Exercise echocardiography in rheumatoid arthritis: a case-control study.
BACKGROUND
Rheumatoid arthritis (RA) is associated with increased cardiovascular risk.


METHODS
To assess the role of exercise echocardiography (EE) in the evaluation of patients with RA, follow-up (mean, 6.7+/-3.7 years) was retrospectively obtained in 159 patients with RA who underwent EE. Patients were matched for age, gender, and cardiovascular risk factors with 454 controls who underwent EE.


RESULTS
Patients with RA were more likely to have positive results for ischemia on EE (odds ratio, 2.32; 95% confidence interval, 1.48-3.64; P=.0003). Rest and exercise wall motion score indexes were higher in the RA group (1.14+/-0.33 and 1.22+/-0.39, respectively, vs 1.06+/-0.18 and 1.10+/-0.24 in controls; P < .005 for each). Logistic regression adjusted for age revealed an increased odds ratio for myocardial ischemia of 1.06 (95% confidence interval, 1.02-1.11; P=.005) per year of RA. Five-year all-cause mortality in subjects with RA with myocardial ischemia on EE was 14.9%, compared with 4.3% in RA subjects without ischemia (P=.028).


CONCLUSIONS
RA was associated with a 2-fold increased risk for myocardial ischemia on EE; risk increased with the duration of RA. Mortality was increased in patients with RA with ischemia on EE.
Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Mohammed K
MK
Saghir
Christine
C
Attenhofer Jost
Kenneth J
KJ
Warrington
Stephen S
SS
Cha
Patricia A
PA
Pellikka
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D016022:Case-Control Studies; D017023:Coronary Angiography; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric