Cardiovascular Mortality in Patients with Rheumatoid Arthritis

Mutru, O.; Laakso, Markku; Isomäki, H; Koota, K

doi:10.1159/000174474

Cited by 117 publications

(73 citation statements)

References 16 publications

(20 reference statements)

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“…7,[11][12][13]17,18 Secondly, CMR also plays a primary role in the exclusion of differential diagnoses. Although rare, myocarditis is one of the recognized cardiovascular sequelae of RA 27 and is clearly visualized on CMR as a hyperintense area or areas on T2-weighted MRI sequences, not seen in this case. Restrictive cardiomyopathy in particular cardiac amyloidosis was an important differential diagnosis in our case due to both the past history and echocardiographic findings; however, CMR did not show the typical imaging features suggestive of cardiac amyloid deposition.…”

Section: Discussionmentioning

confidence: 69%

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

138

126

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Cardiotoxicity is a rare but serious complication of hydroxychloroquine, a 4-aminoquinoline increasingly used in the treatment of rheumatological disorders. We describe typical clinical, echocardiographic, and histological features of this rare condition according to the currently available literature, illustrated with a recent new biopsy-proven case of hydroxychloroquine cardiotoxicity in a 52-year-old female with rheumatoid arthritis. Presentation in this case was of a rapidly progressive decompensated biventricular cardiomyopathy associated with recurrent biomarker elevations, conduction system disease, and possibly neuromyotoxicity. Death occurred suddenly 2 months after diagnosis despite drug discontinuation and clinical improvement. The potential role of cardiac magnetic resonance delayed gadolinium enhancement imaging in the prognosis of this toxic cardiomyopathy is also introduced. This case-based literature review highlights that, although rare, hydroxychloroquine cardiotoxicity can be fatal, particularly if irreversible histopathological changes have occurred prior to drug discontinuation. Given this, regular screening with 12-lead electrocardiography and transthoracic echocardiography to detect conduction system disease and/or biventricular morphological or functional changes should be considered in hydroxychloroquine-treated patients in addition to recommended ophthalmological screening.

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Section: Discussionmentioning

confidence: 69%

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

138

126

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“…Patients with RA have a shortened life span and cardiovascular diseases caused by accelerated atherosclerosis (2) are the most common cause of mortality in these patients (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Osteopontin Is Associated with Increased Arterial Stiffness in Rheumatoid Arthritis

Bazzichi

Ghiadoni

Rossi

et al. 2009

Mol Med

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Rheumatoid arthritis (RA) patients are characterized by increased arterial stiffness, an independent predictor of cardiovascular risk. It has been suggested that osteopontin (OPN), a cytokine involved in RA pathogenesis, might have vascular effects. To study a possible relationship between OPN and arterial stiffness, aortic pulse wave velocity (PWV) was measured by tonometry in 69 patients (41 with RA, 28 with systemic sclerosis [SSc]) and 18 healthy controls. Plasma OPN levels, oxidative stress markers, and endothelin 1 (ET-1) were assessed. OPN levels were significantly (P < 0.05) higher in RA (median 9.93, range 4.36-47.80 ng/mL) than in SSc (4.3, 2.1-19.7 ng/mL) or controls (5.2, 4.1-9.4 ng/mL). In RA patients, log-OPN was related to log-C-reactive protein (log-CRP) (r = 0.30, P < 0.05), age (r = 0.38, P < 0.01), Health Assessment Questionnaire (HAQ) (r = 0.58, P < 0.0001), and inversely related to total cholesterol (r = -0.33, P < 0.05) and apolipoprotein A (apoA) (r = -0.58, P < 0.001), but not to oxidative stress markers and ET-1. PWV was similar in RA (median 8.1, range 4.7-16.4 m/s) and SSc (median 8.7, range 7.1-13.1 m/s), but significantly greater (P < 0.01) than controls (median 7.5, range 4.1-10.4 m/s). Aortic PWV was related to log-OPN (r = 0.40, P < 0.01) only in RA patients. It also was related to age (r = 0.34, P < 0.05), mean blood pressure (r = 0.44, P < 0.001), and HAQ (r = 0.48, P < 0.001). In multiple regression analysis (r 2 = 0.36), including confounders, log-OPN remained a significant predictor (P < 0.05) of PWV in RA. Elevated plasma OPN levels are associated with increased arterial stiffness in RA patients, suggesting that this protein might represent a bridge protein between inflammation and the consequent joint damage and cardiovascular risk in RA patients.

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“…The excess of cardiovascular mortality in these patients has been found to be related to congestive heart failure in particular and not to coronary heart disease or hypertension [5,7,8]. Therefore, it is likely that the rheumatoid patient could have an unrecognized involvement of the heart with consequent progressive changes in left ventricle structure.…”

Section: Introductionmentioning

confidence: 99%

Echo‐Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease

Corrao

Sallì

Arnone

et al. 1996

Eur J Clin Investigation

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Abstract. Our investigation aimed at verifying diastolic abnormalities in rheumatoid patients, without clinically evident cardiovascular disease and other confounding complaints, by using pulsed Doppler examination of transmitral blood flow. We selected 40 patients fulfilling revised American Rheumatism Association (ARA) criteria for the diagnosis of rheumatoid arthritis having no symptoms of cardiac disease or clinical findings of other extracardiac diseases. We also studied 40 rheumatoidmatched healthy volunteers as a control group. An echocardiographic examination was carried out on each subject. Left ventricular structural and functional measurements were obtained. Interventricular septal thickness and left ventricular mass index were significantly higher in rheumatoid patients than in the control group. We also found in rheumatoid patients higher mean values of peak A velocity and A/E ratio. When multiple linear regression analysis was performed on the data of rheumatoid patients we found an independent relationship only between A/E ratio and left ventricular mass. In conclusion, our results confirm diastolic abnormalities in rheumatoid patients and point out that these abnormalities also affect echo-Doppler parameters of left ventricular filling. Moreover, further analysis of our data may suggest the possibility that structural left ventricle changes could be responsible for left ventricular filling impairment.

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Cardiovascular Mortality in Patients with Rheumatoid Arthritis

Cited by 117 publications

References 16 publications

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Osteopontin Is Associated with Increased Arterial Stiffness in Rheumatoid Arthritis

Echo‐Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease

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