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Che G, Liu Y, Zhang N, Zhao J. Yap drives the development of cardiovascular disease in patients with rheumatoid arthritis. J Med Biochem 2024; 43:243-249. [PMID: 38699701 PMCID: PMC11062341 DOI: 10.5937/jomb0-45932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/09/2023] [Indexed: 05/05/2024] Open
Abstract
Background To assess the influence of serum level of YAP on laboratory examination findings, imaging findings and disease activity of rheumatoid arthritis patients combined cardiovascular disease (RA-CVD). Methods RA-CVD patients (n=60), RA-nCVD patients (n=60) and healthy subjects (n=60) were recruited. Serum levels of YAP in them were detected by qRT-PCR. Their baseline characteristics were analyzed and compared. Disease activity, CVD risk factors and imaging findings in RA-CVD and RA-nCVD patients were evaluated and compared. In addition, potential influences of YAP on disease activity, CVD risk factors and imaging findings in RA-CVD patients were assessed. Results RA-CVD patients had higher levels of ERS, anti-CCP, RF, HDL-C, CRP, FRS, BNP, LA, LVs, LVd and cIMT, and lower level of EF in comparison to RA-nCVD patients. Serum level of YAP was higher in RA-CVD patients than that of RA-nCVD patients and healthy subjects. YAP level was positively correlated to DAS28, TG, CRP, PLT, FRS, BNP and cIMT in RA-CVD patients. Conclusions Serum level of YAP increases in RA-CVD patients. YAP is a potential factor driving the development of CVD in RA patients through regulating inflammatory response, lipid metabolism, glycometabolism and thrombosis.
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Affiliation(s)
- Guozhu Che
- Shanxi Bethune Hospital, Department of Rheumatology and Immunology, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyu, China
| | - Ying Liu
- Shanxi Bethune Hospital, Department of Rheumatology and Immunology, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyu, China
| | - Na Zhang
- Shanxi Bethune Hospital, Department of Rheumatology and Immunology, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyu, China
| | - Jing Zhao
- Shanxi Bethune Hospital, Department of Rheumatology and Immunology, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyu, China
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Brahem M, Amor HIH, Sarraj R, Touil I, Kraiem S, Rouabhia R, Hmaier E, Mbarek GH, Ben Salem A, Mlouki I, Mhamdi S, Hachfi H, Younes M. Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis. Curr Rheumatol Rev 2024; 20:72-81. [PMID: 37518997 DOI: 10.2174/1573397119666230727111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA). METHODS We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique. RESULTS Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01). CONCLUSION Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.
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Affiliation(s)
- Mouna Brahem
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | | | - Rihab Sarraj
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Touil
- Department of Pneumology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Kraiem
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ramzi Rouabhia
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ella Hmaier
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ghassen Haj Mbarek
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ameni Ben Salem
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Mlouki
- Department of Preventive Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Sana Mhamdi
- Department of Preventive Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Haifa Hachfi
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Mohamed Younes
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
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Sierra-Galan LM, Bhatia M, Alberto-Delgado AL, Madrazo-Shiordia J, Salcido C, Santoyo B, Martinez E, Soto ME. Cardiac Magnetic Resonance in Rheumatology to Detect Cardiac Involvement Since Early and Pre-clinical Stages of the Autoimmune Diseases: A Narrative Review. Front Cardiovasc Med 2022; 9:870200. [PMID: 35911548 PMCID: PMC9326004 DOI: 10.3389/fcvm.2022.870200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune diseases (ADs) encompass multisystem disorders, and cardiovascular involvement is a well-known feature of autoimmune and inflammatory rheumatic conditions. Unfortunately, subclinical and early cardiovascular involvement remains clinically silent and often undetected, despite its well-documented impact on patient management and prognostication with an even more significant effect on severe and future MACE events as the disease progresses. Cardiac magnetic resonance imaging (MRI), today, commands a unique position of supremacy versus its competition in cardiac assessment and is the gold standard for the non-invasive evaluation of cardiac function, structure, morphology, tissue characterization, and flow with the capability of evaluating biventricular function; myocardium for edema, ischemia, fibrosis, infarction; valves for thickening, large masses; pericardial inflammation, pericardial effusions, and tamponade; cardiac cavities for thrombosis; conduction related abnormalities and features of microvascular and large vessel involvement. As precise and early detection of cardiovascular involvement plays a critical role in improving the outcome of rheumatic and autoimmune conditions, our review aims to highlight the evolving role of CMR in systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA), systemic sclerosis (SSc), limited sclerosis (LSc), adult-onset Still's disease (AOSD), polymyositis (PM), dermatomyositis (DM), eosinophilic granulomatosis with polyangiitis (EGPA) (formerly Churg-Strauss syndrome), and DRESS syndrome (DS). It draws attention to the need for concerted, systematic global interdisciplinary research to improve future outcomes in autoimmune-related rheumatic conditions with multiorgan, multisystem, and cardiovascular involvement.
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Affiliation(s)
- Lilia M. Sierra-Galan
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | | | - Javier Madrazo-Shiordia
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Carlos Salcido
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Bernardo Santoyo
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Eduardo Martinez
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Maria Elena Soto
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
- Immunology Department of the National Institute of Cardiology, “Ignacio Chavez”, Mexico City, Mexico
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Early Myocardial Changes in Patients with Rheumatoid Arthritis without Known Cardiovascular Diseases-A Comprehensive Cardiac Magnetic Resonance Study. Diagnostics (Basel) 2021; 11:diagnostics11122290. [PMID: 34943529 PMCID: PMC8699890 DOI: 10.3390/diagnostics11122290] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 01/16/2023] Open
Abstract
Clinically silent cardiac disease is frequently observed in rheumatoid arthritis (RA), and cardiovascular complications are the leading cause of mortality in RA. We sought to evaluate the myocardium of young RA patients without known cardiac disease using cardiac magnetic resonance (CMR), including T1/T2 mapping sequences. Eighteen RA patients (median age 41 years, 83% females) mainly with low disease activity or in remission and without any known cardiovascular disease were prospectively included to undergo CMR. A control group consisted of 10 sex- and age-matched patients without RA or any known structural cardiovascular disease. Heart chambers size and left/right ventricular systolic function were similar in patients with RA and controls. Signs of myocardial oedema were present in up to 39% of RA patients, including T2 time above cut-off value in 7 patients (39%) in comparison to none of the controls (p = 0.003) and T2 signal intensity ratio above the cut-off value in 6 patients (33%) and in none of the controls (p = 0.06). Extracellular volume was similar in both groups signifying a lack of diffuse fibrosis in studied group of RA patients. There were also no signs of late gadolinium enhancement (LGE) in either group except for one patient with RA who was found to have prior silent myocardial infarction. No correlation was found between markers of disease severity and markers of oedema observed on CMR in patients with RA. Nevertheless, patients with increased T2 time (≥50 ms) were more likely to have X-ray erosions (p = 0.02) and a longer duration between symptom onset and diagnosis (p = 0.02). Finally, there were no significant arrhythmias on 24-h ECG Holter monitoring in RA patients. CMR features of myocardial oedema without signs of myocardial fibrosis were found in 39% of young RA patients without known heart disease or cardiac symptoms. Presence of myocardial oedema was associated with X-ray erosions and a longer duration between symptom onset and diagnosis. The clinical significance of the observed early myocardial changes accompanying RA requires additional studies.
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Left ventricular myocardial strain assessed by cardiac magnetic resonance feature tracking in patients with rheumatoid arthritis. Insights Imaging 2021; 12:5. [PMID: 33410952 PMCID: PMC7790980 DOI: 10.1186/s13244-020-00948-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of the study was to assess a relationship between the occurrence of rheumatoid arthritis (RA) and its selected clinical parameters, and left ventricular myocardial strain. Material and methods Fifty-six subjects were qualified for the study: 30 RA patients and 26 subjects without rheumatoid diseases. The study design included taking medical history, assessment of the disease activity using selected scales of activity, collecting samples of venous blood to assess selected laboratory parameters and the assessment of cardiac magnetic resonance (CMR). Using the feature tracking method, the following parameters of the left ventricular myocardial strain were assessed: longitudinal strain (LS), radial strain (RS) and circumferential strain (CS). Results Regarding global values, peak LS and peak CS were statistically significantly lower in RA patients than in the control group. In the whole study group, the factors independently related to low global LS peaks were as follows: occurrence of RA, occurrence of arterial hypertension, increased activity of antibodies against cyclic citrullinated peptide and increased concentration of neutrophil gelatinase-associated lipocalin. The occurrence of RA, occurrence of diabetes, tobacco smoking, higher activity of antibodies against cyclic citrullinated peptide and current use of methotrexate are the risk factors for low peak of global CS. The current use of steroids constitutes a protecting factor against low global CS peaks. Conclusion In subjects with no clinically manifested cardiac damage, RA is associated with a deteriorated left ventricular systolic function assessed by left ventricular myocardial strain measured by CMR feature tracking.
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The Role of Cardiovascular Magnetic Resonance in Inflammatory Arthropathies and Systemic Rheumatic Diseases. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-0346-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Mackey RH, Kuller LH, Moreland LW. Update on Cardiovascular Disease Risk in Patients with Rheumatic Diseases. Rheum Dis Clin North Am 2018; 44:475-487. [PMID: 30001787 DOI: 10.1016/j.rdc.2018.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) risk is 1.5-fold higher in rheumatoid arthritis (RA), partly due to subclinical atherosclerosis that develops before the diagnosis of RA. Dyslipidemia in RA is better quantified by lipoproteins and apolipoproteins than by cholesterol levels. Current risk factors likely underestimate CVD risk by underestimating prior risk factor levels. Some of the 2-fold higher risk of heart failure and total mortality in RA may be due to myocardial disease caused by inflammation. Per recent recommendations, to reduce CVD risk in RA, control disease activity, reduce inflammation, and aggressively treat CVD risk factors.
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Affiliation(s)
- Rachel H Mackey
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, 542 Bellefield Professional Building, 130 North Bellefield Avenue, Pittsburgh, PA 15213, USA.
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Room 550, Bellefield Professional Building, 130 North Bellefield Avenue, Pittsburgh, PA 15213, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3500 Terrace Street, Thomas E. Starzl Biomedical Science Tower South 711, Pittsburgh, PA 15261, USA
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