The role of inflammation, the autonomic nervous system and classical cardiovascular disease risk factors on subendocardial viability ratio in patients with RA: a cross-sectional and longitudinal studyReport as inadecuate




The role of inflammation, the autonomic nervous system and classical cardiovascular disease risk factors on subendocardial viability ratio in patients with RA: a cross-sectional and longitudinal study - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 14:R258

First Online: 28 November 2012Received: 17 August 2012Revised: 12 November 2012Accepted: 22 November 2012

Abstract

IntroductionEvidence indicates that rheumatoid arthritis RA patients have increased susceptibility to myocardial ischaemia that contributes to myocardial infarction. The subendocardial viability ratio SEVR can be measured using pulse wave analysis and reflects myocardial oxygen supply and demand. The objective of the present study was to examine specific predictors of SEVR in RA patients, with a specific focus on inflammation and classical cardiovascular disease CVD risk factors.

MethodsTwo patient cohorts were included in the study; a primary cohort consisting of 220 RA patients and a validation cohort of 127 RA patients. All patients underwent assessment of SEVR using pulse wave analysis. Thirty-one patients from the primary cohort who were about to start anti-inflammatory treatment were prospectively examined for SEVR at pretreatment baseline and 2 weeks, 3 months and 1 year following treatment. Systemic markers of disease activity and classical CVD risk factors were assessed in all patients.

ResultsThe SEVR mean ± standard deviation for RA in the primary cohort was 148 ± 27 and in the validation cohort was 142 ± 25. Regression analyses revealed that all parameters of RA disease activity were associated with SEVR, along with gender, blood pressure and heart rate. These findings were the same in the validation cohort. Analysis of longitudinal data showed that C-reactive protein P < 0.001, erythrocyte sedimentation rate P < 0.005, Disease Activity Score in 28 joints P < 0.001, mean blood pressure P < 0.005 and augmentation index P < 0.001 were significantly reduced after commencing anti-TNFα treatment. Increasing C-reactive protein was found to be associated with a reduction in SEVR P = 0.02 and an increase in augmentation index P = 0.001.

ConclusionThe present findings reveal that the SEVR is associated with markers of disease activity as well as highly prevalent classical CVD risk factors in RA, such as high blood pressure and diabetes. Further prospective studies are required to determine whether the SEVR predicts future cardiac events in RA.

AbbreviationsAIxaugmentation index

CRPC-reactive protein

CVDcardiovascular disease

cMRIcontrast-enhanced magnetic resonance imaging

DAS28Disease Activity Score in 28 joints

DTIdiastolic time index

ESRerythrocyte sedimentation rate

MBPmean blood pressure

PPpulse pressure

RArheumatoid arthritis

SEVRsubendocardial viability ratio

TTItension time index

TNFtumor necrosis factor.

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Author: Aamer Sandoo - Athanassios D Protogerou - James Hodson - Jacqueline P Smith - Evi Zampeli - Petros P Sfikakis - George D

Source: https://link.springer.com/







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