Investigating the relationship between carotid intima-media thickness, flow-mediated dilatation in brachial artery and nuclear heart scan in patients with rheumatoid arthritis for evaluation of asymptomatic cardiac ischemia and atherosclerotic changes
Abstract
Background: Cardiovascular disease is the most common cause of death worldwide. In order to prevent and treat heart diseases, we need to estimate the trend of non-cardiac diseases with the cardiovascular system. Arthritis Rheumatoid is a chronic immune/inflammatory process which leads to subclinical atherosclerosis and increases cardiovascular disease. We examined the patients who referred to our nuclear medicine center for MPI and correlated their findings with flow-mediated dilatation (FMD) of the brachial artery and carotid intima-media thickness (CIMT) in arthritis rheumatoid patients.
Material and methods: A total 30 known cases with arthritis rheumatoid were referred to our department for MPI and the single-photon emission computed tomography (SPECT) imaging were visually and quantitatively evaluated by two nuclear medicine physicians and the correlation of the measured FMD and CIMT were evaluated and compared with ultrasonography data. Demographic information such as gender, age and sex and medical history (risk factors, cardiovascular sign and symptoms, lab findings, medication etc…) were recorded in questionnaire sheets and were analyzed by SPSS.20. Chi-square and student t-test were used for further analysis.
Results: The mean CIMT (R = 0.452 ± 0.07, L = 0.447 ± 0.08) and %FMD (R = 7.22 ± 8.66, L = 6.42 ± 11.88) were measured for all subjects. Age was the only parameter correlated with both right and left CIMT (P = 0.033 and P = 0.024, respectively). Among the patients, 26.7% had mild ischemia (SSS < 8) and 3 of them suffered from active arthritis rheumatoid. All patients with RA showed normal ventricular ejection fraction and normal volumes and among them, 93.3% had normal functional performance (normal wall motion…). Moreover, the mean CIMT and %FMD were not significantly different in ischemic and non-ischemic patients. Among ischemic patients, just the course of the disease was associated with CIMT and none of the parameters was correlated with FMD.
Conclusions: There is no significant statistical difference between ischemic and non-ischemic patients and also the functional performance with values of CIMT and FMD. Among all populations, the parameter of age, and in ischemic group, the course of disease were found as the only variable correlated with CIMT.
Keywords: Brachial arteryFlow-mediated dilatationIntima-media thicknessnuclear imageRheumatoid arthritisCardiac ischemia
References
- Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012; 18(Suppl 13): s295–w302.
- Cavagna L, Boffini N, Cagnotto G, et al. Atherosclerosis and rheumatoid arthritis: more than a simple association. Mediators Inflamm. 2012; 2012: 147354.
- Ku IA, Imboden JB, Hsue PY, et al. Rheumatoid arthritis: model of systemic inflammation driving atherosclerosis. Circ J. 2009; 73(6): 977–985.
- Del Rincón I, Williams K, Stern MP, et al. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheum. 2003; 48(7): 1833–1840.
- Gonzalez-Gay MA, Gonzalez-Juanatey C, Pineiro A, et al. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. The Journal of rheumatology. 2005; 37(7): 1219–1223.
- Sattar N, McCarey DW, Capell H, et al. Explaining how "high-grade" systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003; 108(24): 2957–2963.
- Kuvin JT, Karas RH. Clinical utility of endothelial function testing: ready for prime time? Circulation. 2003; 107(25): 3243–3247.
- Al-Qaisi Mo, Kharbanda RK, Mittal TK, et al. Measurement of endothelial function and its clinical utility for cardiovascular risk. Vasc Health Risk Manag. 2008; 4(3): 647–652.
- Deanfield J, Donald A, Ferri C, et al. Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension. Endothelial function and dysfunction. Part I: Methodological issues for assessment in the different vascular beds: a statement by the Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension. J Hypertens. 2005; 23(1): 7–17.
- Brunner H, Cockcroft JR, Deanfield J, et al. Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens. 2005; 23(2): 233–246.
- Gonzalez-Juanatey C, Llorca J, Testa A, et al. Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid arthritis patients without clinically evident atherosclerotic disease. Medicine (Baltimore). 2003; 82(6): 407–413.
- Roman MJ, Moeller E, Davis A, et al. Preclinical carotid atherosclerosis in patients with rheumatoid arthritis. Ann Intern Med. 2006; 144(4): 249–256.
- Chatterjee Adhikari M, Guin A, Chakraborty S, et al. Subclinical atherosclerosis and endothelial dysfunction in patients with early rheumatoid arthritis as evidenced by measurement of carotid intima-media thickness and flow-mediated vasodilatation: an observational study. Semin Arthritis Rheum. 2012; 41(5): 669–675.
- Södergren A, Karp K, Boman K, et al. Atherosclerosis in early rheumatoid arthritis: very early endothelial activation and rapid progression of intima media thickness. Arthritis Res Ther. 2010; 12(4): R158.
- Ristić GG, Lepić T, Glisić B, et al. Rheumatoid arthritis is an independent risk factor for increased carotid intima-media thickness: impact of anti-inflammatory treatment. Rheumatology (Oxford). 2010; 49(6): 1076–1081.
- Gonzalez-Juanatey C, Llorca J, Martin J, et al. Carotid intima-media thickness predicts the development of cardiovascular events in patients with rheumatoid arthritis. Semin Arthritis Rheum. 2009; 38(5): 366–371.
- Fan Cy, Zhang Zy, Mei Yf, et al. Impaired brachial artery flow-mediated dilation and increased carotid intima-media thickness in rheumatoid arthritis patients. Chin Med J (Engl). 2012; 125(5): 832–837.
- Veselinovic MV, Zivkovic VI, Toncev S, et al. Carotid artery intima-media thickness and brachial artery flow-mediated vasodilatation in patients with rheumatoid arthritis. Vasa. 2012; 41(5): 343–351.
- Amin M, Salama A, Elaggan A, et al. Brachial artery flow mediated dilatation and carotid intima media thickness measured by high resolution B-mode ultrasound in patients with rheumatoid arthritis. The Egyptian Journal of Radiology and Nuclear Medicine. 2015; 46(1): 89–96.
- Xu SZ, Wang P, Guan SY, et al. Decreased flow-mediated dilatation in patients with rheumatoid arthritis: a meta-analysis. Postgrad Med J. 2017; 93(1099): 260–265.
- Kumeda Y, Inaba M, Goto H, et al. Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis Rheum. 2002; 46(6): 1489–1497.
- Nagata-Sakurai M, Inaba M, Goto H, et al. Inflammation and bone resorption as independent factors of accelerated arterial wall thickening in patients with rheumatoid arthritis. Arthritis Rheum. 2003; 48(11): 3061–3067.
