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Eddarami J, Azzouzi H, Ichchou L. Heart Involvement in a Moroccan Population with Spondyloarthritis: A Cross-sectional Study. J Saudi Heart Assoc 2021; 33:191-197. [PMID: 34307015 PMCID: PMC8294134 DOI: 10.37616/2212-5043.1258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the prevalence of cardiac manifestations and their predictive factors in Moroccan patients with spondyloarthritis (SpA). METHODS We have conducted a cross-sectional study over four months at the Department of Rheumatology in Mohammed VI University Hospital of Oujda, Morocco. All SpA patients fulfilled the 2009 Assessment SpondyloArthritis international Society (ASAS) criteria. Every patient had a cardiac check up including clinical examination, 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE). Multiple logistic regression was used to analyze the associated factors with cardiac manifestations. RESULTS We included 64 men and 30 women with a mean age of 37.32 ± 12.65 years old. The mean disease duration was 10.60 ± 7.61 years. Patients had a mean Ankylosing Spondylitis Disease Activity Score (ASDAS) CRP of 2.25 ± 1.38, a mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 2.88 ± 2.26 and a mean Bath Ankylosing Spondylitis Functional Index (BASFI) of 33.52 ± 30.49. Traditional cardiovascular risk factors (CVRF) included dyslipidemia in 14.9%, hypertension in 9.6% and type 2 diabetes in 7.4% of the cases. Eight patients (8.5%) smoked and 3 patients (3.2%) used alcohol whereas 20 patients (21.3%) had a history of smoking and 5 patients (6.3%) a history of alcohol. Cardiac manifestations were found in 12 patients (13.3%): 3.3% had aortic regurgitation (AR), 1.1% had aortic dilatation, 1.1% had aortic valve thickening (AVT), 2.2% had mitral thickening, 1.1% had mitral regurgitation (MR), 1.1% had mitral stenosis (MS), 3.3 had pericarditis and 2.2% had complete right bundle branch block (RBBB). In multivariate analysis, cardiac involvement was significantly associated with extra-articular manifestations (OR = 6.05; 95% CI: 1.197-30.607, p = 0.029). CONCLUSION Based on these results, cardiac involvement was common and associated with the severity of the disease; hence, early detection of cardiac abnormalities and targeted treatment strategies of SpA and comorbidities are necessary to control the systemic inflammation and improve the excess of cardiovascular mortality in this group of patients.
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Affiliation(s)
- Jalila Eddarami
- Department of Rheumatology, Mohamed VI University Hospital, Oujda,
Morocco
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda,
Morocco
| | - Hamida Azzouzi
- Department of Rheumatology, Mohamed VI University Hospital, Oujda,
Morocco
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda,
Morocco
| | - Linda Ichchou
- Department of Rheumatology, Mohamed VI University Hospital, Oujda,
Morocco
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda,
Morocco
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Tański W, Gać P, Chachaj A, Sobieszczańska M, Poręba R, Szuba A. Selected clinical parameters and changes in cardiac morphology and function assessed by magnetic resonance imaging in patients with rheumatoid arthritis and ankylosing spondylitis without clinically apparent heart disease. Clin Rheumatol 2021; 40:4701-4711. [PMID: 34173901 PMCID: PMC8519900 DOI: 10.1007/s10067-021-05777-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of the study was to assess the relationship between the occurrence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and the cardiac magnetic resonance (CMR) changes in people without clinically overt heart disease. METHODS The study group consisted of 74 people (48.81 ± 11.35 years): 29 patients with RA, 23 patients with AS and 22 people from control group. Blood samples were taken to assess laboratory parameters, disease activity was determined using activity scales, and CMR was performed. RESULTS It was shown that the factors independently related to higher left ventricular mass index are AS occurrence, human B27 leukocyte antigen occurrence, higher neutrophil gelatinase-associated lipocalin concentration (NGAL) and higher body mass index (BMI). The lower right ventricular ejection fraction is result of an independent effect of RA, AS and higher NGAL. RA presence, methotrexate use, higher rheumatoid factor titer, higher NGAL, older age and higher BMI should be considered independent risk factors for greater left ventricular myocardium water content. RA occurrence, AS occurrence, type 2 diabetes occurrence and a higher C-reactive protein concentration can be independently associated with a higher probability of non-ischemic left ventricular myocardium injury. Larger pericardial fluid volume is result of an independent effect of higher NGAL, higher anti-cyclic citrullinated peptide antibodies titer and higher DAS28 disease activity index. Use of steroids is protective factor against larger volume of pericardial fluid. CONCLUSIONS RA and AS in people without clinically apparent heart disease are associated with the occurrence of adverse changes in CMR. Key Points •RA and AS in people without clinically apparent heart disease are associated with the occurrence of adverse changes in CMR.. •The independent risk factors for higher LVEF are AS occurrence, human B27 leukocyte antigen occurrence, higher NGAL concentration and higher BMI.. •RA presence, methotrexate use, higher RF, higher NGAL, older age and higher BMI are independent risk factors for higher LV T2 ratio.. •RA occurrence, AS occurrence, type 2 diabetes occurrence and a higher CRP are independently associated with a higher risk of non-ischemic LV myocardium injury..
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Affiliation(s)
- Wojciech Tański
- Department of Internal Medicine, 4th Military Hospital, Weigla 5, PL 50-981, Wroclaw, Poland
| | - Paweł Gać
- Centre for Diagnostic Imaging, 4th Military Hospital, Weigla 5, PL 50-981, Wroclaw, Poland. .,Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368, Wrocław, Poland.
| | - Angelika Chachaj
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, PL 50-556, Wrocław, Poland
| | - Małgorzata Sobieszczańska
- Department of Geriatrics, Wroclaw Medical University, Curie-Skłodowskiej 66, PL 50-369, Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, PL 50-556, Wrocław, Poland
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, PL 50-556, Wrocław, Poland
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Al-Mehisen R, Alnemri K, Al-Mohaissen M. Cardiac imaging of a patient with unusual presentation of granulomatosis with polyangiitis: A case report and review of the literature. J Nucl Cardiol 2021; 28:441-455. [PMID: 31350714 DOI: 10.1007/s12350-019-01809-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent evidence suggests that cardiac involvement in patients with granulomatosis with polyangiitis (GPA) occurs more frequently than previously reported. Multimodality cardiac imaging is gaining attention in the diagnosis, prognostication, and follow-up of such patients; however, the data remain scarce. RESULTS 2D-TTE was useful for initial screening; while both cardiac magnetic resonance imaging and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) metabolic imaging with rubidium-82 PET perfusion imaging were useful for characterization of myocardial disease. 18FDG-PET/CT was very useful for the follow-up of cardiac disease activity following treatment. CONCLUSION 18FDG-PET/CT is sensitive for the detection of cardiac involvement by GPA and is useful for the tissue characterization and follow-up of disease activity following treatment.
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Affiliation(s)
- Rabah Al-Mehisen
- Department of Cardiology, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Alnemri
- Department of Cardiology, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Maha Al-Mohaissen
- Department of Clinical Sciences (Cardiology), College of Medicine, Princess Nourah Bint Abdulrahman University, PO Box 48247, Riyadh, 11511, Kingdom of Saudi Arabia.
- Princess Nourah Bint Abdulrahman University Cardiovascular Disease in Women Research Chair, Riyadh, Kingdom of Saudi Arabia.
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Left ventricular myocardial strain assessed by cardiac magnetic resonance feature tracking in patients with rheumatoid arthritis. Insights Imaging 2021; 12:5. [PMID: 33410952 PMCID: PMC7790980 DOI: 10.1186/s13244-020-00948-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of the study was to assess a relationship between the occurrence of rheumatoid arthritis (RA) and its selected clinical parameters, and left ventricular myocardial strain. Material and methods Fifty-six subjects were qualified for the study: 30 RA patients and 26 subjects without rheumatoid diseases. The study design included taking medical history, assessment of the disease activity using selected scales of activity, collecting samples of venous blood to assess selected laboratory parameters and the assessment of cardiac magnetic resonance (CMR). Using the feature tracking method, the following parameters of the left ventricular myocardial strain were assessed: longitudinal strain (LS), radial strain (RS) and circumferential strain (CS). Results Regarding global values, peak LS and peak CS were statistically significantly lower in RA patients than in the control group. In the whole study group, the factors independently related to low global LS peaks were as follows: occurrence of RA, occurrence of arterial hypertension, increased activity of antibodies against cyclic citrullinated peptide and increased concentration of neutrophil gelatinase-associated lipocalin. The occurrence of RA, occurrence of diabetes, tobacco smoking, higher activity of antibodies against cyclic citrullinated peptide and current use of methotrexate are the risk factors for low peak of global CS. The current use of steroids constitutes a protecting factor against low global CS peaks. Conclusion In subjects with no clinically manifested cardiac damage, RA is associated with a deteriorated left ventricular systolic function assessed by left ventricular myocardial strain measured by CMR feature tracking.
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Nikdoust F, Bolouri E, Tabatabaei SA, Goudarzvand M, Faezi ST. Early diagnosis of cardiac involvement in systemic lupus erythematosus via global longitudinal strain (GLS) by speckle tracking echocardiography. J Cardiovasc Thorac Res 2018; 10:231-235. [PMID: 30680083 PMCID: PMC6335988 DOI: 10.15171/jcvtr.2018.40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) myocarditis occurs in between 5% and 10%
of patients with lupus. Global longitudinal strain (GLS) via speckle tracking echocardiography
can detect cardiac involvement in patients suffering from SLE. We decided to determine the
echocardiographic features and subsequent early diagnosis of cardiac involvement in patients
with SLE utilizing the GLS index via speckle tracking echocardiography.
Methods: In this cross-sectional study, we compared female patients with SLE of at least 2 years’
duration and healthy controls in terms of the left ventricular (LV) GLS via speckle tracking
echocardiography. After data collection in both groups, the GLS index and the ejection fraction
were evaluated.
Results: We analyzed and compared the LV echocardiographic parameters of 33 patients with
SLE (mean age=25.45±0.63 years) with those of 35 healthy controls (mean age=27±0.45 years).
The apical 2-chamber view indicated a significant decrease in the LV GLS in the case group by
comparison with the healthy controls (P=0.005). The LV GLS in the apical 3-chamber view was
significantly lower in the case group than in the control group (P=0.006). The LV GLS in the
apical 4-chamber view revealed no significant difference between the case and healthy control
groups (P=0.2). While there was a significant difference between the case and control groups visà-
vis the LV GLS (P=0.02), the LV ejection fraction measured with the Simpson method showed
no significant difference between the 2 groups (P=0.96).
Conclusion: GLS speckle tracking echocardiography is a noninvasive method with diagnostic and
prognostic values; it may, therefore, be a sensitive marker for the diagnosis of myocarditis and
other cardiac involvements in patients with SLE.
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Affiliation(s)
- Farahnaz Nikdoust
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Bolouri
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Goudarzvand
- Department of Physiology and Pharmacology, School of medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyedeh Tahereh Faezi
- Department of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Wang Q, Shang Y, Li S, Wu Y, Wang C, Yan X. Complete heart block in systemic sclerosis: A case report and literature review. Medicine (Baltimore) 2018; 97:e13226. [PMID: 30431601 PMCID: PMC6257444 DOI: 10.1097/md.0000000000013226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Complete heart block (CHB) is a common clinical manifestation. Systemic sclerosis (SSc) is a rare etiology of CHB that has not received enough attention. Whether pacemaker implantation is required remains inconclusive, especially when patients have no symptoms or mild symptoms of CHB. PATIENT CONCERNS In this study, we report the case of a 48-year-old Chinese male who suffers from SSc and CHB. DIAGNOSE The patient was previously diagnosed with left anterior hemiblock (LAHB) and right bundle block with normal heart function. CHB was observed on a regular follow-up electrocardiogram (ECG) examination 1 month before his hospitalization. INTERVENTIONS A permanent dual chamber pacemaker was implanted. OUTCOMES The patient responded well to pacemaker implantation treatment, and his exertional dyspnea disappeared. LESSONS The occurrence of heart block associated with SSc often appears concealed. The case highlights the importance of regular follow-up of a patient with SSc. Pacemaker implantation might be unavoidable if CHB is secondary to SSc, even if it is asymptomatic.
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Affiliation(s)
- Qinghai Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Yinghui Shang
- Department of Blood Transfusion, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shicheng Li
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Yanxiang Wu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Chenyu Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
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Chang JC, Knight AM, Xiao R, Mercer-Rosa LM, Weiss PF. Use of echocardiography at diagnosis and detection of acute cardiac disease in youth with systemic lupus erythematosus. Lupus 2018; 27:1348-1357. [PMID: 29688145 DOI: 10.1177/0961203318772022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives There are no guidelines on the use of echocardiography to detect cardiac manifestations of childhood-onset systemic lupus erythematosus (SLE). We quantify the prevalence of acute cardiac disease in youth with SLE, describe echocardiogram utilization at SLE diagnosis, and compare regional echocardiogram use with incident cardiac diagnoses. Methods Using the Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) de-identified United States administrative database from 2000 to 2013, we identified youth ages 5-24 years with new-onset SLE (≥3 ICD-9 SLE codes 710.0, > 30 days apart) and determined the prevalence of diagnostic codes for pericardial disease, myocarditis, endocarditis, and valvular insufficiency. Multiple logistic regression was used to identify factors associated with echocardiography during the baseline period, up to one year before or six months after SLE diagnosis. We calculated a regional echocardiogram utilization index, which is the ratio of observed use over the mean predicted probability based on all available baseline characteristics. Spearman's rank correlation coefficient was used to evaluate the association between regional echocardiogram utilization indices and percentage of imaged youth diagnosed with their first cardiac manifestation following echocardiography. Results Among 699 youth with new-onset SLE, 18% had ≥ 1 diagnosis code for acute cardiac disease, of which valvular insufficiency and pericarditis were most common. Twenty-five percent of all youth underwent echocardiogram during the baseline period. Regional echocardiogram use was positively correlated with the percentage of imaged youth found to have cardiac disease (ρ = 0.71, p = 0.05). There was up to a five-fold difference in adjusted odds of baseline echocardiography between low- and high-utilizing regions (OR = 0.19, p = 0.007). Conclusion Nearly one-fifth of youth with new-onset SLE have acute cardiac manifestations; however, use of echocardiograms at SLE diagnosis is highly variable. There may be incremental diagnostic value to early use of echocardiography, but prospective studies are needed to determine whether greater use of echocardiograms modifies outcomes.
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Affiliation(s)
- J C Chang
- 1 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,2 Division of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A M Knight
- 2 Division of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R Xiao
- 1 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L M Mercer-Rosa
- 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,4 Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - P F Weiss
- 1 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,2 Division of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,5 Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA, USA
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Pan L, Wang T. Features of cardiac remodeling in Patients with Acute Coronary Syndrome Complicated with Rheumatoid Arthritis. Sci Rep 2017; 7:10268. [PMID: 28860666 PMCID: PMC5579266 DOI: 10.1038/s41598-017-11123-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular diseases are important factors to increased morbidity and mortality in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the effects of RA on cardiac remodeling in patients with acute coronary syndrome (ACS). Sixty-one patients with ACS complicated with RA (RA group) and 55 age- and sex-matched patients with ACS without RA (control group) were enrolled. We compared the parameters of laboratory and echocardiogram across the 2 groups. Levels of serum brain natriuretic peptide in patients with RA were significantly higher than control group. Prevalence of left ventricular hypertrophy (LVH), and LV diastolic dysfunction (E/A < 1) were significantly higher in the RA patients, while the LV ejection fraction (EF%) was significantly lower in RA patients. Incidence of tricuspid regurgitation and pulmonary regurgitation were significantly higher in ACS patients with RA than in the ACS patients without RA. In RA group, levels of serum high density lipoprotein cholesterol were negatively correlated with C reactive protein (CRP), EF% was also negatively correlated with CRP. The prevalence of LVH and mitral regurgitation showed positive correlations with ESR. Early intervention for controlling the inflammation associated with RA can play a significant role in preventing cardiac remodeling in ACS patients.
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Affiliation(s)
- Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Tian Wang
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. .,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China.
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Gualtierotti R, Ughi N, Marfia G, Ingegnoli F. Practical Management of Cardiovascular Comorbidities in Rheumatoid Arthritis. Rheumatol Ther 2017; 4:293-308. [PMID: 28752316 PMCID: PMC5696280 DOI: 10.1007/s40744-017-0068-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular (CV) comorbidities are a frequent extra-articular manifestation of rheumatoid arthritis (RA). Cardiovascular disease (CVD) with accelerated atherosclerosis is a major cause of morbidity and mortality in patients with RA. Subclinical CVD may be present since the early phase of RA. Not only traditional but also non-traditional CV risk factors are involved in the pathogenesis of RA-related CVD. Due to the lack of specifically designed randomized clinical trials, it is still unclear which tools to use to perform CV risk assessment, how to interpret the results and which interventions are appropriate in RA patients both to prevent and to manage CVD. Based on the available evidence, we propose a practical approach.
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Affiliation(s)
- Roberta Gualtierotti
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Marfia
- Neurosurgery Unit, Laboratory of Experimental Neurosurgery and Cell Therapy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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