Echocardiographic findings and 24-h electrocardiographic Holter monitoring in patients with nodular and non-nodular rheumatoid arthritis

Abstract

Echocardiographic examination and 24-h electrocardiographic Holter monitoring were carried out on 35 patients with nodular rheumatoid arthritis (RA) and 35 with non-nodular RA, who were matched with the nodular RA group regarding age, sex and BSA. A further 35 patients with osteoarthrosis and spondyloarthrosis matched, with both RA groups, constituted a control group. Patients with a history of myocardial infarction, hypertension, rheumatic fever and diabetes were excluded from the study. Cardiac involvement, evaluated using echo-Doppler cardiography, 24-h electrocardiographic Holter monitoring and ECG at rest, occurred in 25 (71.9%) patients with nodular RA and in 15 (42.9%) with non-nodular RA in comparison to 8 (22.9%) control group patients (P < 0.0002). Holter electrocardiographic monitoring over 24 h did not present any essential differences in frequency of rhythm disorders between the examined groups and the control group. However, it revealed more patients with 1-mm ST depression in the nodular RA group than in the non-nodular and control groups. Echocardiographic examination revealed more cases of valvular heart abnormalities, especially those of mitral insufficiency, in nodular RA patients than in non-nodular and control patients. Both a mitral valve prolapse and a pericardial effusion were noted in 8.6% of nodular RA patients. Patients with nodular RA were noted to have a bigger aortic root diameter, but smaller ejection fraction, mean velocity of circumferential fibre shortening and fractional shortening in comparison to non-nodular and to control group patients.

The risk of congestive heart failure in rheumatoid arthritis: A population‐based study over 46 years

“…However, other hypotheses should also be considered. A higher prevalence of unrecognized or subclinical ischemic heart disease and/or CV risk factors (44) could, at least partly, contribute to our findings. We extensively accounted for silent MI, the incidence of which we recently reported to be increased in patients with RA (37), angina, and revascularization.…”

A 73‐year‐old woman with rheumatoid arthritis and shortness of breath

“…Large QT dispersion, an indication of heterogeneity in ventricular repolarization, is a marker of cardiovascular morbidity and mortality related to complex ventricular arrhythmias (44). However, Holter monitoring in 2 studies did not reveal increased difference in arrhythmias between RA patients and matched controls (46, 47).…”

Cardiorheumatology: cardiac involvement in systemic rheumatic disease

“…Rheumatoid nodules are also thought to predispose patients to cardiac involvement 77. In a study to compare patients with non-nodular RA or nodular RA with control individuals, patients with nodular RA had not only larger aortic root diameter and lower ejection fraction, but also had <1 mm ST-segment depression on 24 h Holter monitoring, when compared with individuals in the control group 77…”