Myocardial Microvascular Dysfunction in Rheumatoid Arthritis_{Quantitation by}

Area of Science:

• Cardiology
• Rheumatology
• Medical Imaging

Background:

• Rheumatoid arthritis (RA) is associated with increased cardiovascular disease risk.
• Subclinical myocardial microvascular dysfunction may contribute to this risk.
• Assessing microvascular function in RA patients without diagnosed heart disease is crucial.

Purpose of the Study:

• To determine the prevalence of myocardial microvascular dysfunction in RA patients without clinical cardiovascular disease.
• To investigate the association between myocardial microvascular dysfunction and RA characteristics.
• To explore the relationship between myocardial microvascular dysfunction and cardiac structure/function.

Main Methods:

• Rest and vasodilator stress N-13 ammonia positron emission tomography (PET) was used.
• Global myocardial blood flow and myocardial flow reserve (MFR) were quantified.
• Echocardiography assessed cardiac structure and function; RA patients were compared to controls.

Main Results:

• 29% of RA patients exhibited reduced MFR (<2.5).
• Lower MFR correlated with male sex, higher interleukin-6 levels, and increased left ventricle mass/volumes.
• Tumor necrosis factor inhibitor use was associated with higher MFR; MFR was similar to symptomatic controls.

Conclusions:

• A significant proportion of RA patients without clinical cardiovascular disease have myocardial microvascular dysfunction.
• This dysfunction is linked to inflammation and cardiac remodeling.
• The role of reduced MFR in the increased heart failure risk in RA requires further investigation.