Clinical Analysis Of Heart Damage In Connective Tissue Disease

Background Connective tissue disease(CTD)is a multisystemic disease which affects the skin,joints,kidneys and other organs.It is also aggravates or induces cardiovascular disease.The clinical phenotype of CTD-related cardiac damages are often hidden.Diagnosis and treatment of cardiac damages are not timely,which will affect the prognosis.Objective Analyzing and summarizing the clinical features,the therapy and review the literatures of CTD combined with heart damages to improve the clinician’s understanding of these damages.It is benefical to achieving early diagnosis and treatment of these diseases,it is also improving the quality of life and the prognosis of those patients.Methods A retrospective analysis method was used to collect 205 patients suffering from CTD combined with heart damages in the Affiliated Hospital of Zunyi Medical College from January 2016 to December 2017.There were 83 patients with systemic lupus erythematosus(SLE),72 patients with rheumatoid arthritis(RA),30 patients with systemic sclerosis(SSc),and 20 patients with polymyositis(PM).The general information,clinical symptoms and signs,various biochemical tests and clinical examination results,and relevant treatment clinical datas were collected,and statistical analysis of the clinical features of different damages were measured.Results1.The occurrence of heart damage in each CTD:A total of 83 patients(83/170,48.82%)suffering from SLE combined with heart damages,72 patients(72/416,18.51%)suffering from RA combined with heart damages,30 patients(30/54,55.56%)suffering from SSc combined with heart damages,and 20patients(20/99,20.20%)suffering from PM combined with heart damages.2.General characteristics and main features of CTD combined with cardiac damage:(1)SLE: The sex ratio of male to female was 1:6.55(11/72),the average age was36.05±15.25 years;the course <1 year have 46 patients(55.42%).Sinus tachycardia occurred in 30 cases(36.14%),T wave changes in 25 cases(30.12%).Pericardial effusion was found in 40 cases(48.19%),diastolic dysfunction in 14 cases(16.87%),mitral valve involvement in 31 cases(37.35%),tricuspid valve involvement in 37 cases(44.58%),and aortic valve involvement in 11 cases(13.25%),pulmonary valve involvement in 15 cases(18.07%),pulmonary hypertension in 8 cases(9.64%).(2)RA: The sex ratio of men and women was 1:1.78(26/46),the average age was 59.14±10.88 years,the course ≥10 years have 38 cases(52.78%).Sinus tachycardia occurred in20 cases(27.78%),atrial fibrillation in 1 case(1.39%)and T wave changes in 22 cases(31.94%).Pericardial effusion was found in 19 cases(26.39%),diastolic dysfunction in 30cases(41.67%),mitral valve involvement in 14 cases(19.44%),tricuspid valve involvement in 26 cases(36.11%),and aortic valve involvement in 5 cases(18.06%),pulmonary valve involvement in 5 cases(6.94%),pulmonary hypertension in 2 cases(2.78%).(3)SSc: The sex ratio of male to female was 1:2.75(8/22);the average age was54.07±13.08 years,there was no obvious time trend in the course of the disease.Sinus tachycardia occurred in 12 cases(40.00%),T wave changes in 5 cases(16.67%).Pericardial effusion was found in 11 cases(36.67%),diastolic dysfunction in 17 cases(56.67%),mitral valve involvement in 13 cases(43.33%),tricuspid valve involvement in21 cases(70.00%),and aortic valve involvement in 5 cases(16.67%),pulmonary valve involvement in 5 cases(13.33%),pulmonary hypertension in 3 cases(10.00%).(4)PM: The sex ratio of male to female was 1:4(4/16),the average age was 51.20±11.67 years,the course <1 year have 13 patients(65.00%).Sinus tachycardia occurred in 7 cases(35.00%),atrial flutter in 1 case(5.00%),and T wave changes in 8 cases(40.00%).Pericardial effusion was found in 7 cases(35.00%),diastolic dysfunction in 6 cases(30.00%),mitral valve involvement in 6 cases(30.00%),tricuspid valve involvement in 12cases(60.00%),and aortic valve involvement in 4 cases(20.00%),pulmonary valve involvement in 1 case(5.00%),pulmonary hypertension in 1 case(5.00%).Conclusion1.Characteristics of the distribution of cardiac lesions in CTD: Cardiac damage in SLE and PM often occurs in the early course;cardiac damage in RA often occurs in the late course.2.Cardiac lesions of SLE and PM have the highest occurrence in 1 year;RA combined with heart damages more frequently after 10 years.2.Electrocardiographic characteristics of CTD combined with heart damages: Sinus tachycardia is the most common type of the characteristics,followed by T wave changes;RA and PM patients have the risk of atrial fibrillation.3.Echocardiographic characteristics of CTD combined with heart damages: Heart valve damage,pericardial effusion,diastolic cardiac dysfunction,pulmonary hypertension are common manifestations of CTD cardiac damage.4.Characteristic of CTD combined with heart valve damage: Each heart valve can be involved,but the tricuspid valve and the mitral valve damage are most common,pulmonary valve damage is relatively rare.5.CTD features of cardiac dysfunction: CTD-induced cardiac dysfunction,diastolic dysfunction is the main performance.