Vol 22, No 1 (2019)
Research paper
Published online: 2019-01-31

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Myocardial ischemia in female patients with rheumatoid arthritis assessed with single photon emission tomography-myocardial perfusion imaging

Andreas Fotopoulos1, Konstantinos Papadimitropoulos1, Athanasios Papadopoulos2, Labros Lakkas3, Maria Spiliotopoulou1, Tzimis - Dimitrios Kotrotsios1, Konstantinos Pappas1, Athanasios Notopoulos1, Chrissa Sioka1
DOI: 10.5603/NMR.2019.0001
Pubmed: 31482536
Nucl. Med. Rev 2019;22(1):8-13.

Abstract

BACKGROUND: Non-specific cardiac symptoms in female patients with rheumatoid arthritis (RA) could indicate early cardiovascular disease.

MATERIALS AND METHODS: Myocardial perfusion imaging (MPI), with 99mTc tetrofosmin stress–rest single photon emission computer tomography (SPECT), in 13 RA female patients with atypical cardiac symptoms, was compared to 44 weight- and age-matched females with similar cardiac complaints (control group). Smoking, hypertension, diabetes mellitus, dyslipidemia, obesity and cardiac heredity were recorded and compared between the study and control group. MPI was assessed using 17 segment polar map and with a scale of 0 to 5 scoring.

RESULTS: Patients with RA demonstrated higher cardiovascular risk (46%) compared to control individuals (17%). In addition, patients with RA had more irreversible myocardial ischemic abnormalities in their MPI than the control group. Dyslipidemia and obesity was found more frequent in RA patients with MPI SSS ≥ 4.

CONCLUSION: RA patients with atypical cardiac complaints are at higher risk for cardiovascular disease; early detection and monitoring of this patient group could potentially reverse or successfully manage the consequences of the upcoming cardiovascular disease.

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References

  1. Backman CL. Employment and work disability in rheumatoid arthritis. Curr Opin Rheumatol. 2004; 16(2): 148–152.
  2. Sokka T. Work disability in early rheumatoid arthritis. Clin Exp Rheumatol. 2003; 21(5 Suppl 31): S71–S74.
  3. Kojima M, Kojima T, Ishiguro N, et al. Psychosocial factors, disease status, and quality of life in patients with rheumatoid arthritis. J Psychosom Res. 2009; 67(5): 425–431.
  4. Cutolo M, Kitas GD, van Riel PL. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint. Semin Arthritis Rheum. 2014; 43(4): 479–488.
  5. Faccini A, Kaski JC, Camici PG. Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases. Eur Heart J. 2016; 37: 1799–1806.
  6. Mellana WM, Aronow WS, Palaniswamy C, et al. Rheumatoid arthritis: cardiovascular manifestations, pathogenesis, and therapy. Curr Pharm Des. 2012; 18(11): 1450–1456.
  7. Furer V, Fayad ZA, Mani V, et al. Noninvasive cardiovascular imaging in rheumatoid arthritis: current modalities and the emerging role of magnetic resonance and positron emission tomography imaging. Semin Arthritis Rheum. 2012; 41(5): 676–688.
  8. Ogino Y, Horiguchi Y, Ueda T, et al. A myocardial perfusion imaging system using a multifocal collimator for detecting coronary artery disease: validation with invasive coronary angiography. Ann Nucl Med. 2015; 29(4): 366–370.
  9. Zhang WC, Tian YQ, Yang MF, et al. [Stress myocardial perfusion single photon emission computed tomography imaging in the detection of coronary artery disease in woman]. Zhonghua Yi Xue Za Zhi. 2007; 87(37): 2623–2626.
  10. Chung CP, Oeser A, Solus JF, et al. Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis. 2008; 196(2): 756–763.
  11. Luck Y, Baron M, Bardakjian S, et al. The role of rheumatologists vis-à-vis assessment of traditional cardiovascular risk factors in rheumatoid arthritis. Clin Rheumatol. 2014; 33(6): 769–774.
  12. Liao KP, Liu J, Lu B, et al. Association between lipid levels and major adverse cardiovascular events in rheumatoid arthritis compared to non-rheumatoid arthritis patients. Arthritis Rheumatol. 2015; 67(8): 2004–2010.
  13. Sioka C, Exarchopoulos T, Tasiou I, et al. Myocardial perfusion imaging with (99 m)Tc-tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case-control study. Radiat Oncol. 2011; 6: 151.
  14. Giannopoulos S, Markoula S, Sioka C, et al. Detecting Myocardial Ischemia With Technetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke. Neurohospitalist. 2017; 7(4): 164–168.
  15. Arumugam P, Harbinson M, Reyes E, et al. Procedure guidelines for radionuclide myocardial perfusion imaging with single-photon emission computed tomography. Nucl Med Commun. 2013; 34(8): 813–826.
  16. Cerqueira M. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Journal of Nuclear Cardiology. 2002; 9(2): 240–245.
  17. Belardinelli R, Cianci G, Gigli M, et al. Effects of trimetazidine on myocardial perfusion and left ventricular systolic function in type 2 diabetic patients with ischemic cardiomyopathy. J Cardiovasc Pharmacol. 2008; 51(6): 611–615.
  18. Imaging guidelines for nuclear cardiology procedures, part 2. American Society of Nuclear Cardiology. J Nucl Cardiol. 1999; 6(2): G47–G84.
  19. Kobayashi Y, Giles JT, Hirano M, et al. Assessment of myocardial abnormalities in rheumatoid arthritis using a comprehensive cardiac magnetic resonance approach: a pilot study. Arthritis Res Ther. 2010; 12(5): R171.
  20. Toutouzas K, Sfikakis PP, Karanasos A, et al. Myocardial ischaemia without obstructive coronary artery disease in rheumatoid arthritis: hypothesis-generating insights from a cross-sectional study. Rheumatology (Oxford). 2013; 52(1): 76–80.
  21. Castro AM, Carmona-Fernandes D, Rodrigues AM, et al. Incidence and predictors of cardiovascular events in a cohort of patients with rheumatoid arthritis. Acta Reumatol Port. 2016; 41(3): 213–219.
  22. Kirillova IG, Novikova DS, Popkova TV, et al. [Left and right ventricular diastolic dysfunction in patients with early rheumatoid arthritis before prescribing disease-modifying antirheumatic therapy]. Ter Arkh. 2015; 87(5): 16–23.
  23. Momose S. [Detection of myocardial lesions by dipyridamole thallium-201 scintigraphy in patients with rheumatoid arthritis]. Ryumachi. 1995; 35(3): 559–565.
  24. Shul'gin DN, Olisaeva DR, Fomicheva OA, et al. [Single-photon emission computed tomography in the diagnosis of myocardial perfusion abnormalities in patients with rheumatoid arthritis: preliminary data]. Ter Arkh. 2012; 84(8): 78–80.
  25. Dessein PH, Joffe BI, Veller MG, et al. Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis. J Rheumatol. 2005; 32(3): 435–442.
  26. Chung CP, Oeser A, Raggi P, et al. Increased coronary-artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors. Arthritis Rheum. 2005; 52(10): 3045–3053.
  27. Li C, Wang Xr, Tang Yd, et al. [A multicenter study of coronary artery disease and its risk factors in rheumatoid arthritis in China]. Beijing Da Xue Xue Bao Yi Xue Ban. 2012; 44(2): 176–181.
  28. Maradit-Kremers H, Crowson CS, Nicola PJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2005; 52(2): 402–411.
  29. Mavrogeni S, Dimitroulas T, Bucciarelli-Ducci C, et al. Rheumatoid arthritis: an autoimmune disease with female preponderance and cardiovascular risk equivalent to diabetes mellitus: role of cardiovascular magnetic resonance. Inflamm Allergy Drug Targets. 2014; 13(2): 81–93.
  30. Mavrogeni S, Dimitroulas T, Gabriel S, et al. Why currently used diagnostic techniques for heart failure in rheumatoid arthritis are not enough: the challenge of cardiovascular magnetic resonance imaging. Rev Cardiovasc Med. 2014; 15(4): 320–331.
  31. Santos MJ, Vinagre F, Silva JJ, et al. Cardiovascular risk profile in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of female patients. Acta Reumatol Port. 2010; 35(3): 325–332.
  32. Corrales A, Dessein PH, Tsang L, et al. Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study. Arthritis Res Ther. 2015; 17: 55.
  33. Södergren A, Karp K, Bengtsson C, et al. The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls. J Rheumatol. 2015; 42(6): 935–942.