Evaluation of the relationship of immuno-inflammatory process with dyslipidemia and myocardial morphofunctional parameters in patients with chronic heart failure on the background of rheumatoid arthritis

Abstract

Objective. To evaluate the relationship between the manifestations of the immune-inflammatory process with dyslipidemia and morphofunctional parameters of the myocardial state in patients with chronic heart failure (CHF) with a preserved left ventricular ejection fraction (CHF-SFV) against the background of seropositive rheumatoid arthritis (RA).Subjects and methods. The study involved 57 women with CHF-SFV, formed as a result of coronary heart disease and/or hypertension. All patients had functional class I and II according to NYHA. All patients were divided into comparable groups: the first group included 31 patients with a combination of CHF and seropositive RA of radiological stage I-III, the second group included 26 patients without RA. Patients with RA had a low and moderate degree of activity according to DAS28. The Diagnosis of CHF was verified by ESC (European Society of Cardiology) criteria, the diagnosis of RA – by EULAR/ACR criteria (2010). The therapy was in line with current clinical recommendations. Methotrexate was used as a basic anti-inflammatory drug in patients with RA. The average dosage was 12,9±2,5 mg/week. In the study groups, a comparative analysis of the main laboratory and instrumental indicators used in the diagnosis and monitoring of CHF, as well as the relationship of manifestations of the immunoinflammatory process with dyslipidemia and indicators of diastolic myocardial dysfunction was performed. Results. The level of total cholesterol in the CHF group without RA averaged 4,4±0,9 mmol/l and 5,2±2,2 mmol/l in the CHF and RA group (p=0,09); triglycerides – 1,9±0,7 and 1,5±0,9 mmol/l (p=0,3); low-density lipoproteins (LDL – C)-2,6±0,8 and 3,1±1,1 mmol/l (p=0,04); high – density lipoproteins (HDL-C) – HDL) – 1,3±0,2 and 1,3±0,1 mmol/l, respectively (p=0,7). In the group of CHF on the background of RA, a direct relationship between the intake of methotrexate (the average dose was 12,9±2,5 mg/week) and the level of HDL-C: R=0,3; R2=0,1; F=0,9; (p=0,01). In the group of CHF and RA, there was a statistically significant relationship between the ratio of transmittal flow parameters with the level of DAS28 and RF: R=0,5; R2=0,3; F=2,6 (p=0,04).Conclusion. Against the background of the immuno-inflammatory process caused by RA, a significant increase in the level of LDL was detected, which can negatively affect the course of dyslipidemia in patients with CHF-SFV. There was an increase in the concentration of HDL on the background of treatment with methotrexate in the group of CHF-SFV and RA. A direct correlation of the ratio of parameters of the transmittal flow with the RF and DAS28 levels was found. This relationship may affect the progression of left ventricular diastolic dysfunction in the group of CHF and RA, but prospective studies are needed to clarify its role.