Abstract 18224: Rheumatoid Arthritis is Associated with High Ischemic Burden, Comparable to Diabetes Mellitus, but in the Absence of Obstructive Coronary Disease
Purpose: Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity, similar to diabetes mellitus (DM). The presence of myocardial ischemia and obstructive coronary artery disease was assessed in asymptomatic high-risk RA patients and compared to DM patients and a control group.
Methods: Eighteen consecutive asymptomatic RA patients without a history of cardiovascular disease that developed a new carotid plaque in follow-up exam underwent dobutamine stress contrast echocardiography with wall motion and perfusion evaluation. Coronary angiography was performed in patients with positive stress tests. The patients were matched 1:1 for age, gender and risk factors with asymptomatic DM type 2 patients and 1:2 with asymptomatic control subjects. DM and control subjects were selected from a database of asymptomatic patients undergoing dobutamine stress contrast echocardiography for risk factor evaluation.
Results: Ischemia by dobutamine stress contrast echocardiography was detected in 67% of RA patients, in whom C-reactive protein levels were higher compared to those with normal findings; incidence of positive stress test in RA was higher than controls (31%, p<0.05) but comparable to DM (78%). Mean wall motion score index (WMSI) in the RA cohort was 1.08±0.06 vs. 1.10±0.07 in DM vs. 1.04±0.08 in the control group (p<0.05 for RA vs. control, p=NS for RA vs. DM, p<0.01 for DM vs. control). Among subjects with positive stress results, WMSI was similar among the study cohorts. The median number of segments with perfusion defect was 2 (interquartile range [IQR] 2) in the RA cohort vs. 2 (IQR 3) in the group of patients with DM, and 0 (IQR 2) in the control group (p<0.05 for RA vs. control, p=NS for RA vs. DM, p<0.01 for DM vs. control). Among subjects with positive stress test the number of segments with perfusion defect was similar among the study cohorts. 25% in the RA group had obstructive disease vs. 50% in the DM group and 73% in the control group. RA was associated with a reduction in the risk for significant lesions compared to the other cohorts (OR: 0.125, 95% CI: 0.016-0.999).
Conclusion: RA patients may display myocardial ischemia at similar levels to DM and higher than matched control subjects, but in the absence of obstructive coronary artery disease.
- © 2012 by American Heart Association, Inc.