scholarly journals Chronic Heart Failure in Early Rheumatoid Arthritis Patients Prior to Basic Antirheumatic Therapy

2020 ◽  
Vol 16 (1) ◽  
pp. 51-58
Author(s):  
I. G. Kirillova ◽  
D. S. Novikova ◽  
T. V. Popkova ◽  
H. V. Udachkina ◽  
E. I. Markelova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Blood Pressure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Systolic Blood Pressure ◽  
Early Rheumatoid Arthritis ◽  
Intima Media Thickness ◽  
Factors Associated ◽  
Early Ra

Aim. To study the clinical manifestations and factors associated with the presence of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA) prior to anti-inflammatory therapy. Material and methods. The study included 74 patients with valid diagnosis of RA (criteria ACR/EULAR, 2010), 56 women (74%), median age – 54 [46;61] years, disease duration – 7 [4;8] months; seropositive for IgM rheumatoid factor (87%) and/or antibodies to cyclic citrullinated peptide (100%) prior to taking disease modifying anti-rheumatic drugs and glucocorticoids. CHF was verified in accordance with actual guidelines. The assessment of traditional risk factors for cardiovascular diseases, echocardiography, tissue Doppler imaging, carotid artery ultrasound, were carried out before the start of therapy in all patients with early RA. The concentration of NT-proBNP was determined by electrochemiluminescence. The normal range for NT-proBNP was less than 125 pg/ml.Results. CHF was diagnosed in 24 (33%) patients: in 23 patients – CHF with preserved ejection fraction, in 1 patient – CHF with reduced ejection fraction. 50% of patients with RA under the age of 60 were diagnosed with CHF. NYHA class I was found in 5 (21%) patients, class II – in 15 (63%), class III – in 1 (4%). Positive predictive value of clinical symptoms did not exceed 38%. All patients with early RA were divided into two groups: 1 – with CHF, 2 – without CHF. Patients with RA+CHF compared with patients without CHF were older, had higher body mass index, frequency of carotid atherosclerosis, of ischemic heart disease (IHD), hypertension, C-reactive protein (CRP) levels and intima media thickness. Independent factors associated with the presence of CHF were identified by linear regression analysis: abdominal obesity, CRP level, systolic blood pressure, dyslipidemia, carotid intima thickness, IHD. The multiple coefficient of determination was R2=57.1 (R-0.76, p<0.001). Level of NT-proBNP in RA patients with CHF (192.0 [154.9; 255.7] pg/ml) was higher than in RA patients without CHF (77 [41.1; 191.2] pg/ml) and in control (49.0 [33.2; 65.8] pg/ml), p<0.0001 and p=0.01, respectively. To exclude CHF in patients with early RA, the optimal NT-proBNP level was 150.4 pg/ml (sensitivity – 80%, specificity – 79%), the area under the ROC curve = 0.957 (95% confidence interval 0.913-1.002, p<0.001).Conclusion. CHF was detected in a third of RA patients at the early stage of the disease. Factors associated with the presence of CHF were abdominal obesity, CRP level, systolic blood pressure, dyslipidemia, intima media thickness, IHD.

scholarly journals The course of chronic heart failure in patients with early rheumatoid arthritis on the anti-rheumatic therapy

2019 ◽  
Vol 47 (5) ◽  
pp. 400-409
Author(s):  
I. G. Kirillova ◽  
D. S. Novikova ◽  
T. V. Popkova ◽  
H. V. Udachkina ◽  
E. I. Markelova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Disease Activity ◽  
Diastolic Function ◽  
Left Atrium ◽  
Early Rheumatoid Arthritis ◽  
Low Disease Activity ◽  
Lv Diastolic Function

Objective: To evaluate the effect of the “treat to target” anti-rheumatic therapy on the course of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA). Materials and methods: The study included 22 patients (17, or 77% female) with CHF with valid diagnosis of RA (ACR/EULAR criteria, 2010), median (Me) age of 60 years, and median disease duration of 7 months. Ten patients (45%) were seropositive for IgM rheumatoid factor and 22 (100%) had antibodies to cyclic citrulline peptide. Their median (1st; 3rd quartiles) DAS28 was 5.6 [4.8; 6.5]. The diagnosis of CHF was confirmed in accordance with the guidelines on the diagnosis and treatment of CHF by the Russian Society of Specialists in Heart Failure (2013). NT-proBNP levels were measured by electrochemiluminescence (Elecsys proBNP II, Roche Diagnostics, Switzerland). All patients were started on subcutaneous methotrexate (MT) with rapid dose titration to 30 mg weekly. If the MT was insufficiently effective, a biological disease-modifying antirheumatic drug (bDMARD) was added to the therapy after 3 months, mainly a TNF-alpha inhibitor. After 18 months, 10 (45%) patients were in remission and had low disease activity, 6 (60%) patients underwent MT therapy in combination with bDMARDs. Results: At baseline, 21 (95%) patients were diagnosed with CHF with preserved ejection fraction and one patient had CHF with reduced ejection fraction. After 18 months there was an improvement of clinical symptoms, echocardiographic parameters (reduction of the left atrium diameter and the left atrium end-systolic volume index, IVRT, E'LV), and diastolic function of the left ventricle (LV). No episodes of acute CHF deterioration were registered. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n=5) and low disease activity (n=2), mainly under the treatment with MT and bDMARDs. In patients with RA and CHF, the NT-proBNP levels decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg/ml (p<0.001) and became normal in 16 of 22 (73%) patients (p<0.001) with remission or low RA activity. In 5 (22%) patients, clinical CHF manifestations resolved, LV diastolic function and NT-proBNP levels were normalized. Conclusion: In the patients with early RA and CHF anti-rheumatic therapy improves the clinical course of CHF, LV diastolic function and reduces NT-proBNP levels.

scholarly journals Chronic Heart Failure in Rheumatoid Arthritis Patients (Part II): Difficulties of Diagnosis

2019 ◽  
Vol 14 (6) ◽  
pp. 870-878 ◽  
Author(s):  
D. S. Novikova ◽  
H. V. Udachkina ◽  
I. G. Kirillova ◽  
T. V. Popkova
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Natriuretic Peptides ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Left Ventricular Ejection

Rheumatoid arthritis (RA) is characterized by a twofold increase in morbidity and mortality due to chronic heart failure (CHF). At the same time, the prevalence of CHF among RA patients is significantly underestimated. The aim of the review was to analyze the results of the main studies on the features of the clinical presentation of heart failure (HF) in RA patients, the role of visualization techniques and biomarkers in the diagnosis of HF and preclinical dysfunction of the myocardium. HF in patients with RA is characterized by a predominance of HF with a preserved left ventricular ejection fraction (LVEF). The use of clinical diagnostic criteria in RA patients can lead to both over- or underdiagnosis of CHF. Systolic dysfunction estimated by LVEF is rare in RA and does not reflect the real frequency of myocardial dysfunction. Echocardiography (ECHO-CG) with tissue Doppler echocardiography (TDE) and visualization of myocardial deformation, magnetic resonance imaging (MRI) of the heart in RA patients revealed a high frequency of HF with preserved ejection fraction, left ventricular remodeling and hypertrophy, pre-clinical systolic and diastolic dysfunction. Determination of natriuretic peptides is useful for verifying the diagnosis of HF and estimating the prognosis in this cohort, despite the possible decrease in the sensitivity and specificity of these indicators in RA patients. The review discusses the advantages of MRI of the heart, including quantitative T1 and T2 regimens, in the diagnosis of myocarditis, myocardial fibrosis, and myocardial perfusion disorders in RA patients. In order to verify the diagnosis of heart failure and detect pre-clinical myocardial dysfunction in RA patients, the determination of natriuretic peptides concentration should become part of the routine examination, beginning with the debut of the disease, along with the collection of a cardiological history, physical examination, ECHO-CT with TDE, and visualization of myocardial deformation. Evaluation of the quantitative characteristics of tissue according to MRI of the heart could improve the diagnosis of myocardial damage.

scholarly journals Systolic blood pressure does not reliably identify vasoactive status in chronic heart failure

2005 ◽  
Vol 18 (2) ◽  
pp. 82-86 ◽  
Author(s):  
C PARROTT ◽  
C QUALE ◽  
D LEWIS ◽  
S FERGUSON ◽  
R BRUNT ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Chronic Heart Failure ◽  
Systolic Blood Pressure

scholarly journals The use of a new type of heart rate-controlled training system HeartGo for patients with chronic Heart failure on the pedelec.

2020 ◽  
Author(s):  
Erik B Friedrich ◽  
Guenter Hennersdorf ◽  
Herbert Loellgen ◽  
Helmut Roeder ◽  
Wolfgang Baltes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Clinical Data ◽  
Health Benefits ◽  
Left Ventricular Ejection ◽  
Rate Controlled

Summary: Background: The study "HI-Herz.BIKE Saar" (August 2017 - September 2019) examined health benefits and training effects of e-bikes (pedelecs) in patients with moderate chronic heart failure (CHF) from ambulatory heart groups. Method: The presented study is explicitly marked as a pilot study. 10 subjects with CHF NYHA stage II-III and a left ventricular ejection fraction (LVEF) of <=50% were selected. In our study, we are the first to employ the novel HeartGo system which allows for heart rate controlled training on pedelecs via a smartphone app. Training groups were accompanied during bike rides by a medical doctor and a paramedic. No cardiac complications occurred. Every six months, training sessions increased in duration, distance, and target frequency. Parameters measured were frequency behaviour, pedaling and motor load on the pedelec as well as clinical data such as ejection fraction, the biomarker NT-pro BNP, risk factors, arterial blood pressure and ergometric courses. Results: Power tolerance increased by almost 2.5 times, while a discrete decrease of the resting heart rate by 3.7% was observed and pedaling power improved accordingly. Clinical data show significant increases in well-being determined by questionnaire, in ergometric power by 45%, and in the LVEF by 29%. This was paralleld by a significant decrease in the NT-pro BNP value by 27% and in systolic blood pressure by 11%. Body Mass Index (BMI) remained constant at 27 and cholesterol levels showed no significant changes. Conclusions: Pedaling according to this pilot study with its methodological limitations of low numbers was safe and accompanied by significant health benefits in patient with CHF. Moreover, subjects were enthusiastic and satisfied with this form of training. Therefore, pedelec training using the HeartGo system could be a helpful tool in the training process of heart group participants with stable CHF. The results of this pilot study with its methodological weaknesses should be verified in a larger follow-up study. Key words: Pedelec, e-bike, heart rate control, heart failure, physical activity

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