title: Myocardial ischaemia without obstructive coronary artery disease in rheumatoid arthritis: hypothesis-generating insights from a cross-sectional study.
abstract: OBJECTIVE
  RA is associated with increased cardiovascular events, reportedly to equal diabetes mellitus (DM). The presence of myocardial ischaemia was assessed in asymptomatic high-risk RA patients and compared with patients with DM and a healthy control group.
  
  
  METHODS
  Eighteen consecutive non-diabetic RA patients without known cardiovascular disease who developed a new carotid atheromatic plaque during the last 3 years were matched 1:1 for traditional cardiovascular risk factors with asymptomatic type 2 DM patients and 1:2 with asymptomatic non-RA, non-DM control subjects. After dobutamine stress contrast echocardiography with wall-motion and perfusion evaluation, coronary angiography was performed in those with positive stress tests.
  
  
  RESULTS
  Ischaemia by echocardiography was found in 67% of RA patients; this was significantly higher than controls (31%, P = 0.019) but comparable to those with DM (78%, P = 0.71). Angiography performed in eight consenting RA patients was normal in four, revealed non-flow-limiting coronary atheromatic lesions in two and significant lesions in two patients. RA patients with ischaemia had CRP serum levels significantly higher by six-fold compared with those with normal stress echocardiography.
  
  
  CONCLUSIONS
  Asymptomatic RA patients may display myocardial ischaemia at similar levels to DM patients but with low prevalence of obstructive coronary artery disease. Microvascular abnormalities associated with increased inflammatory response may account for these findings. Their exact nature and significance require further evaluation.
authors.affiliation: 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece. ktoutouz@gmail.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.forename: Petros P
authors.initials: PP
authors.lastname: Sfikakis
authors.forename: Antonios
authors.initials: A
authors.lastname: Karanasos
authors.forename: Constantina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Ioannis
authors.initials: I
authors.lastname: Felekos
authors.forename: George
authors.initials: G
authors.lastname: Kitas
authors.forename: Evi
authors.initials: E
authors.lastname: Zampeli
authors.forename: Athanase
authors.initials: A
authors.lastname: Protogerou
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors