| Objective:We conducted the current study to:(1) investigate the clinical features of cardiac involvement in polymyositis (PM) or dermatomyositis (DM).(2) study the characteristics of heart disease in PM/DM with Chinese patients.(3) explore heart function in PM/DM patients without overt clinical cardiovascular manifestations by Tissue Doppler Imaging (TDI) echocardiography and plasma N-terminal B-type natriuretic peptide (NT-proBNP), and to analyze the risk factors for early cardiac impairment.Methods:(1) All articles published in English were retrieved by searching MEDLINE via PubMed (1975-2011). After selecting eligible articles according to the predefined inclusion and exclusion criteria, a systemic review was carried out.(2) Data were obtained from retrospective investigation of patients with PM/DM in Department of Rheumatology of21hospitals across China. The data about clinical manifestation, auxillary examination, electrocardiogram and echocardiography were caculated.(3) The study population included46PM/DM patients who did not have overt cardiovascular manifestations and21age-and gender-matched healthy controls. Traditional echocardiography, TDI and NT-proBNP were used to evaluate cardiac function in both groups. Clinical characteristics were recorded. Multivariate logistics regression analysis was applied to investigate risk factors for early cardiac impairment in patients with PM/DM.Results:(1) A total of26articles were included in this study, which included1530patients.The incidence of cardiac involvement was9%～72%. Heart failure was the most frequent (32%-77%) clinical symptom.Among the abnormal electrocardiogram and ultrasonic cardiogram, the incidence of conduction abnormalities, left ventricular diastolic dysfunction, and hyperkinetic left ventricular contraction were25%-38.5%,42%, and6%-12%, respectively. The pathologic findings revealed myocardial inflammation, degenerative changes and necrosis similar to that in skeletal muscles.Cardiac manifestations of some patients improved after glucocorticoid and immunosuppressant treatment.Thirty-seven patients (46.3%) died as a direct result of heart disease.(2)1021patients were included in this study.The incidence of abnormal ECG and UCG were45.1%and24.4%respectively. Among the arrhythmia, sinus tachycardia was most common (10.7%), and3.9%of patients developed conduction block. Changes of heart abnormalities obtained by echocardiography include left ventricular enlargement(8.8%), left ventricular diastolic dysfunction(7.4%) and regurgitation in tricuspid valve (6.9%). Retrospective investigation showed that the patients with poor muscle strength were predisposed to conduction block. Advanced age and duration of disease were risk factors for left ventricular diastolic dysfunction. Pulmonary arterial hypertension had correlation with interstial lung disease.(3) No significant difference was found between patients and healthy controls by traditional echocardiography. However, compared to healthy controls, PM/DM patients had a significantly lower ratio of early diastolic mitral annulus velocity to late diastolic mitral annulus velocity (Em/Am)[(1.23±0.52),(1.79±0.37), t=-4.485, p<0.001] and a higher ratio of peak early diastolic transmitral flow velocity to Em (E/Em)[(8.26±2.57),(6.76±1.17), t=3.287, p<0.05] as found by TDI measurements. There was no significant difference between the TDI parameters of PM and DM patients. The multivariate regression analysis showed that female gender (OR11.044,95%CI1.066～114.357, P=0.044), late onset (OR=1.157,95%CI1.047-1.278, P=0.004) and duration of disease (OR=1.060,95%CI1.008-1.115, P=0.023) were risk factors for abnormal left ventricular filling pressures. The level of NT-proBNP was positively correlated with the E/Em values (r=0.687, p=0.000). The area under receiver operating characteristic curve (AUC) of NT-proBNP was0.858for early diastolic dysfunction diagnosis, p<0.001, and with the optimal cut-off value of120pg/ml, NT-proBNP showed a diagnostic sensitivity of0.818and specificity of0.917。Conclusions:(1) Heart abnormalities are frequent in patients with PM/DM, most of which were subclinical. The efficacy of glucocorticoids and immunosuppressants is uncertain.Cardiac involvement is acommon cause of death.(2) ECG and UCG abnormalities were common in PM/DM patients. The patients with poor muscle strength were predisposed to conduction block. Advanced age and duration of disease were risk factors for left ventricular diastolic dysfunction.(3) TDI is a useful tool for detecting early cardiac impairment in PM/DM patients. Left ventricular diastolic dysfunction is an early feature of cardiac involvement. Female gender, late onset and long course of disease are three independent risk factors for predicting early left ventricular diastolic dysfunction in patients with PM/DM. |
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