The assessment of diastolic function in patients with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune chronic disease. In comparison with the overall population, mortality and morbidity of RA patients are increased due to cardiovascular diseases. There is increasing evidence that autoimmunity mechanisms are included in pathogenesis of cardiovascular diseases. Isolated disorder of diastolic function can, even with normal heart contractility, lead to heart failure. The aim of this study was to assess diastolic function in RA patients and determine factors causing diastolic dysfunction. The study included 88 patients with RA treated at Rheumatology Department, Clinical Hospital Centre, Zemun. All the patients were thoroughly examined (clinical findings, laboratory and echocardiographic examination). All parameters of diastolic function (mitral and pulmonary flow) were measured. In RA patients 98.9% had diastolic function disorder. This parameter had been changed prior to clinical signs of heart failure and decrease of ejection fraction. Indicators of diastolic function, velocities E, A and their ratio V(E)/V(A), as well as velocities S, D and their ratio V(S)/V(D) were lower in patients with positive rheumatoid factor. The patients' age (p < 0.01), duration of the disease (p < 0.05), high level of cholesterol (p < 0.05), triglycerides (p < 0.05) and arterial hypertension (p < 0.05) were significant factors considerably affecting diastolic function. These findings suggest subclinical myocardial disorder in a great number of RA patients. Apart from early and aggressive treatment of the chronic inflammatory process, it is also necessary to prevent further heart complications by timely recognition and treatment of "standard" risk factors fbr cardiovascular diseases.