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Background: Risk of developing cardiovascular complications and death in rheumatoid arthritis (RA) is 50% higher than in the total population. The biomarkers soluble ST2 (sST2), galectin-3, pentraxin and N-terminal pro-brain natriuretic peptide (NT-proBNP) provide prognostic information in pts with heart failure.
Objectives: To determine the frequency of myocardial dysfunction (lower global longitudinal epicardial strain of left ventrical (GLES LV) using echocardiographic method of speckle tracking, the level of NT-proBNP, pentraxin, galectin-3 and sST2 in patients (pts) with RA prior to therapy with bDMARDs.
Methods: A total of 41 pts with RA (ACR/EULAR criteria, 2010) were included in the study: 63% of women, age 56 [37;66] years, disease duration 24 [8;96] months; DAS28 6,01 [5.3;6.3], positive for ACCP (92%), RF (78%), without cardiovascular diseases and prior administration of bDMARDs. All pts underwent echocardiography, tissue Doppler imaging and the speckle tracking assessment of GLES LV. 44% of RA pts received methotrexate (median dose - 15 (15;20) mg / week.), 35% - leflunomide, 9.3% - sulfasalazine, 7% - hydroxychloroquine, 67.4% - glucocorticoids (median dose - 5 (4;8) mg / day.), 74% - nonsteroidal anti-inflammatory drugs. In each RA pts, we measured plasma concentrations of sST2 (Cristal Diagnostics, San Diego), galectin-3 (Bender MedSystems GmbH Biocenter, Vienna Austria) NT-proBNP (Roche Diagnostics, Switzerland) and pentraxin (Hycult Biotech, Netherland). The control group consisted of 10 healthy subjects, which were matched by sex and age.
Results: : In pts with RA speckle-tracking method detected lower global longitudinal epicardial strain (GLES)(–16.5 [-14.6; -18.5]%), compared to the healthy control group (–21.58 [-22.1;-20.4] %, p=0.0001). 27(67%) RA pts showed a decrease GLES. RA pts also had higher levels of NT-proBNP (114.8 [45.1; 277.5] pg/ml vs 52 [40.5; 69.1] pg/ml, p<0.05), lower levels of sST2 (10.6 [9.2; 13.1] ng/ml vs 13.5 [11.0; 19.7] ng/ml, p<0.04) compared to control group.
All RA pts were divided into 2 groups: group 1- with low GLES, group 2 - with preserved GLES. In group 1, the levels of ST2 were significantly lower than in group 2 (
Levels of biomarkers in groups
| low GLES, (n=27) | Normal GLES, (n=14) | p | |
|---|---|---|---|
| sST2, ng/ml | 13.2 [10.6;17.0] | 18.3 [13.7;60.9] | <0.05 |
| Pentraxin, ng/ml | 0.29 [0.05;0.42] | 0.3 [0.02;0.79] | >0.05 |
| galectin-3, ng/ml | 4.0 [2.6;6.9] | 4.3 [3.2;5.3] | >0.05 |
| NT-proBNP, pg/ml | 105 [42;260] | 94 [35.5;378.8] | >0.05 |
There were negative correlations between the global longitudinal epicardial strain and age (r=-0,9, p<0,02), E velocity LV (r=-0,5, p<0,04), sST2 (r=-0,5, p<0,02). Galectin-3 correlates with left atrial volume (r=0,4, p<0,04), septal e’ velocity (r=0,6, p<0,008). ST2 levels correlate with ESR (r=0,6, p<0,04), CRP (r=0,5, p<0,002).
Conclusion: In pts with RA frequently (67%) were detected lower global longitudinal epicardial strain, higher levels of NT-proBNP and lower levels of sST2. In RA pts the sST2 biomarker is better associated with inflammatory activity and myocardial dysfunction.
Disclosure of Interests: None declared