Myocardial Inflammation in Rheumatoid Arthritis: A Descriptive Study
| Status: | Recruiting |
|---|---|
| Conditions: | Arthritis, Peripheral Vascular Disease, Rheumatoid Arthritis, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Rheumatology |
| Healthy: | No |
| Age Range: | 45 - Any |
| Updated: | 12/19/2018 |
| Start Date: | June 22, 2018 |
| End Date: | November 2020 |
Rheumatoid arthritis (RA) patients have a higher prevalence of subclinical atherosclerosis
than the general population. In addition, RA patients experience higher rates of heart
failure with preserved ejection fraction (HFpEF). There is evidence that myocardial mechanics
and left ventricular diastolic function are more abnormal in the RA population and these
changes occur earlier than in the general population. Recently a study suggested that RA
patient have abnormal myocardial inflammation during a disease flare and that this is
improved with anti-inflammatory treatment. This study is aimed at describing the prevalence
of myocardial inflammation in patients during active RA disease flares and comparing that
with RA patients who are in remission. Investigators hope to show that abnormalities in
myocardial inflammation on PET imaging correlate with abnormalities in myocardial strain on
echocardiography. Coronary CT will be performed to establish the presence of subclinical
atherosclerosis and whether its presence affects changes in either myocardial inflammation or
myocardial strain. The hypothesis is that patients with evidence of myocardial inflammation
during the course of their RA disease are more likely to develop HFpEF during their lifetime.
Although the present study will not be of a duration to assess outcome, it will provide
descriptive data which may help guide future prospective study of patients with RA which may
help guide appropriate cardiovascular testing in this high risk population.
than the general population. In addition, RA patients experience higher rates of heart
failure with preserved ejection fraction (HFpEF). There is evidence that myocardial mechanics
and left ventricular diastolic function are more abnormal in the RA population and these
changes occur earlier than in the general population. Recently a study suggested that RA
patient have abnormal myocardial inflammation during a disease flare and that this is
improved with anti-inflammatory treatment. This study is aimed at describing the prevalence
of myocardial inflammation in patients during active RA disease flares and comparing that
with RA patients who are in remission. Investigators hope to show that abnormalities in
myocardial inflammation on PET imaging correlate with abnormalities in myocardial strain on
echocardiography. Coronary CT will be performed to establish the presence of subclinical
atherosclerosis and whether its presence affects changes in either myocardial inflammation or
myocardial strain. The hypothesis is that patients with evidence of myocardial inflammation
during the course of their RA disease are more likely to develop HFpEF during their lifetime.
Although the present study will not be of a duration to assess outcome, it will provide
descriptive data which may help guide future prospective study of patients with RA which may
help guide appropriate cardiovascular testing in this high risk population.
Inclusion Criteria
- Diagnosis of Rheumatoid Arthritis according to 2010 American College of Rheumatology
(ACR) criteria (14)
- RA disease duration ≤ 5 years since diagnosis
- CDAI Score of either ≤ 2.8 (low disease activity) or >10 (moderate to high disease
activity)
- ≥ 45 years of age
- Able to provide informed consent
Exclusion Criteria
- Known clinical atherosclerotic disease (myocardial infarction, severe obstruction CAD
(≥ 1 untreated stenosis (≥ 70% in a major vessel) known by either invasive or
noninvasive testing), prior coronary artery intervention, prior coronary artery bypass
surgery, cerebrovascular event, peripheral vascular disease).
- Patients on any type of lipid lowering medications (ie statin medications, fibrates,
etc.)
- Prednisone >10mg per day (or equivalent corticosteroid dose per day within last week)
- Irregular heart rhythm (arrhythmia or cardiac conduction abnormality (e.g. atrial
fibrillation or flutter, frequent extrasystole, LBBB)
- Relevant valvular heart disease (> moderate regurgitation or stenosis of any heart
valve)
- Clinical occurrence of heart failure with or without preserved ejection fraction
- Relevant lung disease (including COPD, fibrosis, symptomatic pleural effusion, oxygen
dependence)
- Sarcoidosis
- Diabetes mellitus treated with insulin
- estimated glomerular filtration rate (eGFR) < 40ml/min
- Known cancer
- History of any-type of cardiomyopathy
- Ejection fraction (EF) less than 45%
- Life expectancy < 1 year
- BMI >35kg/m2
- Severe claustrophobia
- Any known allergic reactions to intravenous contrast
- Inability to receive beta blocker therapy or IV nitrates
- Pregnant/ Breastfeeding women
- Vulnerable persons due to Helsinki Declaration
- Unable to provide informed consent
We found this trial at
1
site
200 First Street SW
Rochester, Minnesota 55905
Rochester, Minnesota 55905
507-284-2511
Phone: 507-538-7178
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