Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Chronic Heart Failure in Early Rheumatoid Arthritis Patients Prior to Basic Antirheumatic Therapy

https://doi.org/10.20996/1819-6446-2020-01-02

Full Text:

Abstract

Aim. To study the clinical manifestations and factors associated with the presence of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA) prior to anti-inflammatory therapy. Material and methods. The study included 74 patients with valid diagnosis of RA (criteria ACR/EULAR, 2010), 56 women (74%), median age – 54 [46;61] years, disease duration – 7 [4;8] months; seropositive for IgM rheumatoid factor (87%) and/or antibodies to cyclic citrullinated peptide (100%) prior to taking disease modifying anti-rheumatic drugs and glucocorticoids. CHF was verified in accordance with actual guidelines. The assessment of traditional risk factors for cardiovascular diseases, echocardiography, tissue Doppler imaging, carotid artery ultrasound, were carried out before the start of therapy in all patients with early RA. The concentration of NT-proBNP was determined by electrochemiluminescence. The normal range for NT-proBNP was less than 125 pg/ml.

Results. CHF was diagnosed in 24 (33%) patients: in 23 patients – CHF with preserved ejection fraction, in 1 patient – CHF with reduced ejection fraction. 50% of patients with RA under the age of 60 were diagnosed with CHF. NYHA class I was found in 5 (21%) patients, class II – in 15 (63%), class III – in 1 (4%). Positive predictive value of clinical symptoms did not exceed 38%. All patients with early RA were divided into two groups: 1 – with CHF, 2 – without CHF. Patients with RA+CHF compared with patients without CHF were older, had higher body mass index, frequency of carotid atherosclerosis, of ischemic heart disease (IHD), hypertension, C-reactive protein (CRP) levels and intima media thickness. Independent factors associated with the presence of CHF were identified by linear regression analysis: abdominal obesity, CRP level, systolic blood pressure, dyslipidemia, carotid intima thickness, IHD. The multiple coefficient of determination was R2=57.1 (R-0.76, p<0.001). Level of NT-proBNP in RA patients with CHF (192.0 [154.9; 255.7] pg/ml) was higher than in RA patients without CHF (77 [41.1; 191.2] pg/ml) and in control (49.0 [33.2; 65.8] pg/ml), p<0.0001 and p=0.01, respectively. To exclude CHF in patients with early RA, the optimal NT-proBNP level was 150.4 pg/ml (sensitivity – 80%, specificity – 79%), the area under the ROC curve = 0.957 (95% confidence interval 0.913-1.002, p<0.001).

Conclusion. CHF was detected in a third of RA patients at the early stage of the disease. Factors associated with the presence of CHF were abdominal obesity, CRP level, systolic blood pressure, dyslipidemia, intima media thickness, IHD.

About the Authors

I. G. Kirillova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Irina G. Kirillova – MD, Researcher, Systemic Rheumatic Diseases Laboratory

Kashirskoe shosse 34a, Moscow, 115522





D. S. Novikova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Diana S. Novikova – MD, PhD, Leading Researcher, Systemic Rheumatic Diseases Laboratory

Kashirskoe shosse 34a, Moscow, 115522



T. V. Popkova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Tatiana V. Popkova – MD, PhD, Leading Researcher, Systemic Rheumatic Diseases Laboratory

Kashirskoe shosse 34a, Moscow, 115522





H. V. Udachkina
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Helen V. Udachkina – MD, Researcher, Rheumocardiology Laboratory

Kashirskoe shosse 34a, Moscow, 115522





E. I. Markelova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Evgenia I. Markelova – MD, Senior Researcher, Systemic Rheumatic Diseases Laboratory

Kashirskoe shosse 34a, Moscow, 115522





Yu. N. Gorbunova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Yulia N. Gorbunova – MD, Researcher, Systemic Systemic Rheumatic Diseases Laboratory

Kashirskoe shosse 34a, Moscow, 115522

 



Yu. O. Korsakova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Yulia O. Korsakova – MD, Doctor of Ultrasonic Diagnostics, Laboratory of Instrumental and Ultrasonic Diagnostics

Kashirskoe shosse 34a, Moscow, 115522





S. N. Gluchova
Research Institute of Rheumatology named after V.A. Nasonova
Russian Federation

Svetlana N. Gluchova – Researcher, Educational and Methodical Department

Kashirskoe shosse 34a, Moscow, 115522





References

1. Wolfe F., Michaud K. Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am J Med. 2004;116:305-11. DOI:10.1016/j.amjmed.2003.09.039.

2. Nicola P.J., Crowson C.S., Maradit-Kremers H., et al. Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis. Arthritis Rheum. 2006;54:60-7. DOI:10.1002/art.21560.

3. Crowson C.S., Nicola P.J., Kremers H.M., et al. How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease? Arthritis Rheum. 2005;52:3039-44. DOI:10.1002/art.21349.

4. Schau T., Gottwald M., Arbach O., et al. Increased prevalence of diastolic heart failure in patients with rheumatoid arthritis correlates with active disease, but not with treatment type. J Rheumatol. 2015;42(11):2029-37. DOI:10.3899/jrheum.141647.

5. Novikova D.S., Kirillova I.G., Udachkina E.V., Popkova T.V. Chronic heart failure in patients with rheumatoid arthritis (part 1): prevalence, peculiarities of etiology and pathogenesis. Rational Pharmacotherapy in Cardiology. 2018;14(5):703-10 (In Russ.) DOI:10.20996/1819-6446-2018-14-5-703-710.

6. Belenkov Yu. N. Patients with CHF in the Russian outpatient practice: features of the contingent, diagnosis and treatment (based on EPOHA-O-CHF study). Heart Failure. 2004;5(1):4-7 (In Russ.)

7. Mustonen J., Laakso M., Hirvonen T., et al. Abnormalities in left-ventricular diastolic function in malepatients with rheumatoid-arthritis without clinically evident cardiovascular-disease. Eur J Clin Invest. 1993;23:246-53. DOI:10.1111/j.1365-2362.1993.tb00769.x.

8. Corrao S., Salli L., Arnone S., et al. EchoDoppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur J Clin Invest. 1996;26:2937. DOI:10.1046/j.1365-2362.1996.133284.x.

9. Wislowska M., Sypula S., Kowalik I. Echocardiographic findings, 24-hour electrocardiographic Holter monitoring in patients with rheumatoid arthritis according to Steinbrocker’s criteria, functional index, value of Waaler-Rose titre and duration of disease. Clin Rheumatol. 1998;17:369-77. DOI:10.1007/bf01450894.

10. Birdane A., Korkmaz C., Ata N., et al. Tissue Doppler imaging in the evaluation of the left and right ventricular diastolic functions in rheumatoid arthritis. Echocardiography. 2007;24:485-93.

11. Aslam F., Bandeali S.J., Khan N.A., Alam M. Diastolic dysfunction in rheumatoid arthritis: a metaanalysis and systematic review. Arthritis Care Res (Hoboken). 2013;65(4):534-43. DOI:10.1002/acr.21861.

12. Davis III J.M., Roger V.L., Crowson C.S., et al. The presentation and outcome of heart failure in persons with rheumatoid arthritis differs from that of the general population. Arthritis Rheum. 2008;58(9):2603-2611. DOI:10.1002/art.23798.

13. Recommendations for cardiovascular prevention. The Committee of Russian Society of Cardiology (RSC) experts. Kardiovaskuljarnaja terapija i profilaktika 2011;10(6)1-44 (In Russ.) DOI:10.15829/1728-8800-2011-6.

14. National recommendations of Society of Heart Failure Specialists (SHFS), Russian Society of Cardiology (RSC) and Russian Scientific Medical Society of Internal Medicine (RSMSIM) on the diagnosis and treatment of chronic heart failure (fourth revision). Heart Failure. 2013;81(7):379-472 (In Russ.) DOI:10.18087/rhfj.2013.7.1860.

15. Lafitte S. Do we need new echocardiographic prognosticators for the management of heart failure patients? J. Am Coll Cardiol. 2009;54:625-7. DOI:10.1016/j.jacc.2009.04.058.

16. Lang R.M., Bierig M., Devereux R.B., et al. Recommendations for chamber quantification. Eur. J Echocardiogr. 2006;7:79-108. DOI:10.1016/j.euje.2005.12.014.

17. Nagueh S., Appleton C., Gillebert T., et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10(2):165-93. DOI:10.1093/ejechocard/jep007.

18. Norton S., Koduri G., Nikiphorou E. Study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome. Rheumatology. 2013;52:99-110. DOI:10.1093/rheumatology/kes262.

19. Løgstrup B.B., Ellingsen, T., Pedersen A.B., Kjaersgaard A. et al. Development of heart failure in patients with rheumatoid arthritis: A Danish population-based study. Eur J Clin Invest. 2018:48(5):e12915. DOI:10.1111/eci.12915.

20. Nicola P.J., Maradit-Kremers H., Roger V.L., et al. The risk of congestive heart failure in rheumatoid arthritis: A population-based study over 46 years. Arthritis Rheum. 2005;52:412-20. DOI:10.1002/art.20855.

21. Khalid U., Egeberg A., Ahlehoff O., et al. Incident heart failure in patients with rheumatoid arthritis: a nationwide cohort study. J Am Heart Assoc. 2018;7(2).e007227. DOI:10.1161/JAHA.117.007227.

22. Hunt S.A., Baker D.W., Chin M.H., et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. J Am Coll Cardiol. 2013;62(16):1495-539. DOI:10.1016/j.jacc.2013.05.020.

23. Liang K.P., Myasoedova E., Crowson C.S., et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Ann Rheum Dis. 2010;69(9):1665-70. DOI:10.1136/ard.2009.124362.

24. Kenchaiah S., Evans J.C., Levy D., et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305-13. DOI:10.1056/NEJMoa020245.

25. Slack J.D., Waller B. Acute congestive-heart-failure due to the artritis of rheumatoid-arthritis: Early diagnosis by endomyocardial biopsy a case-report. Angiology. 1986;37:477-82. DOI:10.1177/000331978603700609.

26. Mantel A., Holmqvist M., Andersson D.C. Association between rheumatoid arthritis and risk of ischemic and nonischemic heart failure. J Am Coll Cardiol. 2017;69(10):1275-85. DOI:10.1016/j.jacc.2016.12.033.

27. Gottdiener J. S., Arnold A. M., Aurigemma G. P., et al. Predictors of congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol. 2000;35:1628-37. DOI:10.1016/s07351097(00)00582-9.

28. Garza-García C., Sánchez-Santillán R., Orea-Tejeda A., et al. Risk factors for asymptomatic ventricular dysfunction in rheumatoid arthritis patients. ISRN Cardiol. 2013;635439. DOI:10.1155/2013/635439.

29. Kolotova G.B. Morphofunctional state peculiarities and types of left heart remodeling in patients with seropositive and seronegative rheumatoid arthritis. Ul'trazvukovaja i Funkcional'naja Diagnostika. 2008;3:35-41 (In Russ.)

30. Maradit-Kremers H., Nicola P.J., Crowson C.S., et al. Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis. Ann Rheum Dis. 2007;66:76-80. DOI:10.1136/ard.2006.053710.

31. Tomáš L., Lazúrová I., Pundová L., et al. Acute and long-term effect of infliximab on humoral and echocardiographic parameters in patients with chronic inflammatory diseases. Clin Rheumatol. 2013;32:61-6. DOI:10.1007/s10067-012-2091-4.

32. Hess G, Runkel S, Zdunek D. N-terminal pro-brain natriuretic peptide (NT-proBNP) in healthy blood donors and in patients from general practitioners with and without a diagnosis of cardiac disease. Clin Lab. 2005;51(3-4):167-72.


For citation:


Kirillova I.G., Novikova D.S., Popkova T.V., Udachkina H.V., Markelova E.I., Gorbunova Y.N., Korsakova Y.O., Gluchova S.N. Chronic Heart Failure in Early Rheumatoid Arthritis Patients Prior to Basic Antirheumatic Therapy. Rational Pharmacotherapy in Cardiology. 2020;16(1):51-58. (In Russ.) https://doi.org/10.20996/1819-6446-2020-01-02

Views: 225


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)