Cardiac manifestations of rheumatoid arthritis: A case–control transesophageal echocardiography study in 30 patients

Abstract

Objectives. Current knowledge of the cardiac manifestations of rheumatoid arthritis (RA) stems only from clinical and transthoracic echocardiography (TTE) studies. To determine the incidence and type of heart lesions in RA, we coupled TTE with transesophageal echocardiography (TEE), which is more sensitive and more accurate. Methods. Thirty unselected RA patients (26 women and 4 men aged 27 to 84 years, with a mean age of 57.8 ؎ 15.1 years) free of known progressive heart disease underwent a chest radiograph, an electrocardiogram, laboratory tests, and TTE coupled with TEE. Results were compared with those in age-and sex-matched patients who were free of rheumatic disease and who underwent TEE to investigate a neurologic or cardiologic disorder. Results. Mitral regurgitation (MR) was evidenced in 24 cases (80%). Among the controls, only 11 (37%) had MR (P < 0.001). Aortic regurgitation was found in 10 cases (33%), versus 7 controls (not significant-NS). Seven cases (23%) versus only 2 controls (7%) had tricuspid valve abnormalities (NS). Pericarditis was found in 4 cases (13%) and in none of the controls. Eleven cases had evidence of cardiomyopathy (37%) and 12 (40%) had atheroma of the aorta, this last being missed by TTE in 10 patients. Echo-generating nodules were seen on a mitral valve in 2 cases and on an aortic valve in 1. We found no correlations linking cardiac lesions to clinical or laboratory features of RA. Conclusion. Our study demonstrated that cardiac involvement, particularly of the mitral valve, is extremely common in RA patients.

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

“…Additionally, RA-related parameters (patient's disability, pain, severity of RA, RF positivity) were associated with prevalent HF [16,45]. Disease activity is also considered to be an independent risk factor of HF as well as systemic inflammation (ESR, CRP) or duration of RA [46,47]. Besides several RA characteristics, the use of GC was also associated with HF after adjustment for CV risk factors and CHD.…”

“…RA is known to cause rheumatoid nodules leading to valvular disease, particularly regurgitation. The most commonly reported valvular diseases include aortic stenosis and regurgitation, mitral regurgitation, tricuspidal regurgitation, or combined valvular lesions [47,51].…”

“…In the study of Bhatia et al, the prevalence of systolic dysfunction was three times more common as compared to general population [57]. In some studies, HF in RA has been associated with concentric LV hypertrophy and reduced longitudinal strain [46,47].…”

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“…Both necropsy [46] and cross-sectional echocardiographic studies [47] of RA hearts have identified an increased prevalence of granulomatous and non-granulomatous valvular abnormalities, particularly of the mitral valve, and an increased prevalence of mitral regurgitation in RA patients compared to matched non-RA controls. No longitudinal echocardiographic studies have been performed, however, to determine the impact of this finding on the subsequent risk for developing CHF in affected RA patients.…”

A large chronic pericardial effusion in an ultramarathon runner with anti-CCP positive rheumatoid arthritis

“…Pericardial effusions are a common extra-articular feature of RA and 13% of patients with RA will have evidence of asymptomatic pericardial involvement on transoesophageal echocardiogram 2. However, pericardial effusions of the volume reported here are rare 3.…”