Magnetic Resonance Imaging-Detected Myocardial Inflammation and Fibrosis in Rheumatoid Arthritis: Associations With Disease Characteristics and N-Terminal Pro-Brain Natriuretic Peptide Levels.

Abstract

OBJECTIVE:

Myocardial dysfunction and heart failure (HF) are increased in rheumatoid arthritis (RA), yet there are few studies of the myocardium in RA.

METHODS:

RA patients with no known heart disease or risk factors underwent gadolinium-enhanced cardiac magnetic resonance imaging (MRI). Images were assessed for left-ventricular (LV) structural and functional parameters and for myocardial late gadolinium enhancement (LGE; an indicator of myocardial fibrosis) and T2-weighted imaging (an indicator of active inflammation). We modeled the associations between RA characteristics and N-terminal pro-brain natriuretic protein (NT-proBNP) levels with LGE and T2-weighted imaging. We also assessed whether LGE and/or T2-weighted imaging were associated with abnormal LV structure or dysfunction.

RESULTS:

A total of 60 RA patients were studied. LGE was present in 19 (32%) and T2-weighted imaging in 7 (12%), 5 of whom also had LGE. After adjustment for relevant confounders, higher odds of LGE with each swollen joint (odds ratio [OR] 1.87, P = 0.008), each log unit higher C-reactive protein level (OR 3.36, P = 0.047), and each log unit higher NT-proBNP (OR 20.61, P = 0.009) were found. NT-proBNP was also significantly higher (135%) among those with T2-weighted imaging than in those without T2-weighted imaging or LGE. Higher LV mass index and LV mass:end diastolic volume ratio were observed in those with T2-weighted imaging than in those with no myocardial abnormalities and in those with LGE without T2-weighted imaging; however, ejection fraction was not reduced in those with either LGE or T2-weighted imaging.

CONCLUSION:

These data suggest that cardiac MRI findings indicating myocardial inflammation/fibrosis are correlated with RA disease activity and alterations in myocardial structure known to precede clinical HF.

• Authors: Hitomi Kobayashi, Yasuyuki Kobayashi, Isamu Yokoe, Yosikatsu Akashi, Masami Takei, Jon T Giles
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 69 Issue 9 Pg. 1304-1311 (09 2017) ISSN: 2151-4658 [Electronic] United States
• PMID: 27813364 (Publication Type: Journal Article)
• Copyright: © 2016, American College of Rheumatology.

Chemical References

• Contrast Media
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• C-Reactive Protein
• Gadolinium DTPA

Topics

• Adult
• Aged
• Arthritis, Rheumatoid (blood, complications, diagnostic imaging)
• C-Reactive Protein (analysis)
• Contrast Media
• Endomyocardial Fibrosis (diagnostic imaging, etiology)
• Female
• Gadolinium DTPA
• Heart (diagnostic imaging)
• Humans
• Magnetic Resonance Imaging, Cine (methods)
• Male
• Middle Aged
• Myocarditis (diagnostic imaging, etiology)
• Myocardium (pathology)
• Natriuretic Peptide, Brain (blood)
• Odds Ratio
• Peptide Fragments (blood)
• Risk Factors