To determine prediction markers of myocardial ischemia by exercise echocardiography (EE) in patients with rheumatoid arthritis (RA).Methods
27 patients with RA aged ≤ 60 using metotrexat and 27 age and sex matched controls without diabetes mellitus or history of myocardial infarction, angina pectoris or stroke were included. Study subjects completed EE, RA activity and cardiovascular disease (CVD) risk factors assessment. Blood was drawn for analysis of lipids, erythrocyte sedimentation rate, high sensitive C-reactive protein (hs-CRP), rheumatoid factor, intercellular adhesion molecule-1 (ICAM-1), B-type natriuretic peptide (BNP). We used univariate and multivariable logistic regressions to identify risk factors that were associated with myocardial ischemia by EE in patients with RA.Results
There were no significant differences in traditional CVD risk factors between RA patients and controls. Patients with RA were more likely to have positive results for ischemia on EE (OR 13; 95% Cl: 1,5-111,8). Hs-CRP (rs-0,39, p < 0,05), Health Assessment Questionnaire score (rs-0,54, p < 0,01), extraarticular manifestation of RA (rs-0,50, p < 0,01), BNP (rs-0,73, p < 0,001), ICAM-1 (rs =0,53, p < 0,01) were associated with myocardial ischemia on EE in patients with RA. In predicting myocardial ischemia Hs-CRP and BNP were independently associated with the presence of ischemia (OR 32; 95% Cl: 2,7-370,8).Conclusions
Patients with RA had increased odds of having myocardial ischemia on EE when compared to age and sex matched controls. The combination of the levels of Hs-CRP and BNP increased the accuracy of predicting ischemia.