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.