Echocardiographic assessment of cardiac structure and function in patients with rheumatoid arthritis

In order to determine the incidence and significance of cardiac disease in rheumatoid arthritis we studied 51 outpatients with rheumatoid arthritis by clinical examination, electrocardiogram and echocardiography. Among 37 women and 14 men, 16 (31 per cent) had echocardiographic evidence of pericardial effusion; two others had pericardial thickening. Neither recent pleurisy, prednisone therapy, subcutaneous nodules, extra-articular rheumatoid involvement, rheumatoid factor titer nor erythrocyte sedimentation rate correlated with pericardial abnormalities. None of these 18 patients had a pericardial rub, signs of constriction, electrocardiographic S-T segment elevation or T wave inversion. The mitral valve E-F slope was normal in 46 of 51 patients, despite earlier reports of frequent E-F slope reduction in similar patients. Two patients with E-F slope less than 60 mm/sec had rheumatic mitral valve disease; three patients with intermediate slope (60 to 80 mm/sec) had ischemic, hypertensive or pulmonary heart disease, all of which may lower the E-F slope. Of four patients with depressed left ventricular performance (rate of internal diameter shortening less than 1.05 sec −1), only one had recurrent inflammatory pancarditis clinically consistent with rheumatoid heart disease. The other three had ischemic, rheumatic and hypertensive heart disease. We conclude that in unselected outpatients with rheumatoid arthritis (1) pericardial abnormalities by echocardiogram are common but usually clinically inapparent; (2) unexplained reduction of the E-F slope seldom, if ever, occurs; and (3) left ventricular performance is rarely depressed by rheumatoid carditis.