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Slide 1: Title Slide
Content:
• Title: Rheumatoid Heart Failure: An In-Depth Exploration
• Subtitle: Cardiovascular Complications in Rheumatoid Arthritis
• Tagline: “Exploring the Intersection of Rheumatoid Arthritis and Cardiovascular
Health”
• Your Name/Date: (Add your name and the date of the presentation)
• Optional: Institution/Organization Logo
Slide 2: Introduction
Content:
• Definition: Rheumatoid Heart Failure (RHF) is heart failure arising as a
cardiovascular complication of rheumatoid arthritis (RA).
• Key Point: RHF most often manifests as heart failure with preserved ejection
fraction (HFpEF), where the heart’s ability to relax and fill with blood is impaired.
• Statistic: “RHF accounts for ~30% of cardiovascular complications in RA patients.”
• Callout Box: “Why is RHF underdiagnosed?”
– Often masked by RA symptoms.
– Lack of routine cardiac screening in RA patients.
Slide 3: Epidemiology
Content:
• Prevalence: 20–30% of RA patients develop HF over their lifetime.
• Demographics:
– Higher incidence in women (female-to-male ratio ∼2:1).
– Age of onset peaks in the 50s–60s.
• Risk Factors:
– Seropositivity (HR 2.1).
– Longer RA duration (>10 years).
– High disease activity (DAS28 >5.1).
• Mortality:
– RA patients with HF face a 1.5–2-fold higher mortality risk.
– Cardiovascular events account for ∼40% of RA deaths.
• Callout Box: “Why are women more affected?”
– Higher prevalence of RA in women.
– Hormonal and immune system differences.
Slide 4: Pathophysiology
Content:
• Chronic Inflammation:
– Cytokines (IL-6, TNF-α, IL-1β) overactivate fibroblasts, leading to fibrosis.
– Oxidative stress damages cardiomyocytes and endothelial cells.
– Endothelial dysfunction promotes microvascular injury.
• Autoimmune Mechanisms:
– Autoantibodies (RF, ACPA) may cross-react with cardiac antigens.
– T-cell dysregulation (Th17 subset) amplifies tissue injury.
• Structural Changes:
– Myocardial fibrosis stiffens the left ventricle.
– Microvascular dysfunction reduces myocardial perfusion.
– Pericardial involvement (30–40% of RA patients).
• Callout Box: “How does IL-6 drive fibrosis?”
– IL-6 overactivation leads to collagen deposition and myocardial stiffness.
Slide 5: Clinical Presentation
Content:
• Early Stage:
– Dyspnea on exertion (∼80%).
– Fatigue (∼90%).
– Peripheral edema (∼60%).
• Advanced Stage:
– Orthopnea (∼30%).
– Paroxysmal nocturnal dyspnea (∼20%).
– Chest pain (∼15–20%).
– Palpitations (∼25%).
• Physical Signs:
– Elevated jugular venous pressure (>8 cm H2O).
– Lung crackles (rales in 40%).
– S3 gallop (10% in decompensated cases).
• Callout Box: “Why is early diagnosis critical?”
– Delayed diagnosis leads to worse outcomes.
– Early intervention improves survival.
Slide 6: Diagnosis
Content:
• Imaging:
– Echocardiography (gold standard): Shows diastolic dysfunction (E/e’ >14).
– Cardiac MRI: Detects fibrosis and pericardial effusion.
– PET-CT/MRI: Maps myocardial inflammation.
• Biomarkers:
– BNP/NT-proBNP: >100 pg/mL signals HF.
– CRP: >10 mg/L reflects inflammation severity.
– Troponin I/T: >0.03 ng/mL suggests myocyte injury.
• ECG:
– Nonspecific findings (Q waves, AF, left ventricular hypertrophy).
• Callout Box: “Why is BNP a key biomarker?”
– BNP rises with HF and RA flares, making it a reliable indicator.
Slide 7: Treatment
Content:
• RA-Specific Therapies:
– Methotrexate: Reduces HF risk by 20–28%.
– TNF inhibitors: Improve endothelial function.
– IL-6 inhibitors: Ease diastolic stiffness.
– JAK inhibitors: Emerging data on CV safety.
• HF Management:
– SGLT2 inhibitors: Cut HF hospitalization by 25%.
– Diuretics: Relieve edema.
– Beta-blockers: Curb atrial fibrillation.
– ACE inhibitors/ARBs: Modest HFpEF effect.
• Lifestyle:
– Smoking cessation.
– Weight loss (BMI <30).
– Supervised exercise.
• Callout Box: “Why are SGLT2 inhibitors groundbreaking?”
– They improve outcomes in both HFpEF and HFrEF.
Slide 8: Prognosis
Content:
• Survival:
– 5-year rate: ~60–70%.
– 10-year rate: ~40–50%.
• Morbidity:
– 1-year HF readmission: ~25–35%.
• Predictors:
– High DAS28 (>5.1).
– Late RA control.
– Delayed HF therapy.
• Callout Box: “What predicts poor outcomes?”
– High CRP (>20 mg/L).
– Reduced EF (<40%).
Slide 9: Emerging Directions
Content:
• Therapeutics:
– IL-6 blockade (NCT04585711).
– JAK inhibitors under study.
• Diagnostics:
– AI algorithms (92% accuracy).
– Speckle-tracking detects strain shifts.
• Imaging:
– PET-CMR with 18F-FDG (95% precision).
– Technetium scans rule out cardiac amyloidosis.
• Biomarkers:
– Galectin-3 (>17 ng/mL).
– ST2 (>35 ng/mL).
• Callout Box: “How can AI revolutionize diagnosis?”
– AI can detect early RHF years before symptoms appear.
Slide 10: Prevention
Content:
• Screening:
– Annual echocardiography (target E/e’ <14).
– BNP (<100 pg/mL).
– CRP (<10 mg/L).
• RA Control:
– DMARDs within 3 months of RA onset.
• Risk Mitigation:
– Statins (e.g., Atorvastatin 20 mg).
– BP <130/80 mmHg.
– HbA1c <7%.
• Callout Box: “Why is early RA control critical?”
– Early DMARD use cuts HF risk by 30%.
Slide 11: Key Points
Content:
• RHF is HF in RA, predominantly HFpEF.
• Driven by inflammation, fibrosis, and microvascular damage.
• Early intervention and emerging tools offer hope for better outcomes.
• Quote: “Early intervention saves lives.”
Slide 12: References
Content:
• Trials: DELIVER, TOPCAT, NCT04585711.
• Journals: Arthritis & Rheumatology, JACC, Ann Rheum Dis.
• Reviews: Nature Reviews Rheumatology.
• QR Code: Link to the full PDF or additional resources.
• Callout Box: “Where can I learn more?”
– Visit Nature Reviews Rheumatology.
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