WCIM 2014
44 32nd World Congress of Internal Medicine (October 24-28, 2014)
OS-RHEU-04 Rheumatology
Increased Risk of Acute Myocardial Infarction and Mortality in Patients with Systemic Lupus Erythemato- sus: Two Nationwide Retrospective Cohort Studies
Chien-Chang LIAO1, Ta-Liang CHEN1 Taipei Medical University Hospital, Taiwan R.O.C1
Background: This study evaluated the risk of acute myocardial infarction (AMI) and mortality among patients with systemic lupus erythematosus (SLE) in two nationwide retrospective cohort studies.
Methods: Using Taiwan’s National Health Insurance Research Database, we con- ducted a retrospective cohort study and identifi ed 1207 adults newly diagnosed with SLE in 2000-2004. Non-SLE cohort consisted of 9656 adults without SLE, frequen- cy-matched for age and sex and randomly selected from the same data set. Events of AMI were considered as outcome during the follow-up period between 2000 and 2008. Another nested cohort study of 6900 patients with AMI receiving cardiac sur- geries was conducted to analyze the impact of SLE on post-AMI mortality.
Results: During the follow-up period, there were 52 newly diagnosed AMI cases. The incidences of AMI for SLE cohort and non-SLE cohort were 2.10 and 0.49 per 1000 person-years, respectively, with an adjusted hazard ratio (HR) of 5.11 (95% confi dence interval [CI] 2.63-9.92). For females, the adjusted HR of AMI associated with SLE was as high as 6.28 (95% CI 2.67-14.7). Further analyses in the nested cohort showed SLE was signifi cantly associated with post-AMI mortality (odds ratio, 2.83; 95% CI 1.21- 6.64).
Conclusions: Patients with SLE had higher risk of AMI compared with non-SLE control, and this risk was more signifi cant in females. In addition, SLE is an independent risk factor for post-AMI mortality.
OS-RHEU-05 Rheumatology
Impact of Chronic Glucocorticoids Treatment on Cardi- ovascular Risk Profi le in Patients with Systemic Lupus Erythematosus
FERNANDO BRICEÑO2, LUIS PINEDA2, MAXIMILIANO GARCÍA1
Coordinación De Planeación De Infraestructura Médica-IMSS, Mexico1, Hospital de Especialidades, Centro Médico Nacional, Mexico2
Background: Systemic Lupus Erythematosus (SLE) is highly associated with premature atherosclerosis and cardiovascular events. The origin of this subclinical atherosclerosis is not completely clear, but has been attributed mainly to infl ammatory nature of dis- ease. The aim of this study was determine the effect of chronic glucocorticoids intake on cardiovascular risk profi le (CVRP) in patients with SLE.
Methods: A registry-based retrospective cohort study. The study subjects consisted of all patients with SLE meeting the ACR criteria seen at the Division of Internal Medicine on a tertiary care hospital. We registered CVRP with Framingham score at baseline and at the end of follow-up, as well as cumulative dose of glucocorticoids. Then we analyzed the correlation between increase on RCVP and the cumulative dose of gluco- corticoids. We also evaluated the change on Framingham score at baseline and at the end of follow-up. We used the Pearson correlation coeffi cient and one-sample T-Test.
Analyses were performed with SPSS software version 19.0.
Results: The cohort included 101 patients (94 female,7 male) with a mean age of 26.5±5SD years, mean age at study entry of 18.6±7SD years, mean disease duration 7.8±4.9SD years.The total follow-up was 7.8±4.9SD years. The mean daily dose of prednisone was 12±5SD mg. During 7.8 years of follow-up the Framingham score in- creased 8 points, from -8.1±4 at baseline to 0.8±7 at the end of study (p<0.0001).The Pearson correlation coeffi cient between the rise on RCVP and the cumulative dose of glucocorticoids was 0.74 (p<0.001).
Conclusions: The chronic treatment with glucocorticoids plays a fundamental role on the high risk of cardiovascular disease in patients with SLE, and its effect is dose-de- pendent. The Framingham score is not an appropriate tool for predict the risk of cardi- ovascular disease in patients with SLE due their young age.
OS-RHEU-06 Rheumatology
Impaired Functional Capacity in Patients with Systemic Sclerosis is Related to the Right Ventricle Dysfunction
Eugene J. KUCHARZ1, Katarzyna MIZIA-STEC2, Klaudia GIESZCZYK-STROZIK2, Agnieszka SIKORA-PUZ2, Maciej HABERKA2, Magdalena MIZIA2, Jadwiga PAJAK2, Jan BARON3, Katarzyna GRUSZCZYNSKA3, Internal Medicine And Rheumatology, Malgorzata WIDUCHOWSKA1, Magdalena KOPEC-MEDREK1, Anna KOTULSKA1, Zbigniew GASIOR4 Internal Medicine and Rheumatology, Medical University of Silesia, Poland1, First, Cardiology, Medical University of Silesia, Poland2, Radiology, Medical University of Silesia, Poland3, Second, Cardiologz, Medical University of Silesia, Poland4
Background: Systemic sclerosis (SSc) is characterized by cardiovascular abnormali- ties which may affect patient’s clinical symptoms. The study was designed to assess whether the impaired exercise tolerance in patients with SSc without overt cardi- opulmonary complications is related to the left ventricle (LV) or right ventricle (RV) dysfunction and vascular remodeling.
Methods: Forty seven patients (F/M:36/11;age51.7±9.9) with defi nite SSc and clinical symptoms of heart failure (NYHA I/II) were enrolled into the study. In all the patients, pulmonary arterial hypertension (PAH), pulmonary fi brosis, left ventricle (LV) systolic dysfunction and valvular heart diseases were excluded. The following tests were performed: echocardiography, ultrasound vascular indexes: fl ow mediated dilatation, nitroglycerin mediated dilatation and arterial tonometry parameters: pulse wave ve- locity, pulse pressure and augmentation index. The above indexes were related to the 6 minute walk test (6MWT) Results:
Results: The 6MWT mean value was 440.0±72m. LV diastolic dysfunction parameters did not correlate with 6MWT. RV systolic dysfunction (fraction area change<32%), decreased tricuspid annular plane systolic excursion (TAPSE < 20mm) or low peak sys- tolic velocity of lateral tricuspid annulus (TDI: RV S’ <20cm/s) were found in 1(2.1%), 5(10.6%), 43(91.5%) patients, respectively. The 6MWT values correlated with TAPSE (r=0.318, p=0.030) and TDI: RV S’ (r= -0.295, p=0.048). There were no signifi cant cor- relations between ultrasound and arterial tonometry parameters and 6MWT values.
Conclusions: After exclusion of typical causes of low exercise capacity in SSc patients, the shortened 6MWT distance observed in this group seems to be related to the RV systolic impairment, and this fi nding supports regular echocardiographic screening for early detection of cardiac complications in SSc.
OS-RHEU-07 Rheumatology
Predicting Death in Patients with Primary Sjogren Syn- drome: Prognostic Factors and Standardized Mortality Ratio in Comparison to the General Population (RESSP- GEAS-SEMI)
Pilar BRITO ZERÓN2, Marta PEREZ DE LIS NOVO1, Belchin KOSTOV3, Roser SOLANS4, Guadalupe FRAILE5, Carlos SUÁREZ CUERVO6, Arnau CASANOVAS7, Francisco Javier RASCÓN8, Rami QANNETA9, Roberto PÉREZ ALVAREZ10, Mar RIPOLL12, Isabel GARCÍA SÁNCHEZ11, Blanca PINILLA13, Marc RAMENTOL4, Juan NAVA5, José Bernardino DÍAZ LÓPEZ6, Hoda GHEITASI2, Soledad RETAMOZO2, Manuel RAMOS CASALS2
CHUVI, Spain1, Hospital Clinic, Spain2, Centre d’Assistència Primària ABS Les Corts, CAPSE, Spain3, Vall D’He- bron Hospital, Spain4, Ramón y Cajal Hospital, Spain5, Hospital Universitario Central de Asturias, Spain6, Parc Taulí Hospital, Spain7, Son Espases Hospital, Spain8, Joan XXIII Hospital, Spain9, Meixoeiro Hospital, Spain10, Infanta Leonor Hospital, Spain11, Infanta Sofía Hospital, Spain12, Gregorio Marañon Hospital, Spain13 Background: To analyze prognostic factors and standardized mortality ratio (SMR) with respect to the general population in a cohort of Spanish patients with primary Sjögren’s syndrome (SS).
Methods: In October 2013, the RESSP-GEAS-SEMI database included 1045 consecutive patients who met the 2002 SS-criteria. Hazard ratios (HR) and confi dence intervals (95%
CI) obtained in the adjusted regression model were calculated. The SMR was estimated using the life tables of the general population of Spain in 2012.
Results: The cohort included 982 (94%) women with a mean age at diagnosis of 54 years and a mean disease evolution of 118 months; 115 (11%) patients died due to sys- temic disease (n=18), infection (n=21), cardiovascular disease (n=35), hematologic ma- lignancy (n=10) and other causes (n=31). The SMR for the total cohort of patients (ad- justed for age and sex with the general Spanish population) was 4.66. Survival rates at 5, 10, 20 and 30 years were 96.0%, 90.5%, 80.9% and 60.4%, respectively. The Cox-re- gression analysis identifi ed the following baseline variables at diagnosis associated with death: male gender (HR 2.98, p<0.001), altered parotid scintigraphy (HR 2.81, p=0.043), lymphopenia (HR 1.63, p=0.034), anti-La antibodies (HR 1.51, p=0.034), low C3 (HR 1.93, p=0.034), low C4 (HR 2.06, p=0.016), monoclonal gammopathy (HR 1.81, p=0.047) and cryoglobulins (HR 2.58, p<0.001). The main baseline factors associated with mortality caused by systemic disease were systemic-activity at diagnosis, cytopenias, monoclonal gammopathy, cryoglobulins, and hypocomplementemia.
Conclusions: Primary SS should not be considered a mild disease, since mortality is almost 5 times greater with respect to general population, with an overall survival at 20 years of 81%. Patients with a lower survival are those who present with active disease at diagnosis and associated immunological markers of B-cell hyperactivity.
