Subclinical heart failure in juvenile idiopathic arthritis: a consequence of chronic inflammation and subclinical atherosclerosis

Abstract

Chronic inflammation is the basis of juvenile idiopathic arthritis (JIA). Hence, it is expected that JIA may produce harmful effects on the cardiovascular system. The aim of this study was to explore the presence of subclinical atherosclerosis and subclinical heart failure in JIA patients without manifest cardiovascular disease and to examine the risk factors that may be associated with the subclinical heart failure. Fifty JIA patients and 50 healthy matched controls were enrolled in this study. Inflammatory markers in the serum, together with intima-media thickness (IMT) and flow-mediated dilation (FMD) of brachial arteries as surrogate markers of subclinical atherosclerosis, were assessed and compared between patients and controls. Echocardiographic parameters of heart failure, including the Tei index and ejection fraction%, were also evaluated. JIA patients had significantly increased IMT and impaired endothelial dysfunction as measured by FMD% of the brachial artery in comparison with controls. JIA patients had significantly higher Tei index and significantly lower ejection fraction% in comparison with controls. In regression analysis only systemic JIA, FMD%, and IMT were significantly associated with the presence of subclinical heart failure among patients with JIA. Our findings indicate the presence of subclinical heart failure in these patients. JIA patients with subclinical atherosclerosis, with systemic disease, and with active disease are at greatest risk of developing subclinical heart failure.