Ntobeko Ayanda Bubele Ntusi MBBCh, MD, Presenter: Nothing to Disclose

Jane Melanie Francis, Abstract Co-Author: Nothing to Disclose

Paul McMahan Matthews MD, DPhil, Abstract Co-Author: Nothing to Disclose

Paul Bryan Wordsworth MBBS, FRCPC, Abstract Co-Author: Nothing to Disclose

Stefan Neubauer, Abstract Co-Author: Nothing to Disclose

Theodoros D. Karamitsos, Abstract Co-Author: Nothing to Disclose

To assess global and regional left ventricular (LV) function and myocardial fibrosis in patients with rheumatoid arthritis (RA), using cardiovascular magnetic resonance (CMR) and examine the additional effect of traditional cardiovascular risk factors (CVRFs) in RA patients.

25 RA patients with no CVRFs (19 female, mean age 51 ± 12 years), 39 RA patients with CVRFs (26 female, mean age 53 ± 11 years), 49 normal controls (30 female, mean age 51 ± 9 years), and 28 controls with CVRFs (10 female, mean age 53± 10 years), underwent CMR at 1.5 Tesla. LV volumes and function, myocardial strain (tagging CMR), and fibrosis (late gadolinium enhancement technique - LGE, 0.15mmol/kg i.v. gadoterate meglumine) were assessed.

LV volumes and global ejection fraction were similar between the 4 groups. RA patients with CVRFs showed the greatest reduction in mid short axis circumferential systolic strain (-16.8 ± 1.1 vs -19.0 ± 0.9 in normals, p<0.001) compared to all other groups. RA patients without CVRFs showed a similar degree of strain impairment (-17.6 ± 1.1) as controls with CVRFs (-17.2 ± 1.4, p=NS). About half of the RA patients (30/64 patients) were found to have mostly non-ischemic (midwall) areas of fibrosis on LGE-CMR. In 4 RA patients with CVRFs, a previously unknown myocardial infarction was detected. RA disease duration (Rs= 0.26, p=0.038) and disease activity, DAS-28CRP score (Rs=0.41, p=0.001), both correlated with myocardial strain.

CMR demonstrates impaired myocardial strain and a high incidence of non-ischaemic fibrosis in RA patients. The cardiac abnormalities in RA appear to be incremental to those due to traditional CVRFs.

Cardiovascular disease is common in asymptomatic RA patients and traditional CVRFs need to be aggressively controlled as they appear to confer incremental risk in this cohort.

Ntusi, N, Francis, J, Matthews, P, Wordsworth, P, Neubauer, S, Karamitsos, T, Characterisation of Myocardial Function and Structure in Patients with Rheumatoid Arthritis: A Cardiovascular Magnetic Resonance Study.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018438.html