RA disease activity markers identify patients at risk for worsening ventricular function
medwireNews: The risk for impaired left ventricular systolic function (LVSF) is significantly increased in patients with rheumatoid arthritis (RA) if they are positive for anticitrullinated peptide antibody (ACPA), have high disease activity, and a long duration of disease, study findings suggest.
Based on these three variables, the researchers devised “a simple performance indicator” for impaired LVSF, which they say “could be clinically useful, particularly for selecting candidates for CV [cardiovascular] clinical assessment that includes echocardiography.”
Using stress-corrected midwall fractional shortening (sc-MFS) as a measure of LVSF, the team monitored changes from baseline through a median of 36 months of follow-up in 140 patients with RA and no overt cardiac disease.
At the start of the study, 86 of the patients had impaired sc-MFS on echocardiography, scoring a median of 82.0%, which was below the 86.5% cutoff for normal sc-MFS. During follow-up, impaired sc-MFS was seen in 60 patients, comprising 41 of those with impairment at baseline and a further 19 who initially had normal levels.
At baseline, patients who later developed impaired sc-MFS had significantly higher rates of ACPA positivity than those with normal sc-MFS (81 vs 48%). They were also more likely to have moderate to high disease activity (26 vs 11%), as indicated by a mean CDAI score greater than 10 points, and a longer duration of disease, at a mean of 18 years compared with 14 years.
And multivariate analysis showed that ACPA-positivity significantly increased the risk for impaired sc-MFS 6.24-fold, while moderate to high disease activity and a longer duration of disease significantly increased the risk 3.09- and 1.05-fold, respectively.
Based on these variables, Giovanni Cioffi (University of Verona, Italy) and team developed a simple scoring system for predicting occult LVSF, whereby patients are assigned 7 points for ACPA positivity, 3 points for high disease activity, and 1 point for disease duration beyond 13 years.
Among patients scoring 9–11 points in the study, the prevalence of impaired sc-MFS was 80%, compared with 53%, 32%, and 4% among those scoring 7–8, 1–6, and 0 points, respectively.
This scoring system enabled the researchers to discriminate patients who developed impaired sc-MFS from those who did not with an accuracy of 80%, a sensitivity of 78%, and a specificity of 82%.
Cioffi and team say their performance indicator “should be tested in a validation cohort of RA patients and then used as a predictive risk score.”
The researchers highlight in ACR Open Rheumatology that their “findings may lead to [the selection of] those patients at higher risk who do not systematically undergo CV assessment and/or echocardiographic examination due to their asymptomatic condition and, often, normal blood pressure values.”
They add that “[t]hese patients should be more aggressively treated for better control of CV risk factors, inflammation, and modulation of autoimmunity.”
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