Ab0384 changes in left ventricular systolic and diastolic function in patients with autoimmune inflammatory diseases

Background Rheumatological diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA) increase the cardiovascular (CV) risk by the development of a pro-inflammatory state that can affect the ventricular function of the heart. (1) Objectives To compare left ventricular (LV) systolic and diastolic function in patients with RA, SLE, and PsA as compared with healthy controls. Methods A cross-sectional and comparative study. Patients included in the cohort were between 30–75 years old, who fulfilled 2006 Classification Criteria for PsA; patients between 40-75 years old who fulfilled 2010 ACR/EULAR criteria for RA; Patients older than 18 years old who fulfilled 2019 ACR/EULAR Criteria for SLE, and Controls. A transthoracic echocardiogram was performed by a certified cardiologist blinded to clinical data. Normality was assessed by the Kolmogorov-Smirnov test and the Kruskal-Wallis test for comparison among groups. P value <0.05 was considered significant. Results 186 patients were included in the study, divided into groups as its shown in Table 1. Most of them were women (146); the most common comorbidities were hypertension (36%, 20.8%, and 17.5% in the RA, SLE, and Control groups, respectively), and dyslipidemia (73.9% in the PsA group). Echocardiographic findings are shown in Table 1. Conclusion LV systolic and diastolic function changes in the rheumatic population, especially RA, SLE, and PsA, are higher in comparison with healthy people and affect the prognosis in these patients, those changes can be detected by echocardiogram, which is a safe tool that may prevent complications and improve the prognosis with early detection and management of this CV involvement. Table 1. Demographic characteristics and Echocardiographic findings. (N=186) Rheumatic patients (N=146) P value RA (N=75) SLE (N=48) PsA (N=23) Control (N=40) P value Women, n (%) 126 (86.3%) - 73 (97.3%) 43 (89.6%) 10 (43.3%) 20 (50%) - Age, years (iSD) 48.6 (±13.7) 0.018 54.1 (±9) 35.7 (±12.2) 55.4 (±10.4) 42.8 (±14) <0.001 Dyslipidemia, n (%) 41 (28%) 0.046 26 (34.7%) 3 (6.4%) 12 (52.2%) 7 (17.5%) <0.001 Diabetes Mellitus, n (%) 31 (21.2%) 0.003 12 (16%) 2 (4.2) 17 (73.9%) 1 (2.5%) <0.001 Hypertension, n (%) 48 (32.8%) 0.012 27 (36%) 10 (20.8%) 11 (52.2%) 7 (17.5%) <0.001 LV Mass index, g/m 2 (iQR) 64.9 g/m 2 (52-82.3) NS 67.6 g/m 2 (58.3-80) 54.5* g/m 2 (45.3-77.1) 68.7 g/m 2 (58.3-88.4) 61.9 g/m 2 (51- 76) 0.014 LV ejection fraction, % (iQR) 60% (56-65) 0.007 60 % (57-64) 58 1 % (52-64) 65 † % (57-67) 62 % (57 - 68) <0.001 LV end-diastolic volume, ml (iQR) 72 ml (61-93) NS 66 †† ml (59-80) 83* ml (69-101) 74 ml (64- 101) 73 ml (61- 89) <0.001 LV end-systolic volume, ml (iQR) 29 ml (23-38) NS 27 † ml (22-32) 34 1 ml (26-45) 25 ml (23-38) 28 ml (20- 34) 0.001 Left Atrial volume index, ml/m 2 (iQR) 25.6 ml/m 2 (20-32) 0.004 24.3 ml/m 2 (19.2-32) 27 1 ml/m 2 (26.2-45.2) 25.3 ml/m 2 (21.1- 29) 20.7 ml/m 2 (16.8- 28) 0.016 MV peak E velocity, m/s (iQR) 0.84 m/s (0.7-0.94) NS 0.85 m/s (0.73-0.97) 0.83 m/s (0.65-0.93) 0.8 m/s (0.7-0.94) 0.81 m/s (0.67- 0.93) NS MV peak A velocity, m/s (iQR) 0.71 m/s (0.56-0.89) 0.002 0.78 1† m/s (0.64-0.93) 0.56 m/s (0.52-0.75) 0.81 1† m/s (0.58-0.91) 0.61 m/s (0.46- 0.71) <0.001 MV E/A Ratio (±SD) 1.17 (±0.36) 0.001 1.11 1† (±0.3) 1.33 (±0.43) 1.03 1† (±0.28) 1.43 (±0.45) <0.001 E, m/s (iQR) 0.1 m/s (0.08-0.11) 0.002 0.1 m/s (0.08-0.11) 0.1 m/s (0.08- 0.12) 0.08 1 m/s (0.07- 0.1) 0.11 m/s (0.9-0.13) 0.001 E/E (iQR) 8.07 (6.24-10) 0.04 8.88 (7.08-10.97) 6.38* †† (5.69- 8.24) 9.12 (7.72-11.5) 6.86* †† (5.43- 9.15) <0.001 LV, left ventricle; MV, Mitral valve; SD, Standard deviation; iQR, Interquartile range; NS, Non-significant. 1 p<0.05 compared to control * p<0.05 compared to RA † p<0.05 compared to SLE 1 † p<0.05 compared to SLE and control †† p<0.05 compared to PsA *†† p<0.05 compared to RA and PsA Reference [1] Mahtta D, Gupta A, Ramsey DJ, Rifai MA, Mehta A, Krittanawong C, et al. Autoimmune Rheumatic Diseases and Premature Atherosclerotic Cardiovascular Disease: An Analysis From the VITAL Registry. The American Journal of Medicine. 2020 Dec;133(12):1424-1432.e1. Acknowledgements: NIL. Disclosure of Interests None Declared.