Diastolic dysfunction in rheumatoid arthritis: A meta-analysis and systematic review

OBJECTIVE:

To determine if diastolic dysfunction prevalence is increased in rheumatoid arthritis (RA) patients.

METHODS:

We conducted a time and language restricted literature search to identify studies conducted to compare echocardiographic parameters in patients with RA and controls. Mean difference for echocardiographic variables of interest was calculated using random-effects model. A systematic review of the literature was performed.

RESULTS:

A total of 25 studies reporting 5836 subjects (1,614 with RA) were included. Results reflect mean differences with positive values denoting higher values in RA patients. Patients with RA had larger mean left atrial dimension (cm) [mean difference (MD) 0.09, 95% confidence interval (CI) 0.01 - 0.17; p=0.02), higher left ventricular mass index (g/m2) [MD 6.2, 95% CI 1.08 - 11.33, p=0.02], higher mean pulmonary artery systolic pressure (mmHg) [MD 5.87, 95% CI 4.36 - 7.38, p<0.0001], prolonged isovolumetric relaxation time (msec) [MD 9.67, 95% CI 5.78 - 13.56, p<0.0001] and higher trans-mitral A-wave velocity (m/sec) [MD 0.13, 95% CI 0.07 - 0.18, p<0.0001] compared to controls. Sub-analysis of 2183subjects excluding two large unmatched studies showed the same results with the exception that patients with RA had lower mitral E/A ratio [MD -0.17, 95% CI (-) 0.09 - (-) 0.25, p <0.0001], suggestive of DD. There were no differences in left ventricular ejection fraction (%), trans-mitral E-wave velocity (m/sec) and mitral deceleration time (msec).

CONCLUSION:

RA patients were more likely to have echocardiographic parameters of diastolic dysfunction. RA patients have higher pulmonary artery systolic pressures and larger left atrial sizes.

Source: www.ncbi.nlm.nih.gov