4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Abstract

Abstract Aims The most frequent cause of death among patients affected by rheumatoid arthritis (RA) is heart failure, its high prevalence is independent by cardiovascular risk factors. An early diagnosis of heart failure risk may be done assessing left ventricular diastolic dysfunction (LVDD) by Doppler echocardiography. Our study aimed to estimate the LV diastolic function in RA patients. Methods and results We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography, physical examination, and confirmed diagnosis of RA for over a year and 200 PMW free from RA as control group (CG). All women underwent to M-mode, two-dimensional Doppler echocardiography. Seventy-two women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women on CG (23%), Chi-squared 6.8, odds ratio 1.8, confidence interval (CI) 95%, P < 0.0088. In our population of PMW the chance to be affected by LVDD is almost one and a half times. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%), 32 women were affected by LVDD among 98 hypertensive women on CG (32.7%), Chi-squared 72.1, odds ratio 7.2, CI 95%, P < 0.0088, Table II. Among hypertensive PMW of our population the chance to be affected by LVDD is more than triple. All LVDD subjects had abnormal diastole for all different degrees of severity. Conclusions We assess that PMW affected by RA have a significantly high incidence of LV diastolic dysfunction without clinical evidence of heart disease, the incidence is even higher if they are hypertensive, so we recommend a Doppler echocardiography examination for all women with a diagnosis of RA.