Patients with rheumatoid arthritis (RA) have an increased incidence of diastolic dysfunction, which may further raise their already high risk for congestive heart failure, a meta-analysis suggested.

Mean left atrial size was larger in RA patients than in controls, with a mean difference of 0.09 cm, according to Mahboob Alam, MD, of Baylor College of Medicine in Houston, and colleagues.

In addition, pulmonary artery pressure was higher, with a mean difference of 5.87 mm Hg , the researchers reported in the April issue of Arthritis Care & Research.

Patients with RA have double the incidence of heart failure compared with the larger population, and this finding has prompted interest in determining the origins of heart failure in these patients.

"The importance of diastolic dysfunction lies in the fact that it may serve as a precursor to systolic and diastolic congestive heart failure and also may cause morbidity and mortality on its own," they observed.

A total of 80% of the RA patients were women, and mean disease duration was 8.45 years.

A total of 21 of the studies found evidence of diastolic dysfunction in patients, such as with prolonged isovolumetric relaxation time or mitral valve deceleration time and increases in size of the left atrium.

The presence of a single characteristic echocardiographic variable was considered diagnostic for diastolic dysfunction in the analysis.

Of particular importance were the observations of increased left atrial dimension, a risk factor for atrial fibrillation, and higher pulmonary artery pressure.

The elevated pulmonary artery pressure "has important clinical implications because the cause of fatigue or dyspnea in an RA patient may be [coronary artery disease], lung disease, pulmonary hypertension, or [diastolic dysfunction], they noted.

Additional research will be needed to clarify these implications, and to establish whether routine monitoring should be done.

Further study also will be needed to clarify the natural history of diastolic dysfunction in RA.

"Whether the rate of progression of diastolic dysfunction in patients with RA is higher, whether diastolic dysfunction in RA is associated with greater morbidity and mortality, and whether the severity of diastolic dysfunction in RA has a similar prognostic value as in individuals from the general population needs to be researched," wrote Alam and colleagues.

Other areas for future research include the determination of what influence RA disease activity and inflammation have on diastolic dysfunction, whether C-reactive protein or anti-cyclic citrullinated peptide titers are predictive, and if typical real-world comorbidities in RA patients contribute.

Limitations of the study include possible bias from confounding, missing data in some studies, and reliance on a single echocardiographic measure of diastolic dysfunction.

Source: Diastolic Dysfunction Common in RA