Echocardiographic and Doppler findings in long-term treated rheumatoid arthritis patients without clinically evident cardiovascular disease.
OBJECTIVE
To assess the frequency of echocardiographic and Doppler abnormalities in long-term treated rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations.


METHODS
Forty-seven patients with RA were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients were required to have been treated for at least 5 years and to be on treatment with 1 or more disease-modifying antirheumatic drugs. Patients seen during the period of recruitment who had cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Forty-seven healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. Patients were HLA-DRB1 genotyped by using molecular-based methods.


RESULTS
In patients with RA, the prevalence of aortic regurgitation (17%) and tricuspid regurgitation (17%) was not higher than that seen in controls (15% and 6%). The pulmonary artery systolic pressure was higher in patients with RA (30.3 +/- 8.0 mm Hg) than in controls (26.2 +/- 4.8) (P =.004). Incidence of pulmonary artery systolic pressure >35 mm Hg was significantly higher in patients with RA (21% versus 4% in controls; P =.03). Diastolic dysfunction caused by impaired relaxation was also more common in patients with RA (66%) than in controls (43%) (P =.02). It was more frequent in the older patients. Extra-articular manifestations were more common in patients with RA with diastolic dysfunction (P =.05). The HLA-DRB1 genotype was not implicated in the risk of developing diastolic dysfunction.


CONCLUSIONS
The present study confirms a high frequency of left ventricular diastolic dysfunction and pulmonary hypertension in patients with RA without evident cardiovascular disease.
Division of Cardiology, Hospital Xeral-Calde, Lugo, Spain.
Carlos
C
Gonzalez-Juanatey
Ana
A
Testa
Alberto
A
Garcia-Castelo
Carlos
C
Garcia-Porrua
Javier
J
Llorca
William E R
WE
Ollier
Miguel A
MA
Gonzalez-Gay
D000368:Aged; D000483:Alleles; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000235:genetics; D016022:Case-Control Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains