Roldan Carlos A, DeLong Christine, Qualls Clifford R, Crawford Michael H
University of New Mexico School of Medicine and Veterans Affairs Medical Center, Albuquerque, New Mexico, USA.
Am J Cardiol. 2007 Aug 1;100(3):496-502. doi: 10.1016/j.amjcard.2007.03.048. Epub 2007 Jun 14.
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 < or =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.
与类风湿关节炎（RA）相关的心脏瓣膜病（VHD）尚未得到充分描述，其临床预测因素也不明确。因此，对34名平均年龄为50±10岁的类风湿关节炎志愿者进行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检查结果与34名平均年龄为42±6岁、性别匹配的健康志愿者的检查结果进行比较。20例患者（59%）主要（97%）患有左侧心脏瓣膜病（瓣膜结节11例，占32%；瓣膜增厚18例，占53%；瓣膜反流7例，占21%；瓣膜狭窄1例，占3%），而对照组有5例（15%；[结节1例，占3%；增厚4例，占12%；反流1例，占3%；与患者相比，所有差异p≤0.05]）。瓣膜结节通常为单个且较小（4至12毫米）；呈椭圆形，边界规则，超声心动图反射均匀；通常位于瓣叶基部或中部；对主动脉瓣和二尖瓣的影响相同。瓣膜增厚同样呈弥漫性或局限性；当局限时影响瓣叶的任何部分；通常为轻度（89%）；二尖瓣和主动脉瓣受累情况相似（分别为47%和32%）；很少（6%）累及瓣环和瓣下结构。瓣膜反流表现为4例轻度主动脉反流、4例中度二尖瓣反流和1例中度三尖瓣反流。二尖瓣和主动脉瓣狭窄各有1例患者（3%）。未发现心脏瓣膜病与类风湿关节炎的病程、活动度、严重程度、起病方式和病程、关节外疾病、血清学或治疗之间存在相关性。总之，类风湿关节炎相关的心脏瓣膜病很常见，瓣膜结节和增厚是其独特特征，且与类风湿关节炎的临床变量无关。
