Assessment of myocardial perfusion in rheumatoid arthritis : evaluation with radioisotope imaging

الملخص EN

Aim of work : RA patients have a decreased life expectancy and ischemic heart disease (IHD) is accused to be the leading contributor to mortality in this disease.

IHD is a clinically silent disease and difficult to predict with neither symptoms nor ECG changes.

This study aimed to detect myocardial perfusion defects (PDs) by using single photon emission computerized tomography (SPECT) in adult RA patients, with special regards to age, type of medication, disease duration and activity.

Patients and Methods : The study included 31 RA patients diagnosed according to the ACR criteria.

Patients neither had cardiac complaints nor ECG changes.

All patients were subjected to: thorough medical history and cardiac examination, rheumatological assessment for: function status and disease activity.

Lipid profile, CRP and RF were determined.

All patients were assessed with SPECT for the presence of PDs; ischemia, scar and/or combinations of such.

Results : RA patients were 9 males (29%) and 22 females (71%).

Their age ranged between 34-63 years with a mean of 49.32 + 7.71.

The disease duration ranged between 1-22 years with a mean of 9.51 + 6.6.

Based on SPECT evaluation; 14 patients (45.2%) had PDs: 9 patients (29%) had ischemia and 5 patients (16.1%) hah ischemia and scar.

The incidence of cardiac involvement in RA patients when compared with non-ischemic RA patients was found to be highly statistically significant (p ≤ 0.00).

RA patients with myocardial PDs exhibited a more severe disease activity as compared to the patients group without PDs (p ≤ 0.00).

There were high statistical significant relations between the occurrence of cardiac PDs and age, disease duration, function status and the levels of CRP, HDL, LDL, TGL and CHOL (p ≤ 0.00).

As regards the type of medication, there was a high statistical significant relation between cardiac PDs and NSAIDs and steroids only (p ≤ 0.00).

Conclusion : This study confirmed that about 45.2% of our RA patients had microcirculatory disturbance of the heart without any clinical complaint or ECG changes.