Davis John M, Roger Véronique L, Crowson Cynthia S, Kremers Hilal Maradit, Therneau Terry M, Gabriel Sherine E
Mayo Clinic, Rochester, Minnesota, USA.
Arthritis Rheum. 2008 Sep;58(9):2603-11. doi: 10.1002/art.23798.
To compare the clinical presentation, management, and outcome of heart failure in patients with rheumatoid arthritis (RA) compared with non-RA patients.
We conducted a community-based cohort study in the setting of Olmsted County, Minnesota, from 1979 to 2000. One hundred three patients with RA and 852 non-RA patients with incident heart failure (physician diagnosed and Framingham criteria validated) were compared. Age- and sex-adjusted rates/frequencies and multivariable logistic regression models were used to compare the clinical features and mortality of heart failure following its onset in the 2 groups of patients.
The patients with RA were more often female and less frequently were obese, were hypertensive, or had ischemic heart disease. Patients with RA and heart failure had fewer typical symptoms and signs and were less likely to undergo echocardiography compared with non-RA patients. After adjusting for differences, the patients with RA and heart failure were more likely to have preserved ejection fraction (>or=50%). Mortality at 1 year following heart failure was higher in patients with RA compared with non-RA patients (35% versus 19%; multivariable hazard ratio 1.89, 95% confidence interval 1.26-2.84).
Both the clinical presentation and the outcome of heart failure differ significantly between patients with and those without RA from the same population. Among patients with RA, the presentation of heart failure is more subtle, myocardial function is more likely preserved, while mortality from heart failure is significantly higher. These findings emphasize the importance of more vigilant screening of patients with RA for early signs of heart failure and may represent important insights into the biologic mechanisms underlying heart failure in RA.
比较类风湿关节炎（RA）患者与非RA患者心力衰竭的临床表现、治疗及预后。
1979年至2000年，我们在明尼苏达州奥尔姆斯特德县开展了一项基于社区的队列研究。比较了103例RA患者和852例新发心力衰竭的非RA患者（经医生诊断并根据弗雷明汉标准验证）。采用年龄和性别调整后的发病率/频率以及多变量逻辑回归模型比较两组患者心力衰竭发病后的临床特征和死亡率。
RA患者女性居多，肥胖、高血压或患有缺血性心脏病的比例较低。与非RA患者相比，RA合并心力衰竭的患者典型症状和体征较少，接受超声心动图检查的可能性也较小。调整差异后，RA合并心力衰竭的患者更可能射血分数保留（≥50%）。RA患者心力衰竭后1年的死亡率高于非RA患者（35%对19%；多变量风险比1.89，95%置信区间1.26 - 2.84）。
来自同一人群的RA患者和非RA患者心力衰竭的临床表现和预后均存在显著差异。在RA患者中，心力衰竭的表现更为隐匿，心肌功能更可能保留，而心力衰竭导致的死亡率显著更高。这些发现强调了对RA患者更警惕地筛查心力衰竭早期迹象的重要性，可能代表了对RA患者心力衰竭潜在生物学机制的重要见解。
