Cardiovascular disease in Crohnʼs and Ulcerative Colitis: An echocardiographic evaluation

Abstract

Inflammatory bowel disease (IBD) is a systemic affliction. Several case reports have linked pericardial tamponade and pericarditis to IBD and some suggest that cardiovascular disease (CVD) may be one of the extraintestinal manifestations of IBD. Little attention has been paid toward the study of CVD in IBD patients from an echocardiographic perspective. The aim of our study is to survey for such abnormalities in both Crohn's and Ulcerative Colitis as well as being among the first to report such findings in a predominantly black population, an often underreported IBD group. We conducted a retrospective cohort study, from January 2000 to December 2010, approved by our hospital's institutional review board. IBD patients (both inpatients and those seen in clinic) were collected by ICD-9 code and were analyzed for whether or not an echocardiogram was conducted, its indication and findings, demographics and IBD history. Patients under 18 were excluded. If a patient had more than one echocardiogram performed, only the first study was included in our analysis. Forty out of 294 IBD patients had an echocardiogram performed. Thirtysix patients were black (28 being Afro-Caribbean). Twenty-two patients were women. Fifteen patients had Crohn's. Twenty-two patients had exposure to steroids. Seven patients had exposure to immunomodulators. Thirteen patients had exposure to tobacco. Mean age and duration of IBD at time of echocardiogram was 51.5 and 9.3 years, respectively. Twenty patients had extraintestinal manifestations. See Table 1 and 2 for indications and echocardiogram findings. When it was observed that patients with rheumatoid arthritis had a high incidence of heart failure, further investigation led to findings of a lower left ventricular mass and increased end diastolic volume. In an Italian study from 2007, 69% of Crohn's patients had morphologic alterations. Our study affirms the importance of cardiac echo in the evaluation of autoimmune disease, such as IBD. While no large-sized effusions or severe valvulopathies were appreciated, it is well established that other imaging modalities such as cardiac MRI or cardiac PET-CT have better performance in detecting early cardiovascular abnormalities. Perhaps more significant findings could have been observed if the above were used. Given our small sample size, adjusting for cardiac risk factors (e.g. diabetes, family history) was not done but could be remedied with larger scale investigations. Despite our patient population's homogeneity being one of the study's strengths, it is also means results will lack generalizability. Finally, whether the 86% of our IBD patients who did not receive an echo need to have CVD screening is of debate.