CORRESPONDENCE: LETTER TO THE EDITOR
Left Ventricular Systolic Dysfunction in Rheumatoid Disease
Mary J. Roman, MD, FACC*
* Weill Medical College of Cornell University, Division of Cardiology, 525 East 68th Street, Starr 401, New York, New York 10021 (Email: mroman{at}med.cornell.edu).
Bhatia et al. (1) report an increased prevalence of left ventricular (LV) systolic dysfunction among patients with rheumatoid disease in comparison to the general population based on a visual estimate of echocardiographic LV ejection fraction. The investigators acknowledge that this observation may be due to significantly higher prevalences of hypertension, diabetes mellitus, and smoking among the rheumatoid-disease patients, but they do not provide analyses adjusting for these important confounders. Thus, although ischemic heart disease (and preclinical atherosclerosis) occur prematurely in patients with rheumatoid disease, the present study does not distinguish between traditional cardiovascular disease risk factors as opposed to rheumatoid disease-related factors being primarily responsible for their observation. Prevalences of previous myocardial infarction are comparable in the patients and general population, and previous myocardial infarction is strongly related to LV systolic dysfunction among patients with rheumatoid disease. Thus the higher prevalence of LV systolic dysfunction among patients with rheumatoid disease is somewhat difficult to reconcile with these two observations.
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1. Bhatia GS, Sosin, MD, Patel JV, et al. Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden? J Am Coll Cardiol 2006;47:1169-1174.[Abstract/Free Full Text]
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