Clinical profile and outcome of patients with rheumatoid arthritis and abnormally high aortic stiffness

Objectives: Ascending aorta has an increased stiffness (AoSI) in rheumatoid arthritis (RA) patients due to their chronicinflammatory status.We assessed prevalence and factors associated with increased AoSI and its prognostic role in a largecohort of RA patients.Methods: We prospectively analysed 226 RA patients without overt cardiac disease compared with 226 non-RApatients matched for cardiovascular risk factors (non-RA controls). Abnormally high AoSI was diagnosed ifAoSI>6.07% (95th percentile of the AoSI detected in our reference healthy population). AoSI was assessed at thelevel of the aortic root by two-dimensional guided M-mode evaluation as part of a thorough echocardiography performedin all patients.Results: AoSI was significantly higher in the RA patients than non-RA controls (6.34.5% vs. 4.63.5%, p<0.001); itwas related to older age, higher systolic blood pressure and RA disease. Predictors of AoSI in RA patients were olderage, higher systolic blood pressure and the non-prescription of non-steroidal anti-inflammatory drug and/or immunomodulatory/anti-cytotoxic agents. Abnormally high AoSI was diagnosed in 41% RA patients and 21% non-RA controls(p<0.001). The RA phenotype with abnormally high AoSI was a>60 years old subject with systolic bloodpressure>129 mmHg, mitral annular calcification who was not receiving non-steroidal anti-inflammatory drug. By multivariateCox regression analysis abnormally high AoSI independently predicted death or all-cause hospitalization (hazardratio 2.85 (95% confidence interval 1.03–7.85)) at 12-month follow-up.Conclusions: Increased AoSI is common, can be predicted by an ordinary clinical assessment and is a strong predictorof adverse clinical outcome at mid-term follow-up in patients with RA.