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Left ventricular morphology and function in patients with rheumatoid arthritis

Linksventrikuläre Funktion und –Morphologie bei Patienten mit rheumatoider Arthritis

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Summary

Objectives

Congestive heart failure (CHF) and inflammation are important contributors to the excess of overall morbidity and mortality in patients with rheumatoid arthritis (RA). CHF rather than ischaemic heart disease (IHD) appears to participate on the mortality in these patients. However, there are controversial results about significance of plasma N-terminal of pro-B type natriuretic peptide (NT-proBNP) and other inflammatory markers investigation for an early detection of heart dysfunction.

The aim of this study was to examine the cardiac morphology and function in patients with RA in relation to the plasma NT-proBNP and to inflammatory markers.

Subjects and methods

Sixty patients with RA (52 women and 8 men) and 30 gender and age matched controls were included in the study. Blood samples were analyzed for NT-proBNP, tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), and C-reactive protein (CRP). Transthoracic echocardiography was performed on the same day in all subjects.

Results

RA patients had significantly higher plasma NT-pro BNP as compared with controls (99.39 ± 8.98 vs. 66.90 ± 7.93 pg/ml, p < 0.05) and significantly higher levels of TNF-alpha, IL-6 and CRP (for all p < 0.01). In RA group higher levels of NT-proBNP were detected in rheumatoid factor (RF) posivite patients. Patients with RA had significantly worse left ventriclular (LV) systolic function (LV ejection fraction (LVEF) 64.6 ± 0.8 vs. 70.1 ± 1.3 %, p < 0.01) and diastolic function (E/A 1.11 ± 0.05 vs. 1.32 ± 0.07, p < 0.05). There were no correlations of NT-proBNP with paramaters of systolic and diastolic function, however, a negative correlation of TNF-alpha with these parameters was detected (TNF-alpha vs. LV mass index (LVM-i): r = − 0.34, p < 0.05), TNF-alpha vs. LVEF: r = − 0.30, p < 0.05 and TNF-alpha vs. E/A: r = − 0.30, p < 0.05).

Conclusion

We conclude that TNF-alpha may be better marker of heart impairment caused by chronic inflammation in RA patients than NT-proBNP.

Zusammenfassung

Ziel der Studie

Kongestives Herzversagen und Entzündung tragen wesentlich zu der erhöhten Morbidität und Mortalität von Patienten mit rheumatoider Arthritis (RA) bei. Das kongestive Herzversagen scheint eher an der erhöhten Mortalität schuld zu sein als eine ischämische Herzerkrankung. Es existieren allerdings widersprüchliche Ergebnisse bezüglich der Bedeutung von Plasma N-terminal pro-B type natriuretic peptide (NT-proBNP) und anderen Entzündungsparametern bei der Erkennung der Verschlechterung der Herzfunktion.

Ziel dieser Studie war es, die Morphologie und Funktion des Herzens bei Patienten mit RA zu untersuchen und die Ergebnisse mit dem Plasma NT-proBNP und verschiedenen Entzündungsmarkern in Relation zu setzen.

Patienten und Methoden

60 Patienten mit RA (davon 52 Frauen) und 30 geschlechts- und altersmäßig gematchte Kontrollen wurden untersucht. Aus den Blutproben wurden NT-proBNP, TNF-alpha, IL-6 und CRP bestimmt. Bei allen Patienten und Kontrollen wurde am selben Tag eine transthorakale Echokardiographie durchgeführt.

Ergebnisse

RA Patienten hatten signifikant höhere Plasma NT-proBNP Spiegel als die Kontrollen (99,39 ± 8,98 vs. 66,90 ± 7,93 pg/ml, p < 0,05) sowie signifikant höhere TNF-alpha, IL-6 und CRP Spiegel (p < 0,01 für alle). Innerhalb der Pat. mit RA wurden bei den Rheuma-Faktor positiven Patienten höhere NT-proBNP Konzentrationen gemessen. Patienten mit RA hatten eine signifikant schlechtere systolische Linksventrikelfunktion (LVEF 64,6 ± 0,8 vs. 70,1 ± 1,3 %, p < 0,01) und diastolische Funktion (E/A 1,11 ± 0,05 vs. 1,32 ± 0,07, p < 0,05). Es ergab sich keine Korrelation von NT-proBNP mit Parametern der systolischen und diastolischen Funktion. TNF-alpha allerdings war mit diesen Parametern negativ korreliert: TNF-alpha vs. LVM-i: r = − 0,34, p < 0,05, TNF-alpha vs. LVEF: r = − 0,30, p < 0,05 und TNF-alpha vs. E/A: r = − 0,30, p < 0,05.

Schlussfolgerung

Wir schließen aus unseren Ergebnissen, dass TNF-alpha ein besserer Marker der bei RA Patienten durch chronische Entzündung ausgelösten Verschlechterung der Herzfunktion ist als hNT-proBNP.

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The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. 1st Department of Internal medicine, Medical Faculty, P.J. Šafárik University, Trieda SNP1, 040 11, Košice, Slovakia

    L’ubomír Tomáš,  Ivica Lazúrová MD, PhD, Mária Oetterová & Lýdia Pundová

  2. Institute of Experimental Medicine, Medical Faculty, P.J. Šafárik University, Košice, Slovakia

    Darina Petrášová

  3. Eastslovakian Institute of Cardiology, Košice, Slovakia

    Martin Studenčan

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  1. L’ubomír Tomáš
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  2. Ivica Lazúrová MD, PhD
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Correspondence to Ivica Lazúrová MD, PhD.

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Tomáš, L., Lazúrová, I., Oetterová, M. et al. Left ventricular morphology and function in patients with rheumatoid arthritis. Wien Klin Wochenschr 125, 233–238 (2013). https://doi.org/10.1007/s00508-013-0349-8

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