Increase in serum triglyceride was associated with coronary plaque vulnerability in a patient with rheumatoid arthritis

AbstractRates of morbidity and mortality from cardiovascular disease are high in patients with rheumatoid arthritis (RA); however, the mechanisms and biomarkers that reflect coronary plaque vulnerability have not yet been established. We present a case of acute coronary syndrome (ACS) presumably caused by exacerbation of chronic inflammation of RA, in which an abrupt increase in serum triglyceride was seen on the day of onset of ACS but not during effort angina. This case suggests that RA patients with an abrupt increase in triglyceride need intensive care including anti-platelet and statin therapy for the prevention of coronary plaque rupture.<Learning objective: Triglyceride might be a sensitive biomarker of activated macrophages and plaque vulnerability in patients with RA. RA patients with an abrupt increase in triglyceride might need intensive care including anti-platelet and statin therapy for the prevention of coronary plaque rupture.

シン サルコイドーシス シンダン ノ テビキ ニオケル カクシュ シンダン モダリティー ノ ケントウ

Background : Sarcoidosis is a multiple organ granulomatous disease of undefined cause. Although cardiac involvement often leads to adverse outcomes in patients with sarcoidosis, diagnosis of cardiac sarcoidosis（CS）remains difficult due to the lack of sensitive diagnostic tests. Purpose : To determine an appropriate combination of diagnostic tests for detecting CS. Method and Results : Thirteen patients were diagnosed with CS from December ２００６ to November２０１０by the use of２００６revised guidelines for diagnosing CS of the Japanese Society of Sarcoidosis and Other Granulomatous Disorders. Positive rate of each major or minor criterion in the guidelines was examined. We also evaluated positive rate of each diagnostic test. In the major criteria, basal thinning of the ventricular septum showed a high positive rate of７１．４％, although the others were less than５０％. In the minor criteria, positive rates of abnormal electrocardiogram findings and abnormal echocardiogram were７６．９％ and８４．６％, respectively. Late gadolinium enhancement （LGE）of the myocardium on cardiac MRI scanning（CMR）showed a positive rate of１００％ ; however, CMR was not performed in four patients due to life-threatening arrhythmia. All１３patients showed abnormal findings at least in either echocardiogram or LGE on CMR. Conclusion : Echocardiography is a convenient diagnostic test for detecting CS. The combination of cardiac MRI and echocardiography may improve diagnostic sensitivity