Recent studies have shown that heart disease in patients with rheumatoid arthritis occurs according to various data in 20-100% of cases. Hypertension is often the first objectively detectable marker of cardiovascular pathology in patients with rheumatoid arthritis. Hypertension in patients with rheumatoid arthritis usually becomes an active initiator and accelerator of the progression of atherosclerosis and remodeling of the left ventricle. Cardiac remodeling in patients with hypertension and in patients with rheumatoid arthritis, combined with hypertension is a significant factor that affects to the quality of life and prognosis and requires careful study of this problem. The purpose of the work was to study the systolic function and morphological parameters of the left ventricle in patients with rheumatoid arthritis in combination with hypertension and to establish indicators associated with high cardiovascular risk. Material and methods. The main group of patients consisted of 93 patients with rheumatoid arthritis of moderate activity in combination with hypertension stage II. The second group included 45 patients with essential hypertension stage II. The control group had 31 almost healthy people. An ultrasound examination of the heart was performed with studying of systolic function and the main morphological parameters of the left ventricle. Results and discussion. We found a significant increase in the left ventricle myocardial mass index by 11.97% in patients with rheumatoid arthritis in combination with hypertension compared to the patients with essential hypertension and by 30.1% compared to the control group. We also detected the significant increase of the interventricular septum thickness by 9.02%, the posterior wall of left ventricle – by 5.51%, and the relative wall thickness of left ventricle – by 6.0% in patients with rheumatoid arthritis in combination with hypertension compared to the patient with essential hypertension. There was a significant increase in end-diastolic volume by 8.64%; end-systolic volume – by 12.95%; and a decrease of ejection fraction by 2.5% in patients with rheumatoid arthritis in combination with hypertension with m SCORE >4 points compared to the corresponding indicators of patients with m SCORE ≤4 points. The study showed that the most common type of left ventricle remodeling was concentric left ventricle hypertrophy (79% of patients) in patients with rheumatoid arthritis with hypertension. In addition, the subgroup of patients with m SCORE >4 points left ventricle myocardial mass and left ventricle myocardial mass index were by 15.01% and 14.86% significantly higher than the corresponding indicators in the subgroup of patients with m SCORE ≤4 points. Conclusion. The patients with rheumatoid arthritis in combination with hypertension showed an association between increasing of the left atrium size and the volume parameters of the left ventricle, and the presence of fluid in the pericardial cavity. This was manifested by the left atrium size increase by 10.65%, end-diastolic volume – by 8.62%, end-systolic volume – by 12.2% and the ejection fraction decrease by 2.23% in patients with fluid versus to a subgroup of patients without fluid in the pericardium

Keywords: rheumatoid arthritis, hypertension, left ventricular remodeling

Full text: PDF (Ukr) 287K

1. Arts EE, Fransen J, Den Broeder AA, van Riel PLCM, Popa CD. Low disease activity (DAS28 ≤3,2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis. 2017 Oct; 76(10): 1693-1699. https://doi.org/10.1136/annrheumdis-2016-210997 PMid:28606965
2. Prasad M, Hermann J, Gabriel SE, Weyand CM, Mulvagh S, Mankad R, et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nature. 2015; 12: 168-176. https://doi.org/10.1038/nrcardio.2014.206 PMid:25533796 PMCid:PMC4641514
3. Renjith AS, Marwaha V, Aggarwal N, Koshy V, Singal VK, Kumar KVSH. Prevalence of left ventricular dysfunction in rheumatoid arthritis. J Family Med Prim Care. 2017 Jul-Sep; 6(3): 622-626. https://doi.org/10.4103/2249-4863.214431 PMid:29417020 PMCid:PMC5787967
4. Alekseeva GA. Osobennosty pokazateloj ehokardyografyy u bolnih revmatoydnym artrytom [Features of echocardiography index in patients with rheumatoid arthritis]. Tavrycheskyj medyko-byologycheskyj vestnyk. 2011; 1: 7-10. [Russian]
5. Nasonov EL, Popkova TV, Novykova DS. Serdechno-sosudytstaya patologyya pry revmatycheskih zabolevanyyah [Cardiovascular pathology in rheumatic diseases]. Terapevtycheskyj arhiv. 2016; 88(5): 4-12. [Russian] https://doi.org/10.17116/terarkh20168854-12
6. Cavazzana I, Vizzardi E, Franceschini F. Diastolic dysfunction in rheumatoid arthritis: a usual travel-mate? Monaldi Archives for Chest Disease. 2019; 89(3). https://doi.org/10.4081/monaldi.2019.1137 PMid:31505913
7. Ntusi NAB, Piechnik SK, Francis JM, Ferreira VM, Matthews PM, Robson MD, et al. Diffuse Myocardial Fibrosis and Inflammation in Rheumatoid Arthritis: Insights From CMR T1 Mapping. JACC Cardiovasc Imaging. 2015 May; 8(5): 526-536. https://doi.org/10.1016/j.jcmg.2014.12.025 PMid:25890584
8. Midtbø H, Gerdts E, Kvien TK, Olsen IC, Lønnebakken MT, Davidsen ES, et al. The association of hypertension with asymptomatic cardiovascular organ damage in rheumatoid arthritis. Blood Pressure. 2016; 25(5), 298-304. https://doi.org/10.3109/08037051.2016.1172867 PMid:27123584
9. Manavathongchai S, Bian A, Rho YH, Oeser A, Solus JF, Gebretsadik T, et al. Inflammation and hypertension in rheumatoid arthritis. J Rheumatol. 2015; 40: 1806-11. https://doi.org/10.3899/jrheum.130394 PMid:23996293 PMCid:PMC3818311
10. Gavrylyuk EV, Konoplya AY, Karaulov AV. Rol ymmunnyh narushenyj v patogeneze arteryalnoj gypertenzyy [The role of immune disorders in the pathogenesis of arterial hypertension]. Immunologyya. 2016; 7: 29-35. [Russian]
11. Corrao S, Argano C, Pistone G, Messina S, Calvo L, Perticone F. Rheumatoid arthritis affects left ventricular mass: Systematic review and meta-analysis. Eur J Intern Med. 2015; 26(4): 259-67. https://doi.org/10.1016/j.ejim.2015.02.008 PMid:25753937
12. Midtbø H, Gerdts E, Kvien TK, Olsen IC, Hirth A, Davidsen ES, et al. Disease activity and left ventricular structure in patients with rheumatoid arthritis. Rheumatology. 2015; 54: 511-519. https://doi.org/10.1093/rheumatology/keu368 PMid:25224414
13. González A, Ravassa S, López B. Myocardial remodeling in hypertension toward a new view of hypertensive heart disease. Hypertension. 2018; 72: 549-558. https://doi.org/10.1161/HYPERTENSIONAHA.118.11125 PMid:30354762
14. Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther. 2016; 14: 915-926. https://doi.org/10.1080/14779072.2016.1186542 PMid:27159191
15. Gromova MA, Myasoedova SE. Arteryalnaya gypertenzyya, sostoyanye serdechno-sosudystoj systemy y harakterystyka u bolnih revmatoydnym artrytom [Arterial hypertension, the state of the cardiovascular system and characteristics in patients with rheumatoid arthritis]. Fundamentalnye yssledovanyya. 2014; 10(14): 651-653. [Russian]
16. Lindhardsen J, Gislason GH, Jacobsen S, Ahlehoff O, Olsen AM, Madsen OR, et al. Non-steroidal anti-inflammatory drugs and risk of cardiovascular disease in patients with rheumatoid arthritis: a nationwide cohort study. Ann Rheum Dis. 2014; 73(8): 1515-1521. https://doi.org/10.1136/annrheumdis-2012-203137 PMid:23749610
17. Antikainen RL, Peters R, Beckett NS, Fagard RH, Wang JG, Rajkumar C, et al. Left ventricular hypertrophy is a predictor of cardiovascular events in elderly hypertensive patients: Hypertension in the Very Elderly Trial. J Hypertens. 2016; 34: 2280-2286. https://doi.org/10.1097/HJH.0000000000001073 PMid:27552643
18. Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, et al. European Association of Cardiovascular Imaging (EACVI) position paper: multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging. 2015; 16(1): 12-31. https://doi.org/10.1093/ehjci/jeu128 PMid:25248336
19. Wagan AA, Mahmud TE, Rasheed A, Zafar ZA, Rehman AU, Ali A. Cardiovascular risk score in Rheumatoid Arthritis. Pak J Med Sci. 2016 May-Jun; 32(3): 534-8. https://doi.org/10.12669/pjms.323.9779 PMid:27375684 PMCid:PMC4928393
20. Zegkos T, Kitas G, Dimitroulas T. Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps. Ther Adv Musculoskelet Dis. 2016; 8(3): 86-101. https://doi.org/10.1177/1759720X16643340 PMid:27247635 PMCid:PMC4872174
21. Rose S, Sheth NH, Baker JF, Ogdie A, Raper A, Saboury B, et al. A comparison of vascular inflammation in psoriasis, rheumatoid arthritis and healthy subjects by FDG-PET/CT: a pilot study. American Journal of Cardiovascular Disease. 2013; 3(4): 273-278.
22. Navarro-Millán I, Du Vall SL, Yang S. Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration. Ann Rheum Dis. 2016; 75: 341-347. https://doi.org/10.1136/annrheumdis-2013-204987 PMid:25609412 PMCid:PMC4752663