vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"vestim-385Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEМУЛЬТИСПИРАЛЬНАЯ КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ КОРОНАРНОГО АТЕРОСКЛЕРОЗА У ПАЦИЕНТОВ С РЕВМАТОИДНЫМ АРТРИТОМMULTISPIRAL COMPUTER TOMOGRAPHY IN CORONARY ARTERY ATHEROSCLEROSIS DIAGNOSIS IN PATIENTS WITH RHEUMATOID ARTHRITISКуракТ. А.KurakT. A.

канд. мед. наук, доцент

Ph. D. (Med.), Assistant Professor

kurak.tatjana@gmail.comАвдейЛ. Л.AvdeyL. L.

канд. мед. наук, заведующий отделением

Ph. D. (Med.), Head of the Department

mkdc@tut.byИльинаТ. В.IlyinaT. V.

заведующий отделением

Head of the Department

its4ita@gmail.comМитьковскаяН. П.MitkovskayaN. P.

д-р мед. наук, профессор, заведующий кафедрой

D. Sc. (Med.), Professor, Head of the Department

mitkovskaya1@mail.ruБелорусский государственный медицинский университетБеларусьBelarusian State Medical UniversityBelarusМинский консультационно-диагностический центрБеларусьMinsk Diagnostic CenterBelarusРеспубликанский научно-практический центр «Кардиология»БеларусьScientific and Medical Research Center «Cardiology»Belarus201708102017035663Copyright © Курак Т.А., Авдей Л.Л., Ильина Т.В., Митьковская Н.П., 20172017Курак Т.А., Авдей Л.Л., Ильина Т.В., Митьковская Н.П.Kurak T.A., Avdey L.L., Ilyina T.V., Mitkovskaya N.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/385

Изучена взаимосвязь данных, полученных при скрининге коронарного кальция и компьютерно- томографической ангиографии коронарных артерий у пациентов с ревматоидным артритом. Установлено, что с помощью коронарного кальциевого индекса можно определять распространенность и тяжесть коронарного атеросклероза. При стратификации кардиоваскулярного риска у данной категории пациентов помимо оценки традиционных факторов сердечно-сосудистого риска необходимо учитывать активность системного воспаления.

 

A link between the coronary calcium and coronary stenosis revealed by multispiral computer tomography in patients with rheumatoid arthritis was studied. Coronary artery calcium indicates the prevalence and severity of coronary atherosclerotic lesions. Traditional cardiovascular risk factors and systemic inflammatory activity should be considered in cardiovascular risk stratification in patients with rheumatoid arthritis.

ревматоидный артритатеросклерозмультиспиральная компьютерная томографиявоспалениеrheumatoid arthritisatherosclerosismultispiral computer tomographyinflammationReferencesMortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis / A. Young [et al.] // Rheumatology. – 2007. – Vol. 46, iss. 2. – P. 350–357.Young A., Koduri G., Batley M., Kulinskaya E., Gough A., Norton S., Dixey J. Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis. Rheumatology, 2007, vol. 46, no. 2, pp. 350–357. doi: 10.1093/rheumatology/kel253.Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study / A. Naranjo [et al.] // Arthritis Res. Ther. – 2008. – Vol. 10, iss. 2. – P. 30.Naranjo A., Sokka T., Descalzo M. A., Calvo-Alйn J., Hшrslev-Petersen K., Luukkainen R. K., Combe B., Burmester G. R., Devlin J., Ferraccioli G., Morelli A., Hoekstra M., Majdan M., Sadkiewicz S., Belmonte M., Holmqvist A. C., Choy E., Tunc R., Dimic A., Bergman M., Toloza S., Pincus T. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Research and Therapy, 2008, vol. 10, no. 2, p. 30. doi: 10.1186/ar2383.Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study / H. Maradit-Kremers [et al.] // Arthritis Rheum. – 2005. – Vol. 52, iss. 2. – P. 402–411.Maradit-Kremers H., Crowson C. S., Nicola P. J., Ballman K. V., Roger V. L., Jacobsen S. J., Gabriel S. E. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis and Rheumatism, 2005, vol. 52, no. 2, pp. 402–411. doi:10.1002/art.20853.Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study / K. J. Warrington [et al.] // Arthritis Res. Ther. – 2005. – Vol. 7, iss. 5. – P. 984–991.Warrington K. J., Kent P. D., Frye R. L., Lymp J. F., Kopecky S. L., Goronzy J. J., Weyand C. M. Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study. Arthritis Research and Therapy, 2005, vol. 7, no. 5, pp. 984–991.Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis / M. C. Aubry [et al.] // J. Rheumatol. – 2007. – Vol. 34, iss. 5. – P. 937–942.Aubry M. C., Maradit-Kremers H., Reinalda M. S., Crowson C. S., Edwards W. D., Gabriel S. E. Differences in athero-sclerotic coronary heart disease between subjects with and without rheumatoid arthritis. The Journal of Rheumatology, 2007, vol. 34, no. 5, pp. 937–942.Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis / A. Sodergren [et al.] // Ann. Rheum. Dis. – 2007. – Vol. 66, iss. 2. – P. 263–266.Sцdergren A., Stegmayr B., Lundberg V., Ohman M. L., Wеllberg-Jonsson S. Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis. Annals of Rheumatic Diseases, 2007, vol. 66, no. 2, pp. 263–266. doi:10.1136/ard.2006.052456.Синицын, В. Е. Новая роль мультиспиральной компьтерной томографии в диагностике болезней сердца и со-судов / В. Е. Синицын, С. К. Терновой // Терапевт. архив. – 2007. – № 4. – C. 5–10.Sinitsyn V. E., Ternovoi S. K. New role of multispiral computed tomography in heart and vessels diseases diagnostic. Terapevticheskii arkhiv [Therapeutic archive], 2007, no. 4, pp. 5–10. (in Russian).Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study / J. A. Rumberger [et al.] // Circulation. – 2000. – Vol. 92, iss. 74. – P. 2157–2162.Rumberger J. A., Simons D. B., Fitzpatrick L. A., Sheedy P. F., Schwartz R. S. Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerotic plaque area: а histopathologic correlative study. Circulation, 2000, vol. 92, no. 74, pp. 2157–2162.A hypothesis for vulnerable plaque rupture due to stress-induced debonding around cellular microcalcifications in thin fibrous caps / Y. Vengrenyuk [et al.] // Proc. Natl. Acad. Sci. USA. – 2006. – Vol. 103, iss. 40. – P. 14678–14683.Vengrenyuk Y., Carlier S., Xanthos S., Cardoso L., Ganatos P., Virmani R., Einav S., Gilchrist L., Weinbaum S. A hypothesis for vulnerable plaque rupture due to stress-induced debonding around cellular microcalcifications in thin fibrous caps. Proceedings of the National Academy of Sciences of the USA, 2006, vol. 103, no. 40, pp. 14678–14683. doi: 10.1073/pnas.0606310103.Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis / M. J. Pletcher [et al.] // Arch. Intern. Med. – 2004. – Vol. 164, iss. 12. – P. 1285–1292.Pletcher M. J., Tice J. A., Pignone M., Browner W. S. Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Archives of Internal Medicine, 2004, vol. 164, no. 12, pp. 1285–1292.Coronary arterial calcification in rheumatoid arthritis: comparison with the multi-ethnic study of atherosclerosis / J. T. Giles [et al.] // Arthritis Res. Ther. – 2009. – Vol. 11, iss. 2. – P. 36.Giles J. T., Szklo M., Post W., Petri M., Blumenthal R. S., Lam G., Gelber A. C., Detrano R., Scott W. W. Jr., Kronmal R. A., Bathon J. M. Coronary arterial calcification in rheumatoid arthritis: comparison with the multi-ethnic study of atherosclerosis. Arthritis Research and Therapy, 2009, vol. 11, no. 2, p. 36.Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis / M. R. Evans [et al.] // Arthritis Rheum. – 2011. – Vol. 63, iss. 5. – P. 1211–1220.Evans M. R., Escalante A., Battafarano D. F., Freeman G. L., O’Leary D. H., del Rincуn I. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis and Rheumatism, 2011, vol. 63, no. 5, pp. 1211–1220. doi: 10.1002/art.30265.Exercise echocardiography in rheumatoid arthritis: a case-control study / M. K. Saghir [et al.] // J. Am. Soc. Echocardiogr. – 2009. – Vol. 22, iss. 11. – P. 1228–1231.Saghir M. K., Attenhofer Jost C., Warrington K. J., Cha S. S., Pellikka P. A. Exercise echocardiography in rheumatoid arthritis: a case-control study. Journal of American Society of Echocardiography, 2009, vol. 22, no. 11, pp. 1228–1231.Факторы риска кардиоваскулярных заболеваний при ревматоидном артрите / Т. В. Попкова [и др.] // Науч.-практ. ревматология. – 2009. – № 3. – C. 4–12.Popkova T. V., Novikova D. S., Pisarev V. V., Mach E. S., Nasonov Ye. L. Cardiovascular risk factors in rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya [Science and Practical Rheumatology], 2009, no. 3, pp. 4–12. (in Russian).Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? / A. Gonzalez [et al.] // Ann. Rheum. Dis. – 2008. – Vol. 67, iss. 1. – P. 64–69.Gonzalez A., Maradit Kremers H., Crowson C. S., Ballman K. V., Roger V. L., Jacobsen S. J., O’Fallon W. M., Gabriel S. E. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? Annals of Rheumatic Diseases, 2008, vol. 67, no. 1, pp. 64–69. doi:10.1136/ard.2006.059980.Mirjafari, H. Cardiovascular risk factors in inflammatory arthritis / H. Mirjafari, A. Al-Husain, I. N. Bruce // Curr. Opin. Lipidol. – 2011. – Vol. 22, iss. 4. – P. 296–301.Mirjafari H., Al-Husain A., Bruce I. N. Cardiovascular risk factors in inflammatory arthritis. Current Opinion in Lipidology, 2011, vol. 22, no. 4, pp. 296–301. doi: 10.1097/MOL.0b013e3283488c50.Терновой, С. К. Неинвазивная диагностика атеросклероза и кальциноза коронарных артерий / С. К. Терновой. – М.: Атмосфера, 2003 – 415 c.Ternovoi S. K. Noninvasive diagnostic of atherosclerosis and coronary artery calcinosis. Moscow, Atmosfera [Atmosphere], 2003. 415 p. (in Russian).ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain / P. Greenland [et al.] // JACC. – 2007. – Vol. 49, iss. 3. – P. 378–402.Greenland P., Bonow R. O., Brundage B. H., Budoff M. J., Eisenberg M. J., Grundy S. M., Lauer M. S., Post W. S., Raggi P., Redberg R. F., Rodgers G. P., Shaw L. J., Taylor A. J., Weintraub W. S. ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain. Journal of American College of Cardiology, 2007, vol. 49, no. 3, pp. 378–402.Определение кальция в коронарных артериях: новые возможности стратификации риска развития сердечно-сосудистых осложнений у пациентов с аутоиммунными заболеваниями / Д. С. Новикова [и др.] // Науч.-практ. ревматология. – 2009. – № 3. – С. 60–66.Novikova D. S., Popkova T. V., Mach E. S., Nasonov E. L. Coronary calcium: new opportunities in cardiovascular risk stratification in patients with autoimmune diseases. Nauchno-prakticheskaja revmatologija [Science and Practical Rheumatology], 2009, no. 3, pp. 60–66. (in Russian).Accelerated atherosclerosis in rheumatoid arthritis / Z. Szekanecz [et al.] // Ann. NY Acad. Sci. – 2007. – Vol. 1108. – P. 349–358.Szekanecz Z., Kerekes G., Dér H., Sándor Z., Szabó Z., Végvári A., Simkovics E., Soós L., Szentpétery A., Besenyei T., Szücs G., Szántó S., Tamási L., Szegedi G., Shoenfeld Y., Soltész P. Accelerated atherosclerosis in rheumatoid arthritis. Annals of the New York Academy of Science, 2007, vol. 1108, pp. 349–358.High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors / del I. D. Rincon [et al.] // Arthritis Rheum. – 2001. – Vol. 44, iss. 12. – P. 2737–2745.Del Rincуn I. D., Williams K., Stern M. P., Freeman G. L., Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis and Rheumatism, 2001, vol. 44, no. 12, pp. 2737–2745.Wolfe, F. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis / F. Wolfe, B. Freundlich, W. L. Straus // J. Rheumatol. – 2003. – Vol. 30, iss. 1. – P. 36–40.Wolfe F., Freundlich B., Straus W. L. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. The Journal of Rheumatology, 2003, vol. 30, no. 1, pp. 36–40.Influence of nonclassical cardiovascular risk factors on the accuracy of predicting subclinical atherosclerosis in rheumatoid arthritis / P. H. Dessein [et al.] // J. Rheumatol. – 2007. – Vol. 34, iss. 5. – P. 943–951.Dessein P. H., Norton G. R., Woodiwiss A. J., Joffe B. I., Wolfe F. Influence of nonclassical cardiovascular risk factors on the accuracy of predicting subclinical atherosclerosis in rheumatoid arthritis. The Journal of Rheumatology, 2007, vol. 34, no. 5, pp. 943–951.Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five year prospective study / L. Innala [et al.] // Arthritis Res. Ther. – 2011. – Vol. 13, iss. 4. – P. 131.Innala L., Mцller B., Ljung L., Magnusson S., Smedby T., Sцdergren A., Цhman M. L., Rantapдд-Dahlqvist S., Wеllberg-Jonsson S. Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five year prospective study. Arthritis Research and Therapy, 2011, vol. 13, no. 4, p. 131.Kleinert, S. Cardiovascular comorbidity and its risk factors in rheumatoid arthritis / S. Kleinert, K. Krueger // Rheumatol. – 2011. – Vol. 70, iss. 6. – P. 464–472.Kleinert S., Krueger K. Cardiovascular comorbidity and its risk factors in rheumatoid arthritis. Rheumatology, 2011, vol. 70, no. 6, pp. 464–472. doi:10.1007/s00393–011–0755–0.Chung, C. P. Increased coronary artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors / C. P. Chung, A. Oeser, P. Raggi // Arthritis Rheum. – 2005. – Vol. 52, iss. 10. – P. 3045–3053.Chung C. P., Oeser A., Raggi P. Increased coronary artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors. Arthritis and Rheumatism, 2005, vol. 52, no. 10, pp. 3045–3053.Kao, A. H. C-reactive protein and coronary artery calcium in asymptomatic women with systemic lupus erythematosus or rheumatoid arthritis / A. H. Kao, M. C. Wasko, S. Krishnaswami // Am. J. Cardiol. – 2008. – Vol. 102, iss. 6. – P. 755–760.Kao A. H., Wasko M. C., Krishnaswami S. C-reactive protein and coronary artery calcium in asymptomatic women with systemic lupus erythematosus or rheumatoid arthritis. American Journal of Cardiology, 2008, vol. 102, no. 6, pp. 755–760.Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis / Y. H. Rho [et al.] // Arthritis Rheum. – 2009. – Vol. 61, iss. 11. – P. 1580–1585.Rho Y. H., Chung C. P., Oeser A., Solus J., Asanuma Y., Sokka T., Pincus T., Raggi P., Gebretsadik T., Shintani A., Stein C. M. Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis. Arthritis and Rheumatism, vol. 61, 2009, no. 11, pp. 1580–1585. doi: 10.1002/art.25009.Ребров, А. П. Факторы риска развития сердечно-сосудистых заболеваний при псориатическом и ревматоидном артритах / А. П. Ребров, Н. М. Никитина, И. З. Гайдукова // Терапевт. архив. – 2011. – № 83. – C. 20–24.Rebrov A. P., Nikitina N. M., Gaidukova I. Z. Cardiovascular risk factors in rheumatoid and psoriatic arthritis. Terapevticheskii arkhiv [Therapeutic archive], 2011, vol. 83, pp. 20–24. (in Russian).Bisoendial, R. J. Critical determinants of cardiovascular risk in rheumatoid arthritis / R. J. Bisoendial, E. S. Stroes, P. P. Tak // Curr. Pharm. Des. – 2011. – Vol. 17, iss. 1. – P. 21–26.Bisoendial R. J., Stroes E. S., Tak P. P. Critical determinants of cardiovascular risk in rheumatoid arthritis. Current Pharmaceutical Design, 2011, vol. 17, no. 1, pp. 21–26.Systemic inflammation as a risk factor for atherothrombosis / van S. I. Leuven [et al.] // Rheumatology. – 2008. – Vol. 47, iss 1. – P. 3–7.Van Leuven S. I., Franssen R., Kastelein J. J., Levi M., Stroes E. S., Tak P. P. Systemic inflammation as a risk factor for atherothrombosis. Rheumatology, 2008, vol. 47, no. 1, pp. 3–7. doi:10.1093/rheumatology/kem202.Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study / H. K. Choi [et al.] // Lancet. – 2002. – Vol. 359, iss. 9313. – P. 1173–1177.Choi H. K., Hernán M. A., Seeger J. D., Robins J. M., Wolfe F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet, 2002, vol. 359, no. 9313, pp. 1173–1177.

The authors declare that there are no conflicts of interest present.