Обоснование. Болезнь депонирования кристаллов пирофосфатов кальция (БДПК) может быть связана с наличием диастолической дисфункции (ДД). Цель. Определить вариабельность эхокардиографических показателей у пациентов с БДПК, получающих противовоспалительную терапию. Материалы и методы. В исследование «случай-контроль» включены по 26 пациентов с БДПК и остеоартритом (ОА) от 18 до 65 лет. Всем пациентам выполнены эхокардиография, оценка лабораторных показателей исходно и через 6 мес. Пациенты с БДПК получали один из препаратов (метотрексат – МТ 15 мг/нед, гидроксихлорохин – ГХ 200 мг/сут или колхицин – КОЛ 1 мг/сут). ДД оценивали по данным эхокардиографии. Результаты. ДД выявлена у 19 пациентов: 11 (42%) при БДПК и 8 (31%) – ОА (p=0,39). Уровень С-реактивного белка сыворотки оказался выше в группе БДПК (p=0,03). Завершили исследование 22 пациента с БДПК и 19 – с ОА. У получавших МТ выявлено: снижение Е/Е' левого желудочка (ЛЖ), повышение Е' ЛЖ, IVRT ЛЖ, Е/А правого желудочка (ПЖ); КОЛ – снижение конечного-диастолического объема, повышение Е/А ПЖ, ГХ – снижение А ЛЖ, ЛП; повышение Пл ПП сист., IVRT ЛЖ, Е/А ЛЖ. У пациентов с ОА значимых изменений показателей, отражающих диастолическую функцию желудочков, не отмечено. Заключение. Терапия КОЛ, ГХ и МТ позитивно влияет на показатели диастолической функции у пациентов с БДПК.
Background. Calcium pyrophosphate crystal deposition disease (CPPD) may be associated with developing of diastolic dysfunction (DD). Aim. To determine the variability of echocardiographic parameters in patients with CPPD receiving anti-inflammatory therapy. Materials and methods. Twenty six patients with CPPD and osteoarthritis (OA) from 18 to 65 years old were included in the case-control study. All patients underwent echocardiography, laboratory parameters at baseline and after 6 months. Patients with CPPD received methotrexate 15 mg per week or hydroxychloroquine 200 mg once a day, or colchicine 1 mg per day. Diastolic function according to echocardiography was assessed. Results. Diastolic dysfunction was detected in 19 patients: in 11 (42%) patients with CPPD and 8 (31%) patients with OA (p=0.39). The baseline serum CRP level was higher in the CPPD group (p=0.03), no differences were found for other indicators. Twenty-two patients with CPPD and 19 patients with OA completed the study. In patients with OA, there were no significant changes in indicators reflecting the diastolic function of ventricles. Conclusion. CPPD therapy with colchicine, hydroxychloroquine and methotrexate has a positive effect on indicators of diastolic ventricular function.
1. Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2014;11(9):507-15. DOI:10.1038/nrcardio.2014.83
2. Dick SA, Epelman S. Chronic Heart Failure and Inflammation: What Do We Really Know? Circ Res. 2016;119(1):159-76. DOI:10.1161/CIRCRESAHA.116.308030
3. Reuss-Borst M, Tausche AK. Gicht und Calciumpyrophosphat-Dihydrat-Arthropathie („Pseudogicht“) – ein Update [Update on Gout and Calcium pyrophosphate deposition (CPPD)]. Dtsch Med Wochenschr. 2018;143(16):1157-66 (in German)]. DOI:10.1055/a-0504-5684
4. Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71. DOI:10.1016/j.jacc.2013.02.092
5. Lawler PR, Bhatt DL, Godoy LC, et al. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J. 2021;42(1):113-31. DOI:10.1093/eurheartj/ehaa099
6. Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70(4):563-70. DOI:10.1136/ard.2010.139105
7. Ревматология: клинические рекомендации. Под ред. акад. РАМН Е.Л. Насонова. 2-е изд., испр. и доп. М.: ГЭОТАР-Медиа, 2011 [Revmatologia: klinicheskie rekomendatsii. Pod red. akad. RAMN EL Nasonova. 2-ye izd., ispr. i dop. Moscow: GEOTAR-Media, 2011 (in Russian)].
8. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79-108. DOI:10.1016/j.euje.2005.12.014
9. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4):613-8. DOI:10.1161/01.cir.55.4.613
10. Pfeffer MA, Shah AM, Borlaug BA. Heart Failure With Preserved Ejection Fraction In Perspective. Circ Res. 2019;124(11):1598-617. DOI:10.1161/CIRCRESAHA.119.313572
11. Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355(3):260-9. DOI:10.1056/NEJMoa051530
12. D'Amario D, Migliaro S, Borovac JA, et al. Microvascular Dysfunction in Heart Failure With Preserved Ejection Fraction. Front Physiol. 2019;10:1347. DOI:10.3389/fphys.2019.01347
13. Елисеев М.С., Желябина О.В., Чикина М.Н., и др. Влияние терапии на субклинический атеросклероз сонных артерий у пациентов с болезнью депонирования кристаллов пирофосфатов кальция и остеоартритом (пилотное исследование). Научно-практическая ревматология. 2021;59(6):708-14 [Eliseev MS, Zhelyabina OV, Chikina MN, et al. The effect of therapy on subclinical atherosclerosis of the carotid arteries in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis (pilot study). Rheumatology Science and Practice. 2021;59(6):708-14 (in Russian)]. DOI:10.47360/1995-4484-2021-708-714
14. Dalbeth NHD. Pathophysiology of crystal-induced arthritis. In: Wortmann RLSHJ, Becker MA, Ryan LM, eds. CrystalInduced Arthropathies: Gout, Pseudogout, and Apatite-Associated Syndromes. New York, 2006; p. 239.
15. Елисеев М.С., Новикова А.М., Желябина О.В., и др. Оценка сердечно-сосудистого риска у пациентов с микрокристаллическими артритами и ревматоидным артритом с помощью шкал ATP III и Reynolds Risk Score. Научно-практическая ревматология. 2020;58(5):512-9 [Eliseev MS, Novikova AM, Zhelyabina OV, et al. Assessment of cardiovascular risk in patients with crystal-induced arthritides and rheumatoid arthritis by the ATP III and Reynolds Risk Score. Rheumatology Science and Practice. 2020;58(5):512-9 (in Russian)]. DOI:10.47360/1995-4484-2020-512-519
16. Gong K, Zhang Z, Sun X, et al. The nonspecific anti-inflammatory therapy with methotrexate for patients with chronic heart failure. Am Heart J. 2006;151(1):62-8. DOI:10.1016/j.ahj.2005.02.040
17. Quan A, Pan Y, Singh KK, et al. Cardiovascular inflammation is reduced with methotrexate in diabetes. Mol Cell Biochem. 2017;432(1-2):159-67. DOI:10.1007/s11010-017-3006-0
18. Ahlers MJ, Lowery BD, Farber-Eger E, et al. Heart Failure Risk Associated With Rheumatoid Arthritis-Related Chronic Inflammation. J Am Heart Assoc. 2020;9(10):e014661. DOI:10.1161/JAHA.119.014661
19. Кириллова И.Г., Новикова Д.С., Попкова Т.В., и др. Течение хронической сердечной недостаточности у больных ранним ревматоидным артритом на фоне противоревматической терапии. Альманах клинической медицины. 2019;47(5):400-9 [Kirillova IG, Novikova DS, Popkova TV, et al. The course of chronic heart failure in patients with early rheumatoid arthritis on the background of antirheumatic therapy. Almanac of Clinical Medicine. 2019;47(5):400-9 (in Russian)]. DOI:10.18786/2072-0505-2019-47-056
20. Попкова Т.В., Новикова Д.С., Насонов Е.Л. Сердечно-сосудистые заболевания при ревматоидном артрите: новые данные. Научно-практическая ревматология. 2016;54(2):122-8 [Popkova TV, Novikova DS, Nasonov EL. Cardiovascular diseases in rheumatoid arthritis: latest data. Rheumatology Science and Practice. 2016;54(2):122‑8 (in Russian)]. DOI:10.14412/1995-4484-2016-122-128
21. Ridker PM, Everett BM, Pradhan A, et al. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med. 2019;380(8):752-62. DOI:10.1056/NEJMoa1809798
22. Meng J, Lu Y, Dong X, Liu H. Long-term effects of hydroxychloroquine on metabolism of serum lipids and left ventricular structure and function in patients of systemic lupus erythematosus. Zhonghua Yi Xue Za Zhi. 2014;94(13):965-8. DOI:10.1136/lupus-2017-000215.261
23. Casula M, Andreis A, Avondo S, et al. Colchicine for cardiovascular medicine: a systematic review and meta-analysis. Future Cardiol. 2022;18(8):647-59. DOI:10.2217/fca-2020-0206
24. Deftereos S, Giannopoulos G, Angelidis C, et al. Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction: A Pilot Study. Circulation. 2015;132(15):1395-403. DOI:10.1161/CIRCULATIONAHA.115.017611
25. Higashikuni Y, Liu W, Numata G, et al. NLRP3 Inflammasome Activation Through Heart-Brain Interaction Initiates Cardiac Inflammation and Hypertrophy During Pressure Overload. Circulation. 2023;147(4):338‑55. DOI:10.1161/CIRCULATIONAHA.122.060860
26. Silvis MJM, Fiolet ATL, Opstal TSJ, et al. Colchicine reduces extracellular vesicle NLRP3 inflammasome protein levels in chronic coronary disease: A LoDoCo2 biomarker substudy. Atherosclerosis. 2021;334:93‑100. DOI:10.1016/j.atherosclerosis.2021.08.005
27. Shen S, Duan J, Hu J, et al. Colchicine alleviates inflammation and improves diastolic dysfunction in heart failure rats with preserved ejection fraction. Eur J Pharmacol. 2022;929:175126. DOI:10.1016/j.ejphar.2022.175126
________________________________________________
1. Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2014;11(9):507-15. DOI:10.1038/nrcardio.2014.83
2. Dick SA, Epelman S. Chronic Heart Failure and Inflammation: What Do We Really Know? Circ Res. 2016;119(1):159-76. DOI:10.1161/CIRCRESAHA.116.308030
3. Reuss-Borst M, Tausche AK. Gicht und Calciumpyrophosphat-Dihydrat-Arthropathie („Pseudogicht“) – ein Update [Update on Gout and Calcium pyrophosphate deposition (CPPD)]. Dtsch Med Wochenschr. 2018;143(16):1157-66 (in German)]. DOI:10.1055/a-0504-5684
4. Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71. DOI:10.1016/j.jacc.2013.02.092
5. Lawler PR, Bhatt DL, Godoy LC, et al. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J. 2021;42(1):113-31. DOI:10.1093/eurheartj/ehaa099
6. Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70(4):563-70. DOI:10.1136/ard.2010.139105
7. Revmatologia: klinicheskie rekomendatsii. Pod red. akad. RAMN EL Nasonova. 2-ye izd., ispr. i dop. Moscow: GEOTAR-Media, 2011 (in Russian).
8. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79-108. DOI:10.1016/j.euje.2005.12.014
9. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4):613-8. DOI:10.1161/01.cir.55.4.613
10. Pfeffer MA, Shah AM, Borlaug BA. Heart Failure With Preserved Ejection Fraction In Perspective. Circ Res. 2019;124(11):1598-617. DOI:10.1161/CIRCRESAHA.119.313572
11. Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355(3):260-9. DOI:10.1056/NEJMoa051530
12. D'Amario D, Migliaro S, Borovac JA, et al. Microvascular Dysfunction in Heart Failure With Preserved Ejection Fraction. Front Physiol. 2019;10:1347. DOI:10.3389/fphys.2019.01347
13. Eliseev MS, Zhelyabina OV, Chikina MN, et al. The effect of therapy on subclinical atherosclerosis of the carotid arteries in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis (pilot study). Rheumatology Science and Practice. 2021;59(6):708-14 (in Russian). DOI:10.47360/1995-4484-2021-708-714
14. Dalbeth NHD. Pathophysiology of crystal-induced arthritis. In: Wortmann RLSHJ, Becker MA, Ryan LM, eds. CrystalInduced Arthropathies: Gout, Pseudogout, and Apatite-Associated Syndromes. New York, 2006; p. 239.
15. Eliseev MS, Novikova AM, Zhelyabina OV, et al. Assessment of cardiovascular risk in patients with crystal-induced arthritides and rheumatoid arthritis by the ATP III and Reynolds Risk Score. Rheumatology Science and Practice. 2020;58(5):512-9 (in Russian). DOI:10.47360/1995-4484-2020-512-519
16. Gong K, Zhang Z, Sun X, et al. The nonspecific anti-inflammatory therapy with methotrexate for patients with chronic heart failure. Am Heart J. 2006;151(1):62-8. DOI:10.1016/j.ahj.2005.02.040
17. Quan A, Pan Y, Singh KK, et al. Cardiovascular inflammation is reduced with methotrexate in diabetes. Mol Cell Biochem. 2017;432(1-2):159-67. DOI:10.1007/s11010-017-3006-0
18. Ahlers MJ, Lowery BD, Farber-Eger E, et al. Heart Failure Risk Associated With Rheumatoid Arthritis-Related Chronic Inflammation. J Am Heart Assoc. 2020;9(10):e014661. DOI:10.1161/JAHA.119.014661
19. Kirillova IG, Novikova DS, Popkova TV, et al. The course of chronic heart failure in patients with early rheumatoid arthritis on the background of antirheumatic therapy. Almanac of Clinical Medicine. 2019;47(5):400-9 (in Russian). DOI:10.18786/2072-0505-2019-47-056
20. Popkova TV, Novikova DS, Nasonov EL. Cardiovascular diseases in rheumatoid arthritis: latest data. Rheumatology Science and Practice. 2016;54(2):122‑8 (in Russian). DOI:10.14412/1995-4484-2016-122-128
21. Ridker PM, Everett BM, Pradhan A, et al. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med. 2019;380(8):752-62. DOI:10.1056/NEJMoa1809798
22. Meng J, Lu Y, Dong X, Liu H. Long-term effects of hydroxychloroquine on metabolism of serum lipids and left ventricular structure and function in patients of systemic lupus erythematosus. Zhonghua Yi Xue Za Zhi. 2014;94(13):965-8. DOI:10.1136/lupus-2017-000215.261
23. Casula M, Andreis A, Avondo S, et al. Colchicine for cardiovascular medicine: a systematic review and meta-analysis. Future Cardiol. 2022;18(8):647-59. DOI:10.2217/fca-2020-0206
24. Deftereos S, Giannopoulos G, Angelidis C, et al. Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction: A Pilot Study. Circulation. 2015;132(15):1395-403. DOI:10.1161/CIRCULATIONAHA.115.017611
25. Higashikuni Y, Liu W, Numata G, et al. NLRP3 Inflammasome Activation Through Heart-Brain Interaction Initiates Cardiac Inflammation and Hypertrophy During Pressure Overload. Circulation. 2023;147(4):338‑55. DOI:10.1161/CIRCULATIONAHA.122.060860
26. Silvis MJM, Fiolet ATL, Opstal TSJ, et al. Colchicine reduces extracellular vesicle NLRP3 inflammasome protein levels in chronic coronary disease: A LoDoCo2 biomarker substudy. Atherosclerosis. 2021;334:93‑100. DOI:10.1016/j.atherosclerosis.2021.08.005
27. Shen S, Duan J, Hu J, et al. Colchicine alleviates inflammation and improves diastolic dysfunction in heart failure rats with preserved ejection fraction. Eur J Pharmacol. 2022;929:175126. DOI:10.1016/j.ejphar.2022.175126
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*elicmax@yandex.ru
________________________________________________
Maxim S. Eliseev*1, Olga V. Zheliabina1, Irina G. Kirillova1, Yulia O. Korsakova1, Elena V. Cheremushkina1, Evgeny L. Nasonov1,2
1 Nasonova Research Institute of Rheumatology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*elicmax@yandex.ru