Progression rate of severity of aortic stenosis in patients with rheumatoid arthritis

John P. Bois, Cynthia Crowson, Tamanna Khullar, Sara J. Achenbach, Megan L. Krause, Rekha Mankad

Research output: Contribution to journalArticle

Abstract

Objective: Valvular heart disease is common in patients with rheumatoid arthritis (RA). However, there is uncertainty about how often to perform echocardiographic surveillance in this population. The objective of this study was to assess the progression rate of mild and moderate aortic stenosis (AS) in patients with RA. Methods: A population-based cohort of patients with RA and either mild (2.0–2.9 m/second) or moderate (3.0–3.9 m/second) AS was identified. Demographic, clinical, and echocardiographic data were collected. Annual progression rate of AS was then calculated for the study cohort and the impact of pertinent RA variables on progression rate determined. Results: Sixty-eight patients with RA and mild or moderate AS met the inclusion requirements. Peak aortic valve (AV) velocity and mean AV gradient increased during the study period, whereas AV area decreased, consistent with progression of AS (P<.001). Mean (SD) annual increase in peak AV jet velocity was 0.05 m/second (0.01) and in mean AV gradient was 1.0 mm Hg (0.18). Mean annual decrease in AV area was 0.04 (0.01) cm 2 . The progression rate of AS was higher in patients with increased erythrocyte sedimentation rates (ESR) (P=.001). Conclusions: The rate of AS progression in the RA population was higher in patients with increased ESR but less than that of the reported rate of AS progression in the general population. Although the cause for this finding is uncertain, these results suggest that patients with RA who have mild or moderate AS should undergo echocardiographic surveillance for disease progression similar to that of the general population.

Original languageEnglish (US)
Pages (from-to)1410-1416
Number of pages7
JournalEchocardiography
Volume34
Issue number10
DOIs
StatePublished - Oct 1 2017

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Aortic Valve Stenosis
Rheumatoid Arthritis
Aortic Valve
Blood Sedimentation
Population
Population Surveillance
Heart Valve Diseases
Uncertainty
Disease Progression
Cohort Studies
Demography

Keywords

  • aortic stenosis
  • echocardiography
  • rheumatoid arthritis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Bois, J. P., Crowson, C., Khullar, T., Achenbach, S. J., Krause, M. L., & Mankad, R. (2017). Progression rate of severity of aortic stenosis in patients with rheumatoid arthritis. Echocardiography, 34(10), 1410-1416. https://doi.org/10.1111/echo.13652

Progression rate of severity of aortic stenosis in patients with rheumatoid arthritis. / Bois, John P.; Crowson, Cynthia; Khullar, Tamanna; Achenbach, Sara J.; Krause, Megan L.; Mankad, Rekha.

In: Echocardiography, Vol. 34, No. 10, 01.10.2017, p. 1410-1416.

Research output: Contribution to journalArticle

Bois, JP, Crowson, C, Khullar, T, Achenbach, SJ, Krause, ML & Mankad, R 2017, 'Progression rate of severity of aortic stenosis in patients with rheumatoid arthritis', Echocardiography, vol. 34, no. 10, pp. 1410-1416. https://doi.org/10.1111/echo.13652
Bois, John P. ; Crowson, Cynthia ; Khullar, Tamanna ; Achenbach, Sara J. ; Krause, Megan L. ; Mankad, Rekha. / Progression rate of severity of aortic stenosis in patients with rheumatoid arthritis. In: Echocardiography. 2017 ; Vol. 34, No. 10. pp. 1410-1416.
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AB - Objective: Valvular heart disease is common in patients with rheumatoid arthritis (RA). However, there is uncertainty about how often to perform echocardiographic surveillance in this population. The objective of this study was to assess the progression rate of mild and moderate aortic stenosis (AS) in patients with RA. Methods: A population-based cohort of patients with RA and either mild (2.0–2.9 m/second) or moderate (3.0–3.9 m/second) AS was identified. Demographic, clinical, and echocardiographic data were collected. Annual progression rate of AS was then calculated for the study cohort and the impact of pertinent RA variables on progression rate determined. Results: Sixty-eight patients with RA and mild or moderate AS met the inclusion requirements. Peak aortic valve (AV) velocity and mean AV gradient increased during the study period, whereas AV area decreased, consistent with progression of AS (P<.001). Mean (SD) annual increase in peak AV jet velocity was 0.05 m/second (0.01) and in mean AV gradient was 1.0 mm Hg (0.18). Mean annual decrease in AV area was 0.04 (0.01) cm 2 . The progression rate of AS was higher in patients with increased erythrocyte sedimentation rates (ESR) (P=.001). Conclusions: The rate of AS progression in the RA population was higher in patients with increased ESR but less than that of the reported rate of AS progression in the general population. Although the cause for this finding is uncertain, these results suggest that patients with RA who have mild or moderate AS should undergo echocardiographic surveillance for disease progression similar to that of the general population.

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