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. 2024 Sep 30.
doi: 10.1007/s00392-024-02548-6. Online ahead of print.

Subclinical left ventricular dysfunction in rheumatoid arthritis: findings from the prospective Porto-RA cohort

André Alexandre #  1   2 , David Sá-Couto #  3   4 , Mariana Brandão  4   5   6 , Sofia Cabral  3   4 , Tomás Fonseca  4   5   6 , Rita Quelhas Costa  7 , António Marinho  4   5   6 , Carlos Vasconcelos  5   6 , Betânia Ferreira  6   8 , João Pedro Ferreira  9   10 , Patrícia Rodrigues  3   4   11
Affiliations

Subclinical left ventricular dysfunction in rheumatoid arthritis: findings from the prospective Porto-RA cohort

André Alexandre et al. Clin Res Cardiol. .

Abstract

Aim: Patients with rheumatoid arthritis (RA) have an increased risk of cardiac dysfunction and heart failure (HF) due to a pro-inflammatory state. Detecting cardiac dysfunction in RA is challenging as these patients often present preserved ejection fraction (EF) but may have subclinical ventricular dysfunction. Echocardiographic strain analysis is a promising tool for early detection of subclinical left ventricular systolic dysfunction (LVSD). This study assesses the prognostic role of strain analysis in RA.

Methods and results: Prospective study of 277 RA patients without known heart disease and preserved EF, categorized by left ventricular global longitudinal strain (GLS): normal GLS (≤ - 18%) vs. subclinical LVSD (> - 18%). Primary outcome was a composite of myocardial infarction, HF hospitalization, stroke, or cardiovascular death (MACE). Mean age was 57 years, 79% female. Although mean GLS was within normal (- 20 ± 3%), subclinical LVSD was observed in 24% of patients (n = 67) and was positively correlated with older age (OR 1.54 per 10 years; p < 0.001) and comorbid conditions, such as dyslipidemia (OR 2.27; p = 0.004), obesity (OR 2.29; p = 0.015), and chronic kidney disease (OR 8.39; p = 0.012). Subclinical LVSD was independently associated with a 3.9-fold higher risk of MACE (p = 0.003) and a 3.4-fold higher risk of HF hospitalization/cardiovascular death (p = 0.041). A GLS threshold of > - 18.5% provided optimal sensitivity (78%) and specificity (74%) in identifying patients at elevated MACE risk (AUC = 0.78; p < 0.001).

Conclusion: Subclinical LVSD, identified by reduced GLS, was strongly associated with adverse cardiovascular events in RA. Whether these findings have therapeutic implications is worth exploring in clinical trials.

Keywords: Heart failure; Left ventricular global longitudinal strain; Major adverse cardiovascular events; Rheumatoid arthritis; Subclinical cardiac dysfunction.

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