SPC365

Risk of adverse cardiovascular events across the global longitudinal strain spectrum in rheumatoid arthritis patients

Session: Sessão de Posters 11 - Miocardite Aguda
Speaker: André Filipe Macedo Alexandre

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.4 Myocardial Disease – Treatment
Session Type: Cartazes
FP Number: ---
Authors: André Alexandre; David Sá Couto; Mariana Brandão; Sofia Cabral; Tomás Fonseca; Rita Quelhas Costa; António Marinho; Betânia Ferreira; João Pedro Ferreira; João Silveira; Severo Torres; Patrícia Rodrigues

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background:</span></span></u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Rheumatoid arthritis (RA) is a common chronic systemic inflammatory disease. Individuals with RA face an elevated risk of heart failure (HF), with rates up to twice as high as the general population. HF significantly contributes to adverse cardiovascular outcomes in this population. Many RA patients remain undiagnosed for HF, and there are currently no established recommendations for echocardiographic screening. Strain analysis has emerged as a promising tool for the early detection of ventricular dysfunction and hence, risk of adverse cardiovascular outcomes.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aims:</span></span></u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> This study aimed to assess the relationship between left ventricle&nbsp;(LV)&nbsp;global longitudinal strain&nbsp;(GLS) and the risk of cardiovascular adverse events in RA patients.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> This was a prospective study of RA patients without known heart disease, who were followed for 7 years. They were categorized into three groups based on their LV GLS: normal GLS (&ge; 18%), borderline GLS (-16% to -17.9%), and abnormal GLS (&lt; 16%). Clinical characteristics and outcomes across these groups were compared. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), as a composite of acute coronary syndrome, heart failure hospitalization, stroke or cardiovascular death. The secondary endpoint included all-cause mortality.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Of 290 RA patients included in the analysis, 73% exhibited normal LV GLS, 15% borderline LV GLS, and 12% abnormal LV GLS. The median age was 58 years and 78% were females. Patients with abnormal LV GLS were older and most likely male. Additionally, they were more likely to have dyslipidemia and chronic kidney disease. Regarding serum biomarkers</span></span>,<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> NT-proBNP, high-sensitivity-troponin T and C-reactive protein were also higher in this group. A shorter distance in 6-minute-walk-test was noted for the abnormal LV GLS patients.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Survival analysis revealed higher risk of MACE in the abnormal and borderline LV GLS groups compared to the normal LV GLS group in the 7-year follow-up period (Log-rank test p &lt; 0.001)</span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">. No significant differences in all-cause mortality were evidenced. In multivariate Cox regression, RA patients with abnormal LV GLS exhibited a 15 times higher risk of MACE compared to patients with normal LV GLS (Figure 1), also without significant differences in all-cause mortality.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions:</span></span></u><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> RA patients with abnormal LV GLS exhibited a significantly higher risk of MACE when compared to patients with normal LV GLS, without significant differences in all-cause mortality.</span></span></span></span></span></p>