Exercise Echocardiography in Rheumatoid Arthritis: A Case-Control Study

Background: Rheumatoid arthritis (RA) is associated with increased cardiovascular risk. Methods: To assess the role of exercise echocardiography (EE) in the evaluation of patients with RA, follow-up (mean, 6.7 ± 3.7 years) was retrospectively obtained in 159 patients with RA who underwent EE. Patients were matched for age, gender, and cardiovascular risk factors with 454 controls who underwent EE. Results: Patients with RA were more likely to have positive results for ischemia on EE (odds ratio, 2.32; 95% confidence interval, 1.48-3.64; P = .0003). Rest and exercise wall motion score indexes were higher in the RA group (1.14 ± 0.33 and 1.22 ± 0.39, respectively, vs 1.06 ± 0.18 and 1.10 ± 0.24 in controls; P < .005 for each). Logistic regression adjusted for age revealed an increased odds ratio for myocardial ischemia of 1.06 (95% confidence interval, 1.02-1.11; P = .005) per year of RA. Five-year all-cause mortality in subjects with RA with myocardial ischemia on EE was 14.9%, compared with 4.3% in RA subjects without ischemia (P = .028). Conclusion: RA was associated with a 2-fold increased risk for myocardial ischemia on EE; risk increased with the duration of RA. Mortality was increased in patients with RA with ischemia on EE.