AB0168 BODY MASS INDEX IS ASSOCIATED WITH SIGNIFICANT ECHOCARDIOGRAPHIC ABNORMALITIES IN RHEUMATOID ARTHRITIS
Authors: S. Hannawi, K. Naeem, H. Hannawi
Journal: Annals of the Rheumatic Diseases (2021)

Background: Overweight/obesity is associated with a high incidence of chronic autoimmune diseases such as rheumatoid arthritis (RA). In RA, obesity represents an increasingly prevalent comorbidity even at its first presentation, with more than 60% of patients with RA classified as overweight or obese by the body mass index (BMI ≥25 kg/m 2 ). On the other hand, RA is related with excess cardiovascular disease (CVD) mortality, which accounts for over 50% of premature deaths in RA. Obesity contributes to the development of inflammation via changes in metabolism and function of adipose tissue and it appears to coexist with other CVD risk factors such as hypertension, insulin resistance and dyslipidemia. Objectives: For the first time, this study looks at the effect of the BMI on echocardiography parameters in established RA cases. Methods: A cross section study was carried out to recruit patients meeting the 2010 ACR/EULAR criteria during 2019. Standard trans-thoracic echocardiography examination was performed by a specialist cardio-sonographer who was blinded to the status of the participants. The echocardiography parameters studied included left ventricular dimensions, wall geometry, systolic and diastolic parameters, ejection fraction, right ventricular size and function, valve structure and function, aortic root dimensions, pulmonary pressures and pericardium. Anthropometric measurements of BMI were carried out as weight in kilograms divided by the square of height in meters (kg/m 2 ). Data was analysed using the BMI as the explanatory variable and repeating the simple linear regression analysis using the echocardiography parameters as outcome variables. P value of &lt;0.05 was considered significant. Results: During the one-year period, 44 RA patients were recruited, of which 91% (40) were female and 4 (9 %) male. The mean (SD) of age was 50±13 years (Min 28, Max 72). The mean (SD) of BMI was 30.887 ± 6.348 Kg/m 2 (Min 21, Max 44.38). As per BMI classification of obesity, only 11% patients were found to have normal BMI. Echocardiography revealed that 14% patients had aortic regurgitation, 2% had aortic stenosis, 2% had mitral stenosis, and 7% had tricuspid regurgitation. Using BMI as an explanatory variable, with echocardiography parameters as outcome variables, it was found that BMI contributed positively in a linear manner to the Interventricular Septal thickness in diastole (mm) (p=0.004, CI: 0.048-0.227), LV End Diastolic Diameter (mm) (p=0.033, CI: 0.033-0.722), LV mass (g) (0.04, CI: 0.022-6.339), Early Diastolic Velocity, E, by PW mitral inflow measurement (cm/s) (p=0.02, CI: 0.150-1.933), E/E’ ratio by Tissue Doppler study (p=0.01, CI: 0.025-0.225), and to Right Ventricle function measured by Tricuspid Annular Plane Systolic Excursion (TAPSE) (mm) (p=0.02, CI: 0.035-0.346). Conclusion: Obesity and Inflammation overlap syndrome may interplay to produce various cardiovascular abnormalities. Body Mass Index is shown to be associated with significant echocardiographic abnormalities including left ventricular dimension, diastolic parameters and right ventricular function. In view of the complex interrelation between obesity, rheumatoid arthritis and cardiovascular disease, measuring Body Mass Index might help predict adverse cardiovascular events in rheumatoid arthritis patients. References: [1]Body mass index and the risk of rheumatoid arthritis: a systematic review and dose-response meta-analysis. Qin B, Yang M, Fu H, Ma N, Wei T, Tang Q, Hu Z, Liang Y, Yang Z, Zhong R. Arthritis Res Ther. 2015; 17(1): 86. doi: 10.1186/s13075-015-0601-x. [2]Cardiac eccentric remodeling in patients with rheumatoid arthritis. Pascale V, Finelli R, Giannotti R, Coscioni E, Izzo R, Rozza F, Caputo D, Moscato P, Iaccarino G, Ciccarelli M. Sci Rep. 2018; 8: 5867. doi: 10.1038/s41598-018-24323-0. Disclosure of Interests: None declared