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CLINICAL RESEARCH: LV FUNCTION AND RISK

Left Ventricular Systolic Dysfunction in Rheumatoid Disease

An Unrecognized Burden?

Gurbir S. Bhatia, MRCP^_*, Michael D. Sosin, MRCP^_*, Jeetesh V. Patel, PhD^_*, Karl A. Grindulis, FRCP, Fazal H. Khattak, FRCP, Elizabeth A. Hughes, BSc, FRCP, Gregory Y.H. Lip, MD, FRCP, FACC, FESC^_* and Russell C. Davis, MRCP, MD^_*,_*

^_* Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, England
Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich, England
Department of Chemical Pathology, Sandwell and West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich, England

Manuscript received April 26, 2005; revised manuscript received October 3, 2005, accepted October 10, 2005.

^_* Reprint requests and correspondence: Dr. Russell C. Davis, University Department of Medicine, City Hospital, Dudley Road, Birmingham, West Midlands, England. (Email: Russell.Davis{at}swbh.nhs.uk).

OBJECTIVES: This study sought to ascertain whether left ventricular systolic dysfunction (LVSD) is more common among clinic patients with rheumatoid disease (RD) compared with the general population, and to assess the diagnostic utility of brain natriuretic peptide (BNP).

BACKGROUND: Patients with RD are at increased risk of ischemic heart disease. However, there are few large echocardiographic studies identifying cardiac dysfunction in RD. We hypothesized that LVSD would be more prevalent in RD patients than in the general population.

METHODS: A total of 226 hospital out-patients with RD (65% women) underwent clinical evaluation, electrocardiography (ECG), echocardiography, and plasma BNP assay (218 patients). Prevalence of LVSD was compared with local population estimates.

RESULTS: Definite LVSD (left ventricular ejection fraction <40%) occurred in 5.3% of the RD group: standardized prevalence ratio, 3.20; 95% confidence interval, 1.65 to 5.59. Median BNP values were higher in patients with LVSD compared with those without: 16.6 pmol/l versus 8.5 pmol/l, p < 0.005, although values between the two groups overlapped. One in nine patients with an abnormal ECG had definite LVSD.

CONCLUSIONS: Definite LVSD was three times more common in RD patients than in the general population. Given the prognostic benefits of treating LVSD, echocardiographic screening of RD patients with an abnormal ECG may be worthwhile.

Abbreviations and Acronyms   BNP = brain natriuretic peptide   CHF = chronic heart failure   CI = confidence interval   ECG = electrocardiogram/electrocardiography   IHD = ischemic heart disease   LVEF = left ventricular ejection fraction   LVSD = left ventricular systolic dysfunction   RD = rheumatoid disease

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