Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review
Article first published online: 28 MAR 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 4, pages 534–543, April 2013
How to Cite
Aslam, F., Bandeali, S. J., Khan, N. A. and Alam, M. (2013), Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review. Arthritis Care Res, 65: 534–543. doi: 10.1002/acr.21861
- Issue published online: 28 MAR 2013
- Article first published online: 28 MAR 2013
- Accepted manuscript online: 23 SEP 2012 03:50PM EST
- Manuscript Accepted: 10 SEP 2012
- Manuscript Received: 2 APR 2012
To determine if the prevalence of diastolic dysfunction is increased in rheumatoid arthritis (RA) patients.
We conducted a time- and language-restricted literature search to identify studies conducted to compare echocardiographic parameters in patients with RA and controls. The mean difference for echocardiographic variables of interest was calculated using a random-effects model. A systematic review of the literature was performed.
A total of 25 studies reporting on 5,836 subjects (1,614 with RA) were included. Results reflect mean differences, with positive values denoting higher values in RA patients. Patients with RA had larger mean left atrial dimension (mean difference 0.09 cm [95% confidence interval (95% CI) 0.01, 0.17]; P = 0.02), higher left ventricular mass index (mean difference 6.2 gm/m2 [95% CI 1.08, 11.33]; P = 0.02), higher mean systolic pulmonary artery pressure (mean difference 5.87 mm Hg [95% CI 4.36, 7.38]; P < 0.00001), prolonged isovolumetric relaxation time (mean difference 9.67 msec [95% CI 5.78, 13.56]; P < 0.00001), and higher transmitral A wave velocity (mean difference 0.13 meters/second [95% CI 0.07, 0.18]; P < 0.00001) compared to controls. A subanalysis of 2,183 subjects excluding 2 large unmatched studies showed the same results, with the exception that patients with RA had a lower mitral E/A ratio (mean difference −0.17 [95% CI −0.25, −0.09]; P < 0.00001), suggestive of diastolic dysfunction. There were no differences in left ventricular ejection fraction (%), transmitral E wave velocity (meters/second), and mitral deceleration time (msec).
Patients with RA were more likely to have echocardiographic parameters of diastolic dysfunction, and have higher systolic pulmonary artery pressures and larger left atrial sizes.