Assessment and Characterisation of Coronary Disorder in a Rheumatoid Arthritis Cohort: A Cross-Sectional Study

Abstract

Abstract Purpose To assess the prevalence of macrovascular or microvascular coronary dysfunction in a cohort of rheumatoid arthritis patients with a heart score > 1%. Materials and methods We included, in a cross-sectional study, RA patients treated with biologic or targeted synthetic Disease Modifying Anti Rheumatic Drug, without history of cardiovascular disease, ≥ 50 years old and a pathological Heart Score > 1%. First, myocardial perfusion reserve (MPR), the ratio of myocardial blood flow in stress to myocardial blood flow at rest, was assessed with single photon emission computed tomography (SPECT). RA patients with impaired MPR < 2 were referred for invasive coronary angiography to assess macrovascular or microvascular coronary dysfunction. Demographics, RA outcomes and cardiovascular risk factors were recorded. A multivariate analysis was performed with variables significantly associated with coronary dysfunction. Results A total of 108 RA patients were screened for eligibility. Sixty patients were included. A total of 37/60 (61%) patients had impaired MPR on SPECT, of whom one patient presented significant ischemia on myocardial perfusion imaging. According to invasive coronary angiography, 17/31 (54%) had coronary microvascular dysfunction, 7/31 (22%) had macrovascular dysfunction and 7/31 (22%) had no coronary dysfunction. A total of 23/31 patients (74%) had cardiovascular medical treatment optimization. RA characteristics significantly associated with coronary dysfunction were higher disease activity and shorter disease duration. Conclusion This is the first study to reveal, on invasive coronary angiography, a high proportion of microvascular dysfunction in RA patients with impaired MPR. Coronary dysfunction screening could be considered in RA patients with a heart score > 1% (ESC guidelines), as SPECT and invasive coronary angiography showed coronary dysfunction in 44% of RA patients, which led to substantial cardiovascular treatments. Trial registration : Ethics approval was obtained from Comité de protection des personnes Sud-Est (22.04002.000195). Participants gave informed consent.