Objective. The aim of the study was to describe echocardiographic abnormalities in patients with rheumatoid arthritis, concurrent systemic comorbidities, rheumatologic clinical activity, serologic markers of rheumatoid arthritis, and inflammatory activity. Methods. In an observational, cross-sectional study, rheumatoid arthritis outpatients were included ( ). Conventional transthoracic echocardiographic variables were compared between patients with arthritis and non-RA controls ( ). For rheumatoid arthritis patients, articular activity and rheumatologic and inflammatory markers were obtained. Results. Ventricular dysfunction was found in 54.3% of the population: systolic (18.1%), diastolic (32.4%), and/or right (24.8%), with lower ejection fraction ( ). Pulmonary hypertension was found in 46.9%. Other echocardiographic findings included increased left atrial diameter ( ), aortic diameter ( ), ventricular septum ( ), left ventricular posterior wall ( ), and right ventricular ( ) and atrial diameters compared to control subjects. Rheumatoid factor and anti-CCP antibodies levels were significantly elevated in cases with ventricular dysfunction. Angina and myocardial infarction, diabetes, and dyslipidemia were the main risk factors for ventricular dysfunction. Conclusions. Ventricular dysfunction is common in rheumatoid arthritis and associated with longer disease duration and increased serologic markers of rheumatoid arthritis. Screening for cardiac abnormalities should be considered in this kind of patients. 1. Background Rheumatoid arthritis (RA) is a chronic inflammatory disease [1–4], and even though its major characteristic is polyarticular affection it is associated with such extra-articular features as vasculitis, keratoconjunctivitis sicca, bronchiolitis obliterans, organizing pneumonia, portal fibrosis, secondary amyloid, and cryoglobulinemia [5]. It has also been associated with increased cardiovascular risk due to conduction and valve alterations, heart failure, and premature atherosclerosis [6–8]. Multiple studies have shown that accelerated and increased atherosclerosis in autoimmune diseases leads to ischemic coronary artery disease. The proposed mechanisms for this are a major systemic inflammatory state involving T cell lymphocytes, tumor necrosis factor alpha (TNF alpha), high density lipoprotein dysfunction, and treatment related hyperhomocysteinemia. All of these factors lead to thickening of arterial intima, myocardial dysfunction, and in some cases myocardial infarction and are responsible for up to 50% of deaths in this population
References
[1]
E. García Melchor and a. Olivé Marqués, “Artritis Reumatoide: formas de presentación, diagnóstico y tratamiento actual,” FMC, vol. 14, no. 3, pp. 126–132, 2007.
[2]
J. O. Belzunegui, “Artritis reumatoide (II) Manifestaciones clínicas,” Medicine, vol. 9, no. 28, pp. 1815–1821, 2005.
[3]
Z. Tutuncu and A. Kavanaugh, “Rheumatic disease in the elderly: rheumatoid arthritis,” Rheumatic Disease Clinics of North America, vol. 33, no. 1, pp. 57–70, 2007.
[4]
T. A. Pearson, “Heightened risk of cardiovascular disease in patients with rheumatoid arthritis,” The American Journal of Medicine, vol. 121, no. 10, supplement 1, pp. S1–S2, 2008.
[5]
J. K. Dawson, N. G. Goodson, D. R. Graham, and M. P. Lynch, “Raised pulmonary artery pressures measured with Doppler echocardiography in rheumatoid arthritis patients,” Rheumatology, vol. 39, no. 12, pp. 1320–1325, 2000.
[6]
F. Wolfe and K. Michaud, “Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy,” American Journal of Medicine, vol. 116, no. 5, pp. 305–311, 2004.
[7]
I. Del Rincón, K. Williams, M. P. Stern, G. L. Freeman, D. H. O'Leary, and A. Escalantel, “Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects,” Arthritis and Rheumatism, vol. 48, no. 7, pp. 1833–1840, 2003.
[8]
A. E. Voskuyl, “The heart and cardiovascular manifestations in rheumatoid arthritis,” Rheumatology, vol. 45, no. 4, pp. iv4–iv7, 2006.
[9]
E. Ingelsson, J. ？rnl？v, J. Sundstr？m, and L. Lind, “Inflammation, as measured by the erythrocyte sedimentation rate, is an independent predictor for the development of heart failure,” Journal of the American College of Cardiology, vol. 45, no. 11, pp. 1802–1806, 2005.
[10]
J. M. Davis III, V. L. Roger, C. S. Crowson, H. M. Kremers, T. M. Therneau, and S. E. Gabriel, “The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population,” Arthritis and Rheumatism, vol. 58, no. 9, pp. 2603–2611, 2008.
[11]
S. Setoguchi, S. Schneeweiss, J. Avorn et al., “Tumor necrosis factor-α antagonist use and heart failure in elderly patients with rheumatoid arthritis,” American Heart Journal, vol. 156, no. 2, pp. 336–341, 2008.
[12]
T. J. Wang, D. Levy, E. J. Benjamin, and R. S. Vasan, “The epidemiology of “asymptomatic” left ventricular systolic dysfunction: implications for screening,” Annals of Internal Medicine, vol. 138, no. 11, pp. 907–I51, 2003.
[13]
J. T. Giles, A. A. Malayeri, V. Fernandes et al., “Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging,” Arthritis and Rheumatism, vol. 62, no. 4, pp. 940–951, 2010.
[14]
P. Libby, “Role of inflammation in atherosclerosis associated with rheumatoid arthritis,” American Journal of Medicine, vol. 121, no. 10, pp. S21–S31, 2008.
[15]
M. C. M. Wasko and S. Manzi, “Inflammation-mediated rheumatic diseases and atherosclerosis,” Annals of the Rheumatic Diseases, vol. 59, no. 5, pp. 321–325, 2000.
[16]
E. Vizzardi and I. Cavazzana, “Echocardiographic evaluation of asymptomatic patients'affected by rheumatoid arthritis,” Journal of Investigative Medicine, vol. 60, no. 8, pp. 1204–1208, 2012.
[17]
M. Wislowska, B. Jaszczyk, M. Kochmański, S. Sypu？a, and M. Sztechman, “Diastolic heart function in RA patients,” Rheumatology International, vol. 28, no. 6, pp. 513–519, 2008.
[18]
T. A. Pearson, “Heightened risk of cardiovascular disease in patients with rheumatoid arthritis, heightened risk of cardiovascular disease in patients with rheumatoid arthritis. Introduction,” The American Journal of Medicine, vol. 121, no. 10, pp. S1–S8, 2008.
[19]
A. Orea-Tejeda, O. Arrieta-Rodríguez, L. Castillo-Martínez et al., “Effects of thalidomide treatment in heart failure patients,” Cardiology, vol. 108, no. 4, pp. 237–242, 2007.
[20]
S. R. J. Maxwell, R. J. Moots, and M. J. Kendall, “Corticosteroids: do they damage the cardiovascular system?” Postgraduate Medical Journal, vol. 70, no. 830, pp. 863–870, 1994.
