Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates.
Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates.
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通过经食管超声心动图和临床相关性来表征类风湿性关节炎中的瓣膜性心脏病。
DOI：
10.1016/j.amjcard.2007.03.048
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Crawford,MichaelH
中科院分区：
文献类型：
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作者：
Roldan,CarlosA;DeLong,Christine;Qualls,CliffordR;Crawford,MichaelH
与类风湿性关节炎 (RA) 相关的瓣膜性心脏病 (VHD) 尚未得到很好的表征，其临床预测因素也不确定。因此，34 名平均年龄为 50 ± 10 岁的 RA 志愿者接受了临床评估和经食管超声心动图检查。将经食管超声心动图的结果与 34 名性别匹配的健康志愿者（平均年龄为 42 ± 6 岁）的结果进行了比较。 20 名患者 (59%) 主要 (97%) 左侧 VHD（瓣膜结节 11 例， 32%；瓣膜增厚 18 例， 53%；瓣膜反流 7 例， 21%；瓣膜狭窄 1 例， 3%），而 5 名对照者（15%；[结节 1 例， 3%；瓣膜增厚 4 例， 12%；瓣膜返流 1, 3%） 1, 3%；所有患者与患者的 p ≤0.05）。瓣膜结节一般为单个且较小（4至12毫米）；呈椭圆形，边界规则，超声心动图反射率均匀；通常位于小叶的基部或中部；并且同样影响主动脉瓣和二尖瓣。瓣膜增厚同样呈弥漫性或局部性；当局部影响任何小叶部分时；通常是轻度的（89%）；同样涉及二尖瓣和主动脉瓣（分别为 47% 和 32%）；很少（6%）累及瓣环和瓣膜下装置。瓣膜关闭不全表现为轻度主动脉关闭不全4例，中度二尖瓣关闭不全4例，中度三尖瓣关闭不全1例。 1 名患者 (3%) 发生二尖瓣和主动脉瓣狭窄。未发现 VHD 与 RA 的持续时间、活动性、严重程度、发病模式和病程、关节外疾病、血清学或治疗之间存在相关性。总之，RA 相关的 VHD 很常见，瓣膜结节和增厚是其显着特征，与 RA 的临床变量无关。
Valvular heart disease (VHD) associated with rheumatoid arthritis (RA) has not been well characterized and its clinical predictors are undefined. Therefore, 34 volunteers with RA with a mean age of 50 ± 10 years underwent clinical evaluation and transesophageal echocardiography. Findings on transesophageal echocardiography were compared with those of 34 gender-matched healthy volunteers with a mean age of 42 ± 6 years. Twenty patients (59%) had mainly (97%) left-sided VHD (valve nodules in 11, 32%; valve thickening in 18, 53%; valve regurgitation in 7, 21%; and valve stenosis in 1, 3%) compared with 5 controls (15%; [nodules in 1, 3%; thickening in 4, 12%; and regurgitation in 1, 3%; p ≤0.05 for all vs patients). Valve nodules were generally single and small (4 to 12 mm); were oval with regular borders and had homogenous echocardiographic reflectance; were typically located at the leaflets’ basal or mid portions; and equally affected the aortic and mitral valves. Valve thickening was equally diffuse or localized; when localized affected any leaflet portion; was usually mild (89%); involved similarly the mitral and aortic valves (47% and 32%, respectively); and rarely (6%) involved the annulus and subvalvular apparatus. Valve regurgitation manifested as mild aortic regurgitation in 4 patients, moderate mitral regurgitation in 4 patients, and moderate tricuspid regurgitation in 1 patient. Mitral and aortic valve stenoses occurred in 1 patient (3%). No correlation was found between VHD and duration, activity, severity, pattern of onset and course, extra-articular disease, serology, or therapy of RA. In conclusion, RA-associated VHD is common, valve nodules and thickening are its distinctive features, and it is not associated with clinical variables of RA.