Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Myocardial Ischemia in Asymptomatic Patients with Rheumatoid Arthritis: A Comparative Study with Diabetes Mellitus.
Karanasos1, A., Felekos1, I., Aggeli1, C., Zampeli1, E., Protogerou1, A., Stefanadis1, C., Kitas2, G.
Athens University, Medical School, Athens, Greece
The Dudley Group of Hospitals NHS Foundation Trust, Dudley, and Arthritis Research Campaign Epidemiology Unit, University of Manchester, UK, Manchester, United Kingdom
Rheumatoid arthritis (RA) is associated with increased ischemic events. The possible presence of myocardial ischemia, by dobutamine stress-contrast echocardiography was studied in asymptomatic patients and compared to patients with diabetes mellitus and a control group.
We prospectively enrolled 18 (12 women) consecutive non-diabetic RA patients with no evidence of coronary artery disease (68±7 years old with disease duration of 11±7 years, 50% smokers, 72% hypertensives, 33 % dyslipidemics) who developed new carotid plaques during the past 3 years. All underwent stress contrast echocardiography using the 17-segment model of the left ventricle for wall-motion and perfusion evaluation; consented patients with a positive stress test underwent coronary angiography. RA patients were compared to 18 asymptomatic patients with diabetes mellitus (matched 1:1 for traditional cardiovascular risk factors), as well with 36(matched 1:2) asymptomatic 'healthy' individuals.
A positive stress result was found in 12 RA patients (67%), 14 diabetics (78%) and 11 controls (31%; p<0.05 for RA vs. control, p<0.01 for diabetes vs control group, p=NS for RA vs diabetes). Median number of myocardial segments with perfusion defect was 1 (interquartile range [IQR] 2) in RA, 2 (IQR 3) in diabetes and 0 (IQR 1.5) in controls (p<0.05 for RA vs. control, p<0.01 for diabetes vs control, p=NS for RA vs diabetes). Median wall motion score index was 1.05 (IQR 0.1) in RA, 1.1 (IQR 0.05) in diabetes and 1 (IQR 0.075) in the control group (p<0.05 for RA vs. control, p<0.01 for diabetes vs control, p=NS for RA vs DM). Among subjects with positive stress results either the number of segments with perfusion defect (median of 2) or wall motion score index (median of 1.1) was similar between RA, diabetes and controls. Of the 12 RA patients with positive stress result, coronary angiography performed in 8 revealed normal findings in 4, non significant coronary atheromatic lesions in 2 and lesions requiring angioplasty in 2 patients.
Asymptomatic patients with RA displayed high myocardial ischemic burden which was comparable to diabetes mellitus. In the absence of obstructive coronary artery disease myocardial ischemia, potentially caused by microvascular coronary dysfunction, was common in these patients.
To cite this abstract, please use the following information:
Karanasos, A., Felekos, I., Aggeli, C., Zampeli, E., Protogerou, A., Stefanadis, C., et al; Myocardial Ischemia in Asymptomatic Patients with Rheumatoid Arthritis: A Comparative Study with Diabetes Mellitus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1163