rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2012-1107rsp-1027Research ArticleСтатьиArticlesСвязь показателей реактивности плечевой артерии с диастолической дисфункцией левого желудочка у больных ревматоидным артритомRelationship of brachial artery responsiveness parameters to left ventricular diastolic dysfunction in patients with rheumatoid arthritisMyasoyedovaElena EvgenyevnaMyasoyedovaElena Evgenyevnaelenamyasoyedova@yahoo.comMyasoyedovaS EMyasoyedovaS E-ObzherinaS VObzherinaS V-SvyatovaN DSvyatovaN D-201215082012504№4 (2012)2427Copyright © Myasoyedova E.E., Myasoyedova S.E., Obzherina S.V., Svyatova N.D., 20122012Myasoyedova E.E., Myasoyedova S.E., Obzherina S.V., Svyatova N.D.Myasoyedova E.E., Myasoyedova S.E., Obzherina S.V., Svyatova N.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1027

Цель - изучить показатели сосудистой реактивности у больных ревматоидным артритом (РА), имеющих диастолическую дисфункцию (ДД) левого желудочка, и у пациентов с РА без ДД и выделить предикторы ДД из числа характеристик сосудистой реактивности у больных РА, не имеющих кардиоваскулярных заболеваний. Материал и методы. В исследование включен 61 пациент с РА (средний возраст 47,1 года; 87% женщин) без сопутствующих кардиоваскулярных заболеваний. Всем пациентам проведено стандартное эхокардиографическое исследование с оценкой диастолической функции в соответствии с рекомендациями Европейского общества кардиологов (2005). Сосудистую реактивность исследовали с помощью допплер-ультрасонографии плечевой артерии в 5-минутной компрессионной пробе. Ассоциации между показателями сосудистой реактивности и ДД изучали с помощью моделей логистической регрессии с поправкой на пол и возраст больных. Результаты и обсуждение. ДД обнаружена у 35 (57%) больных. Показатели сосудистой реактивности у больных РА, имеющих ДД, отличались от таковых у больных РА без ДД. Снижение объемной скорости кровотока в плечевой артерии через 10 с (отношение шансов [ОШ] 0,8; 95% доверительный интервал [ДИ] 0,7-0,97) и через 1 мин (ОШ 0,7; 95% ДИ 0,5-0,96) после декомпрессии, а также относительный прирост объемной скорости кровотока в течение первой минуты после декомпрессии (ОШ 0,9; 95% ДИ 0,9-0,99) были ассоциированы с наличием ДД. Статистически значимых ассоциаций изменения диаметра плечевой артерии с ДД обнаружено не было. Заключение. Снижение объемного кровотока в плечевой артерии по данным компрессионной пробы ассоциировано с ДД у больных РА, не имеющих кардиоваскулярных заболеваний. Взаимосвязь нарушений сосудодвигательной и диастолической функции при РА предполагает общность патогенетических механизмов развития этих изменений и открывает возможности для более ранней диагностики ДД по результатам исследования сосудистой реактивности.

Objective: to study vascular responsiveness parameters in rheumatoid arthritis (RA) patients with and without left ventricular diastolic dysfunction (DD) and to identify the predictors of DD among the characteristics of vascular responsiveness in RA patients having no cardiovascular diseases. Subjects and methods. The investigation enrolled 61 RA patients (mean age 47.1 years; 87% of females) without cardiovascular comorbidity. All the patients underwent standard echocardiographic study with diastolic function assessment in accordance with the 2005 European Society of Cardiology guidelines. Vascular responsiveness was studied using brachial artery Doppler ultrasonography in a 5-minute compression test. Associations between vascular responsiveness parameters and DD were studied using logistic regression models and adjusting for patient gender and age. Results and discussion. DD was found in 35 (57%) patients. The parameters of vascular responsiveness in RA patients with DD differed from those in RA patients without DD. The decrement in blood flow volumetric velocity in the brachial artery 10 sec (odds ratio [OR] 0.8; 95% confidence interval [CI] 0.7-0.97), and 1 min (OR 0.7; 95% CI 0.5-0.96) after decompression and the relative increment in blood flow volumetric velocity within the first minute after decompression (OR = 0.9; 95% CI 0.9-0.99) were associated with the presence of DD. There were no statistically significant associations of the changes in brachial artery diameter with DD. Conclusion. The decrement in blood flow volumetric velocity in the brachial artery, as evidenced by the compression test, is associated with DD in RA patients without cardiovascular diseases. The association of impairments in vasomotor and diastolic functions in RA shows the commonness of pathogenic mechanisms for the development of these changes and opens considerable scope for the earlier diagnosis of DD according to the results of the study of vascular responsiveness.

ревматоидный артритдиастолическая дисфункциясосудодвигательная функция эндотелияфакторы рискаrheumatoid arthritisdiastolic dysfunctionendothelial vasomotor functionrisk factorsReferences<div><p>Parodi M., Bensi L., Maio T. et al. Comorbidities in rheumatoid arthritis: analysis of hospital discharge records. Reumatismo 2005;57:154-60.</p><p>Michaud K., Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 2007;21:885-906.</p><p>Del Rincon I.D., Williams K., Stern M.P. et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthr Rheum 2001;44:2737-45.</p><p>Kremers H.M., Crowson C.S., Therneau T.M. et al. High ten-year risk of cardiovascular disease in newly diagnosed rheumatoid arthritis patients: a population-based cohort study. Arthr Rheum 2008;58:2268-74.</p><p>Maradit-Kremers H., Nicola PJ., Crowson C.S. et al. Cardiovascular death in rheumatoid arthritis: a population-based study. Arthr Rheum 2005;52:722-32.</p><p>Corrao S., Salli L., Arnone S. et al. Echo-Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur J Clin Invest 1996;26:293-7.</p><p>Wislowska M., Jaszczyk B., Kochmanski M. et al. Diastolic heart function in RA patients. Rheumatol Int 2008;28:513-9.</p><p>Liang K.P., Myasoedova E., Crowson C.S. et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Ann Rheum Dis 2010;69:1665-70.</p><p>Prasad A., Higano S.T., Suwaidi J.A. et al. Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction. Am Heart J 2003;146:549-54.</p><p>Elesber A.A., Redfield M.M., Rihal C.S. et al. Coronary endothelial dysfunction and hyperlipidemia are independently associated with diastolic function in humans. Am Heart J 2007;153:1081-7.</p><p>Bonetti P.O., Pumper G.M., Higano S.T. et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol 2004;44:2137-41.</p><p>Arnett F.C., Edworthy S.M., Bloch D.A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 1988;31:315-24.</p><p>Swedberg K., Cleland J., Dargie H. et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005;26:1115-40.</p><p>Roman M.J., Naqvi T.Z., Gardin J.M. et al. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 2006;19:943-54.</p><p>Giles J.T., Malayeri A.A., Fernandes V. et al. Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging. Arthr Rheum 2010;62:940-51.</p><p>Udayakumar N., Venkatesan S. Rajendiran C. Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease. Singapore Med J 2007;48:537-42.</p><p>Montecucco C., Gobbi G., Perlini S. et al. Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 1999;17:407-12.</p><p>Teerlink J.R., Clozel M., Fischli W. et al. Temporal evolution of endothelial dysfunction in a rat model of chronic heart failure. J Am Coll Cardiol 1993;22:615-20.</p></div><br /><div><p>Parodi M., Bensi L., Maio T. et al. Comorbidities in rheumatoid arthritis: analysis of hospital discharge records. Reumatismo 2005;57:154-60.</p><p>Michaud K., Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 2007;21:885-906.</p><p>Del Rincon I.D., Williams K., Stern M.P. et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthr Rheum 2001;44:2737-45.</p><p>Kremers H.M., Crowson C.S., Therneau T.M. et al. High ten-year risk of cardiovascular disease in newly diagnosed rheumatoid arthritis patients: a population-based cohort study. Arthr Rheum 2008;58:2268-74.</p><p>Maradit-Kremers H., Nicola PJ., Crowson C.S. et al. Cardiovascular death in rheumatoid arthritis: a population-based study. Arthr Rheum 2005;52:722-32.</p><p>Corrao S., Salli L., Arnone S. et al. Echo-Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur J Clin Invest 1996;26:293-7.</p><p>Wislowska M., Jaszczyk B., Kochmanski M. et al. Diastolic heart function in RA patients. Rheumatol Int 2008;28:513-9.</p><p>Liang K.P., Myasoedova E., Crowson C.S. et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Ann Rheum Dis 2010;69:1665-70.</p><p>Prasad A., Higano S.T., Suwaidi J.A. et al. Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction. Am Heart J 2003;146:549-54.</p><p>Elesber A.A., Redfield M.M., Rihal C.S. et al. Coronary endothelial dysfunction and hyperlipidemia are independently associated with diastolic function in humans. Am Heart J 2007;153:1081-7.</p><p>Bonetti P.O., Pumper G.M., Higano S.T. et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol 2004;44:2137-41.</p><p>Arnett F.C., Edworthy S.M., Bloch D.A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 1988;31:315-24.</p><p>Swedberg K., Cleland J., Dargie H. et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005;26:1115-40.</p><p>Roman M.J., Naqvi T.Z., Gardin J.M. et al. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 2006;19:943-54.</p><p>Giles J.T., Malayeri A.A., Fernandes V. et al. Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging. Arthr Rheum 2010;62:940-51.</p><p>Udayakumar N., Venkatesan S. Rajendiran C. Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease. Singapore Med J 2007;48:537-42.</p><p>Montecucco C., Gobbi G., Perlini S. et al. Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 1999;17:407-12.</p><p>Teerlink J.R., Clozel M., Fischli W. et al. Temporal evolution of endothelial dysfunction in a rat model of chronic heart failure. J Am Coll Cardiol 1993;22:615-20.</p></div><br />

The authors declare that there are no conflicts of interest present.