determined. Results and discussion. Signs of diastolic dysfunction of left ventricle were found in 79 patients and no signs of diastolic dysfunction were found in 14 patients. It was detected that there was a significant increase of concentration of asymmetric dimethylarginine by 16.3%, interleukin-1β by 35.3%, interleukin-10 by 24.3%, the ratio of interleukin-1β / interleukin-10 by 62.0%, C-reactive protein by 52.6% and there was a significant decrease of total nitric oxide metabolites by 36.9%, nitrires by 37.5% and nitrates by 37.0% in patients with signs of diastolic dysfunction of left ventricle compared to the patients without diastolic dysfunction of left ventricle (p <0.01). It was found that the levels of isolated double bonds, diene conjugates, diene ketones, schiff bases and malonic aldehyde in patients with diastolic dysfunction of left ventricle were significantly higher by 24.4%, 25.2%, 20.4%, 17.6% and 21.4% respectively compared to the corresponding markers in patients without signs of diastolic dysfunction of left ventricle (p <0.01). The levels of vitamin A, vitamin E and catalase in patients with diastolic dysfunction of left ventricle were significantly lower by 18.2%, 27.4% and 13.4% compared to the corresponding markers of patients with normal left ventricle diastolic function (p <0.01). The highest predictor value for the diagnostic of diastolic dysfunction of left ventricle was detected in interleukin-1β area under the ROC curve 0.882, sensitivity 72.15% and specificity 100%, 95% CI [0.798-0.939] at the optimal distribution point >9.67 pg/ml and in asymmetric dimethylarginine area under the ROC curve 0.879 sensitivity 75.95% and specificity of 100%, 95% CI [0.795-0.937] at the optimal distribution point >0.715 μmol/l. In 17 (18.28%) patients, the effusion in the pericardial cavity was detected. It was detected that there was a significant increase of isolated double bonds by 18.65%, diene conjugates by 19.73%, diene ketones by 25.25%, schiff bases by 20%, malonic aldehyde by 26.76% and there was a significant decrease of vitamin A by 38.4%, vitamin E by 55.4% and catalase by 37.2% in patients with effusion in the pericardial cavity. The significant increase of asymmetric dimethylarginine was detected by 25.25%, interleukin-1β – by 52.24%, interleukin-10 – by 15.76%, the ratio of interleukin-1β / interleukin-10 – by 38.86% and C-reactive protein – by 26.9% in patients with effusion in the pericardial cavity. In addition, patients with cavity effusion have significant decrease of nitric oxide metabolites by 25.0%, nitrires by 30.0% and nitrates by 11.11% compared to the patient without effusion. The highest predictor value for the detection of effusion in the pericardial cavity was found in asymmetric dimethylarginine area under the ROC curve 0.913, 95% CI area under the ROC curve [0.836-0.961] at the optimal distribution point >0.841 μmol/l, sensitivity 94.12% and specificity 85.53%. Conclusion. The markers, which have the highest prognostic value for diagnostic of diastolic dysfunction of left ventricle in patients with rheumatoid arthritis combined with hypertension, are interleukin-1β and asymmetric dimethylarginine. In addition, asymmetric dimethylarginine has the highest predictor value for detecting fluid in the pericardial cavity