Vascular pathology and morphofunctional remodeling of the left heart in rheumatoid arthritis: impact of systemic manifestations and rheumatoid vasculitis

Aim. To study and determine the characteristics of structural-geometric remodeling of the left heart chambers.

Materials and methods. The study included 102 patients with a confirmed diagnosis of rheumatoid arthritis who were hospitalized in the cardiorheumatology department. Patients were divided into two groups according to the degree of disease activity. The control group consisted of 40 healthy subjects. Disease activity was assessed using the DAS28 index. All patients underwent echocardiography and morphologic evaluation of the blood vessels.

Results and discussion. Significant changes in morphofunctional parameters of the left heart were observed in patients with rheumatoid arthritis, especially in those with systemic manifestations. These changes included increased left ventricular end-diastolic and end-systolic volumes, myocardial hypertrophy, and diastolic dysfunction. An association was found between inflammatory activity and cardiac geometry parameters. In addition, associations were found between cutaneous manifestations of vasculitis and vascular pathologies.

Conclusion. Left ventricular hypertrophy and diastolic dysfunction serve as early markers of cardiovascular complications in rheumatoid arthritis, especially in combination with ischemic heart disease. The progression of the inflammatory process contributes to the development of hypertrophy, and cutaneous manifestations of rheumatoid vasculitis may reflect common pathogenetic mechanisms underlying vascular disorders.

1. Gerasimova E.V. Serdechno-sosudistye zabolevaniya u bolnykh revmatoidnym artritom na fone dlitelnoy terapii metotreksatom [Cardiovascular disease in patients with rheumatoid arthritis against the background of longterm therapy with methotrexate]. Terapevticheskiy arkhiv - Therapeutic Archive, 2014, pp. 26-30.

2. Kamilova U.K. Otsenka serdechno-sosudistogo riska u patsientov s revmatoidnym artritom [Cardiovascular risk assessment in patients with rheumatoid arthritis]. Kardiologiya v Belarusi - Cardiology in Belarus, 2019, Vol. 11, No. 4, pp. 614-619.

3. Mazurova V.I. Taktika vracha-revmatologa: prakticheskoe rukovodstvo [Rheumatologist’s tactics: a practical guide]. Moscow, GEOTAR-Media Publ., 2022. 322 p.

4. Nasonov E.L. Revmaticheskie zabolevaniya i multimorbidnost [Rheumatic diseases and multimorbidity]. Terapevticheskiy arkhiv - Therapeutic Archive, 2015, No. 5, pp. 4-9.

5. Novikova D.S. Khronicheskaya serdechnaya nedostatochnost u bolnykh revmatoidnym artritom: rasprostranennost, osobennosti etiologii i patogeneza [Chronic heart failure in patients with rheumatoid arthritis: prevalence, features of etiology and pathogenesis]. Ratsionalnaya farmakoterapiya v kardiologii - Rational pharmacotherapy in cardiology, 2018, No. 5, pp. 703-710.

6. Rebrov A.P. Porazhenie serdtsa u bolnykh s revmatoidnym artritom [Cardiac damage in patients with rheumatoid arthritis]. Sovremennaya revmatologiya - Modern rheumatology, 2022, No. 2, pp. 15-18.

7. Ridker P.M., Luscher TF. Anti-inflamatory therapies for cardiovascular disease. European Heart Journal, 2014, No. 35 (27), pp. 1782-1791.

8. Solomon D.H., Reed G.W., Kremer J.M. Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis and Rheumatology, 2015, No. 67, pp. 1449-1455.

9. Piepoli M.F., Hoes A.W., Agewall S. 2016 European Guedeniles on cardiovascular disease prevention in clinical practice; The Sixth Joint Task Force of the European Society of Cardiology an Other Societies jon Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 socienties and byinvited experts). European Heart Journal, 2016, No. 37 (29), pp. 2315-2381.

10. Agca R., Heslinga S.C., Rollefstad S. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of infiammatory joint disorders;2015\2016 update. Annals of the Rheumatic Diseases, 2017, No. 76 (1), pp. 17-28

11. Arida A., Protogerou A.D., Kitas G.D., Sfi kakis P.P. Systemic Infiammatiry response and Atherosclerotsis; The paradigm of Chronic InfI amatory Rheumatic Diseases. International Journal of Molecular Sciences, 2018, No. 19 (7), pp. 1890.

12. Francula-Zaninovic S., Nola I.A. Management of Measurable Variable Cardiovascular Disease Risk Factors. Current Cardiology Reviews, 2018, No. 14 (3), pp. 153-163.

13. England B.R., Thiele G.M., Anderson D.R. Increased cardiovascular risk inrheumatoid arthritis; mechanism and implications. British Medical Journal, 2018, No. 23, pp. 361.