AB0376 Pulmonary Pressure and Diastolic Function in Long-Standing Rheumatoid Arthritis on Biological Therapy
Authors: N. Lozano Rivas, P. Mesa-Del-Castllo B, F. Pastor-Perez, G. de la Morena, M. Diaz Navarro, B. Cascales Sanchez, F. Martinez Angosto, C. Marras Fernández-Cid
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Patients with rheumatoid arthritis (RA) are more likey to have diastolic dysfunction and this finding may explain the higher risk of heart failure and pulmonary hypertension in this population<sup>1</sup>. These features could be specially relevant in patients with long-term evolution of the disease in which the influence of the biological treatment is unknown. <h3>Objectives</h3> To study the prevalence and the degree of diastolic function (DF) and pulmonary hypertension (PH) in long-standing AR patients on biological therapy. <h3>Methods</h3> Retrospective study of long-standing AR patients on biological therapy (16% abatacept, 16% adalimumab, 18% etanercept, 2% golimumab, 8% infliximab, 20% rituximab and 20% tocilizumab) with unknown cardiac disease and with a transthoracic echocadiographic study available. Clinical and echocardiographics measurements of DF were obtained with transmitral E and A wave ratio with the following patterns in order of increasing impairment of DF: normal, impaired relaxation, pseudonormal and restrictive. A normal DF was considered in the presence of either normal or altered relaxation in patients &gt;45 years. DF was also measured with tissue Doppler (E/e9 ratio at the level of the septal annulus) being abnormal a ratio &gt;15. The degree of pulmonary pressure was estimated using the tricuspid regurgitation velocity and PH was graded as follows: mild (30-39mmHg), moderate (40-49 mmHg) and severe (≥50mmHg). <h3>Results</h3> Fifty patients were included, age 59±13 years, 78% females. Seventy-two percent had hypertension and 16% diabetes. Median disease evolution was 12 [6-18] years. With respect to E/A ratio, 74% patients had normal DF. In 7 patients (14%) there was a pseudonormal pattern (with an attributable cause in all of them: atrial fibrillation, ischemic heart disease and age &gt;75 years). With respect to E/e9 ratio, mean value was 10.2±4.6 and 20% had E/e9 &gt;15. These patients were older (67.5±8.1 vs 57.6±13.9 years, p=0.036) and had higher antiCCP levels (median 340 vs 31.5, p=0.016) without statistically significant differences in the time of evolution of the disease and in other clinical characteristics. We found pulmonary hypertension in 42% of patients, 86% mild and only 14% moderate (3 patients, with ischemic heart disease and/or age &gt;70 years). The presence of pulmonary hypertension was associated to age (65.5±8.9 vs 57.2±14.4 years, p=0.05) and E/e9 values (12.9 vs 9.2, p=0.011) <h3>Conclusions</h3> In our population of long-standing AR on biological therapy, the presence of impaired DF is uncommon and is associated to age, comorbidity and higher levels of anti-CCP, whereas pulmonary hypertension is mainly mild reflecting the age and the inherent diastolic dysfunction in these elderly patients <h3>References</h3> Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic dysfunction in rheumatoid arthritis: a meta-analysis and systematic review. Arthritis Care Res (Hoboken). 2013 Apr;65(4):534-43 <h3>Disclosure of Interest</h3> None declared