Background/Purpose:

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of the joints with several extra-articular features. Cardiovascular disease (CVD) mortality accounts for 40-50% of all deaths in RA. Apart from atherosclerotic heart disease other cardiac abnormalities had been found to be prevalent in RA; including, pericarditis, heart failure, coronary vasculitis and valve disease. Due to scarcity of data regarding cardiac disease in the Middle East population, we studied echocardiographic features in RA patients compared to their age, sex, and traditional CVD risk factors matched controls.

Methods:

In a cross-sectional study, we recruited 39 RA patients meeting the 1987 revised criteria of RA and 37 age, sex and traditional CVD risk factors matched controls. Standard trans-thoracic echocardiography examination was carried out by a specialties cardio-sonographer who was blinded to the status of the participants. Left ventricular dimensions, wall geometry, ejection fraction, diastolic parameters, right ventricular size and function, valve structure and function, pericardium, pulmonary pressures and aortic root dimensions were assessed by echocardiography. t-test and chi-2 test were used to compare the echocardiographic findings between the two groups. P value of <0.05 was considered significant.

Results:

Thirty-nine RA patients (34 F, 4 M) and 37 controls (32 F, 5 M) were studied. Among RA, 27 (69%) were rheumatoid factor positive. The two groups were similar in terms of age (p=0.86), gender (p=0.71), and traditional cardiovascular risk factors (hypertension (p=0.61), diabetes mellitus (P=0.51), hyperlipidemia (p=0.75), history of smoking (p=0.97), and obesity by body mass index definition (p=0.77))

No significant difference was found between RA and the controls in term of left ventricular ejection fraction, wall geometry, diastolic parameters, right ventricular size and function, valves diseases, pulmonary pressures, pericardium and aortic root dimensions. However, left ventricular end-diastolic diameter (43.11 ± 1.14 vs. 39.35 ± 0.84 mm respectively, p=0.01), end-systolic diameter (24.39 ± 0.70 vs. 26.96 ± 0.96 mm, respectively, p=0.03) and Left ventricular mass index (79.83 ± 5.11 vs. 63.64 ± 3.15, respectively, p=0.01) were significantly higher in RA patients than in the controls.

Conclusion:

Patients with rheumatoid arthritis have higher left ventricular end-diastolic and end-systolic dimensions, and greater left ventricular mass index compared to their age, sex and traditional CVD risk factors-matched controls. As the increase in the left ventricular mass index is a predictor of cardiac sudden death, echocardiography might be a simple non-invasive tool for cardiac risk screening in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/echocardiographic-abnormalities-in-rheumatoid-arthritis-patients-compared-to-age-sex-and-traditional-cardiovascular-risk-factors-matched-controls/