AB0332 CLINICAL FEATURES AND RISK FACTORS OF CHRONIC HEART FAILURE IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS PRIOR TO THERAPY WITH BASIC ANTI-INFLAMMATORY DRUGS
Authors: Irina Kirillova, Diana Novikova, Tatiana Popkova, Eugenia Markelova, Helen Udachkina, Yulia Gorbunova, Maria Cherkasova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Heart failure (HF) is a major cause of premature mortality, there is little information regarding its prevalence and associated risk factors in patients (pts) with early rheumatoid arthritis (RA). Objectives: to study the frequency, clinical manifestations and risk factors associated with the development of HF in pts with early RA prior to therapy with basic anti-inflammatory drugs. <h3>Methods</h3> A total of 74 pts with early RA (ACR/EULAR criteria, 2010) were included in the study: 78% of women, median (Me) age - 56 years [47; 61], Me of disease duration - 7 [4;8] months; Me DAS28 5.3 [5.0;6.2], IgM RF seropositive (87%) and/or ACCP (100%), without any experience of administration of disease-modifying antirheumatic drugs and glucocorticoides. All pts underwent blood pressure monitoring, echocardiography, tissue Doppler imaging, NT-proBNP. The normal range for NT-proBNP was less than 125 pg/ml. HF was diagnosed according to the recommendations of the European Society of Cardiology (2012). <h3>Results</h3> HF was diagnosed in 24 (33%) pts: in 23 pts - HF with preserved ejection function (EF), in 1 pts - HF with reduced EF. Dyspnea was detected in 21 (87%) RA pts with HF (positive predictive value (PPV)-33%), in 6 (25%) - ankle edema (PPV-35%), in 24 (100%) - fatigue (PPV-38%). In 5 (21%) pts dyspnea NYHA=1 was observed, 15 (63%) - NYHA=2, in 1 (4%) - NYHA=3. Diastolic dysfunction of the left ventricle was detected in all pts with HF (PPV-69%). Elevated NT-proBNP level wasn't highly indicative for HF in early RA (PPV=41%). All pts with early RA were divided into 2 groups: 1- with HF, 2-without HF. Pts with RA and HF were older (61 [58;65] vs 51 [36;56] years), had higher BMI (28 [25;32] vs 24 [22;29] kg/m<sup>2</sup>, p&lt;0,05), NT-proBNP level (192.0 [154.9;255.7] vs 77.0 [41.1;191.2] pg/ml, p&lt;0.05), more likely to have arterial hypertension (AH) (83% vs 51%, p&lt;0.05), carotid atherosclerosis (91% vs 48%, p&lt;0.05), coronary artery disease (CAD) (40% vs 7%, p&lt;0.05) then RA pts without HF. DAS28, CRP and ESR did not differ in two groups. In order to identify factors associated with the risk of development of HF, a step-by-step linear regression analysis was performed. The multiple coefficient of determination is R<sup>2</sup> = 57.1 (R-0.76, p&lt;0.001) (Tabl.1). According to ROC analysis, the diagnostic significance of studied factors was high with 88% sensitivity and 88% specificity. <h3>Conclusion</h3> HF mainly with preserved EF was found in 1/3 of pts with early RA with high and moderate activity. Clinical manifestations of HF had low diagnostic value. The risk factors of HF in pts with RA were the level of CRP and traditional risk factors (abdominal obesity, AH, dyslipidemia), the value of TIM of carotid arteries and the presence of CAD. <h3>Disclosure of Interests</h3> None declared