THU0069

INCREASED RATE OF DIASTOLIC HEART FAILURE IN RHEUMATOID ARTHRITIS CORRELATES WITH SYSTEMIC INFLAMMATION AND PERSISTENT DISEASE ACTIVITY, INDEPENDENT FROM TREATMENT STRATEGY

M. Gottwald ^1,*T. Schau ²M. Neuss ²D. Ridjab ²I. Fischer ³C. Butter ²M. Zaenker ^{1 4}

¹Rheumatology Dept., ²Cardiology Dept., Immanuel Klinikum Bernau & Heart Center Brandenburg, Bernau, ³Institute for Biostatistics, Tuebingen, ⁴Rheumatic Disease Center North Brandenburg, Bernau, Germany

Background: Increased prevalence of chronic heart failure is observed in patients with rheumatoid arthritis (RA) and heart failure with normal ejection fraction (HFNEF) is the predominant type. Although traditional cardiovascular risk factors are overrepresented in RA patients, they alone do not sufficiently explain higher morbidity. Chronic inflammation is a suspected contributor to myocardial dysfunction. Further data is necessary to elucidate the influence of persistent RA disease activity and RA treatment on HFNEF.

Objectives: To correlate clinical signs, laboratory findings and echocardiographic markers of heart failure in a well-characterized cohort of RA-patients with cardiovascular risk factors and comorbidity

Methods: Prospective cross-sectional study including all RA-patients consecutively treated in our community based outpatient-clinic in a 3 months period. Inclusion criteria were written consent and diagnosis of RA, fulfilling ACR/EULAR-criteria. All patients were interviewed using a standardized questionnaire. Clinical signs were evaluated based upon Framingham criteria. Laboratory tests included NT-proBNP. Echocardiography contained tissue doppler and global longitudinal strain (GLS) imaging.

Results: 162 patients with RA, n=110 (68%) female, mean (SD) age 61.3 (±13.1) years, mean disease duration 12.5 (±11.4) years, mean DAS₂₈ 2.8 (±1.0), mean FFbH 68 (±27)%, mean HAQ 1.3 (±0.9) were included. Rate of remission or low-disease-activity (DAS₂₈<3.2) was 79%. CAD was found in 26 (16%), previous MI in 8 (5%), stroke in 3 (2%), and PAOD in 17 (10,5%) patients. For 155 patients appropriate echocardiographic data was available. In 6 patients (3.7%) LVEF<50% was found, 3 (2%) patients had additional symptoms of NYHA class>1 and were classified having systolic heart failure. Of the 149 patients with normal EF, 92 (61.7%) showed diastolic dysfunction, 36 (24.2%) had reduced GLS, 62 (41,6%) had symptoms of NYHA-class>1, and HFNEF according to ESC criteria was classified in 31 (21%) patients. Hypertension was found in 92 (57%), diabetes in 22 (14%) patients. In multivariate regression analysis of risk factors for HFNEF, age (OR 22.7 [95%CI 5.4-133] p<0.001), female gender (OR 9.6 [95%CI 8.3-3648] p<0.01), reduced GLS (OR 11.6 [95%CI 2.4-76.7] p<0.01),duration of RA>10 years (OR 2.5 [95%CI 1.25-5.14] p=0.01), DAS₂₈>2.6 (OR 2.5 [95%CI 1.01-6.05] p=0.047), ESR>8 mm (OR 4.8 [95%CI 1.53-16.1] p=0.007) were found significant. Comparing treatment groups (DMARDs, vs. TNFa-antagonists vs. other biologics), there were higher mean DAS₂₈ and lower remission rates in the biologic groups according to more severe disease state and longer disease duration. However, no significantly differences were found for HFNEF rates and cardiovascular comorbidity.

Conclusions: Traditional risk factors as well as RA-related factors are responsible for HFNEF in RA. RA-duration, persistent disease activity with DAS₂₈>2.6, increased ESR as markers of chronic inflammation were shown to be significant and independent contributors. The reduced GLS in HFNEF patients supports a putative role of endomyocardial fibrosis as a link between inflammation and impaired myocardial function.

Disclosure of Interest: None Declared