Abstract
Studying the factors leading to a pathological change in the cardiac structure in patients with rheumatoid arthritis (RA) can contribute to improvement in early diagnosis and to prevention of premature mortality from cardiovascular events.Objective. To study the types of left ventricular (LV) remodeling in patients with RA, by taking into account traditional cardiovascular risk factors, and to assess the clinical and immunological features of RA and the impact of drug therapy.Patients and methods. The investigation enrolled 74 RA patients who underwent assessment of echocardiography findings, by determining the type of LV remodeling, traditional cardiovascular risk factors, clinical and immunological features of the disease, as well as the current drug therapy.Results and discussion. Eccentric LV hypertrophy (ELVH) (n=33 (44.59%)) and concentric LV hypertrophy (CLVH) (n=34 (45.95%)) occurred at almost the same frequency among the pathological types of LV remodeling in patients with RA. Higher DAS28 values (p<0.0001) were noted in ELVH than in CLVH. There were also positive correlations of EHLH with ESR and CRP level (r= 0.51, p<0.0001; r=0.48, p=0.0001, respectively). The higher values of systolic blood pressure (p=0.0002), body mass index (p=0.01), patient age (p=0.0001), and the incidence of dyslipidemia (p= 0.008) were established in CVLH than in ELVH. LV diastolic dysfunction (DD) was detected much more frequently in RA patients with CLVH than in those with ELVH (p=0.01). The DD parameters (peak A, E/A) correlated with the degree (r=0.5, p<0.0001; r=-0.5. p<0.0001) and stage of hypertension (r=0.54, p<0.0001; r=-0.48, p=0.0001, respectively), as well as with peak A and traditional risk factors, such as patient age (r=0.52, p<0.0001), and high-density lipoprotein cholesterol levels (r=-0.48, p=0.0001).Conclusion. Most patients with RA had signs of LV hypertrophy; moreover, ELVH was closely linked with disease activity, whereas CLVH was related to the traditional risk factors.
Highlights
Изучение факторов, приводящих к патологическому изменению структуры сердца у пациентов с ревматоидным артритом (РА), может способствовать улучшению ранней диагностики и предупреждению преждевременной летальности от кардиоваскулярных осложнений
Studying the factors leading to a pathological change in the cardiac structure in patients with rheumatoid arthritis (RA) can contribute to improvement in early diagnosis and to prevention of premature mortality from cardiovascular events
Most patients with RA had signs of left ventricular (LV) hypertrophy; Eccentric LV hypertrophy (ELVH) was closely linked with disease activity, whereas concentric LV hypertrophy (CLVH) was related to the traditional risk factors
Summary
Кривотулова И.А., Корочина К.В., Чернышева Т.В., Кузнецов Г.Э., Тенчурина Л.Р. ФГБОУ ВО «Оренбургский государственный медицинский университет» Минздрава России, Оренбург Россия, 460000, Оренбург, ул. Цель исследования – изучение типов ремоделирования левого желудочка (ЛЖ) у пациентов с РА с учетом традиционных факторов кардиоваскулярного риска, а также оценка клинических и иммунологических особенностей РА и влияния медикаментозной терапии. При КГЛЖ были установлены более высокие значения систолического артериального давления (р=0,0002), индекса массы тела (р=0,01), возраста пациента (р=0,0001) и встречаемости дислипидемии (р=0,008), чем при ЭГЛЖ. Диастолическая дисфункция (ДД) ЛЖ у больных РА с КГЛЖ выявлялась гораздо чаще, чем у пациентов с ЭГЛЖ (р=0,01). Большинство пациентов с РА имели признаки гипертрофии ЛЖ, при этом ЭГЛЖ была тесно связана с активностью заболевания, а КГЛЖ – с традиционными факторами риска. Цель исследования – определение типов ремоделирования ЛЖ у пациентов с РА с учетом традиционных факторов кардиоваскулярного риска, а также оценка клинических и иммунологических особенностей РА и влияния медикаментозной терапии. Традиционные факторы кардиоваскулярного риска у пациентов с РА в зависимости от типа геометрии миокарда ЛЖ Table 2.
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