Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden?

Area of Science:

• Cardiology
• Rheumatology
• Medical Diagnostics

Background:

• Rheumatoid disease (RD) patients face elevated risks for ischemic heart disease.
• Limited large-scale echocardiographic data exists on cardiac dysfunction in RD.
• A hypothesis proposed higher prevalence of LVSD in RD patients compared to the general population.

Purpose of the Study:

• To determine if left ventricular systolic dysfunction (LVSD) is more prevalent in rheumatoid disease (RD) patients than in the general population.
• To evaluate the diagnostic utility of brain natriuretic peptide (BNP) in assessing LVSD in RD patients.

Main Methods:

• 226 hospital out-patients with RD underwent clinical evaluation, ECG, echocardiography, and plasma BNP assay.
• Prevalence of LVSD was compared with general population estimates.
• Brain natriuretic peptide (BNP) levels were analyzed in relation to LVSD status.

Main Results:

• Definite LVSD (ejection fraction <40%) was found in 5.3% of RD patients, a standardized prevalence ratio of 3.20 compared to the general population.
• Median BNP levels were significantly higher in patients with LVSD (16.6 pmol/l) versus those without (8.5 pmol/l), though with overlap.
• One in nine RD patients with an abnormal ECG had definite LVSD.

Conclusions:

• Definite LVSD is approximately three times more common in rheumatoid disease patients than in the general population.
• Echocardiographic screening for LVSD in RD patients with abnormal ECGs may be clinically beneficial due to the prognostic importance of treating LVSD.