Prevalence and Factors Associated with Subclinical Left Ventricular Systolic Dysfunction Evaluated by Mid-Wall Mechanics in Rheumatoid Arthritis

due to the arterial stiffness which leads to coronary atherosclerosis and concentric left ventricular (LV)geometry. These conditions predispose to LV systolic dysfunction (LVSD), which can be detected bystress-corrected mid-wall shortening (sc-MS), an early prognosticator of cardiovascular events in asymptomaticpatients with arterial hypertension and/or diabetes. In these subjects, sc-MS is frequentlyimpaired even though LV ejection fraction (LVEF) is preserved. In this study, we analyzed the prevalenceand the factors associated with asymptomatic LVSD measured by sc-MS among patients with RA andverified whether RA per se was independently related to LVSD. Methods: We prospectively recruited198 outpatients with RA without overt cardiac disease between January and June 2014 and comparedthem to 198 controls matched for age, gender, body mass index, and prevalence of hypertension anddiabetes. sc-MS was taken as index of LVSD and considered impaired if <86.5%. Results: Impaired sc-MS was detected in 110 (56%) RA patients and in 30 (15%) controls (P < 0.001), whereas LVEF wasimpaired (value <50%) in six (3%) RA patients and in two (1%) controls (P = ns). Multiple logisticregression analysis revealed that RA was independently associated with impaired sc-MS (Exp b 2.01 [CI1.12–3.80], P = 0.02) together with increased LV mass and concentric geometry. Conclusions: Morethan half RA patients without overt cardiac disease have LVSD detectable by sc-MS. RA emerges as acondition closely related to LVSD. These findings might explain the high risk for adverse cardiovascularevents in RA patients.