Hagendorff A, Pfeiffer D
Medizinische Universitätsklinik und Poliklinik, Abteilung Kardiologie/Angiologie, Johannisallee 32, 04103, Leipzig, Germany.
Z Rheumatol. 2005 May;64(4):239-48. doi: 10.1007/s00393-005-0734-4.
Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients with collagenoses, the coagulation system is activated and the reactivity of the endothelium is reduced. Thus, thrombus formation at the heart valves with consecutive stenosis and/or regurgitations as well as ischemia-induced regional wall motion defects due to reduced vasodilator response of the coronary arteries can be expected. In the literature in patients with rheumatoid arthritis and other collagenoses, pericardial effusion and pulmonary hypertension are most frequently described. The echocardiographic analysis, however, is more complex due to the variability of the patient cohort. Quantification of valve defects and the analysis of wall motion and perfusion at rest and during stress is necessary to detect early changes of the diseases. The prerequisites for successful diagnostic echocardiography in these patients are the knowledge of modern echocardiographic techniques like tissue Doppler and contrast echocardiography and clinical experience with patients with rheumatoid arthritis and other collagenoses. The standardization of the echocardiographic diagnostic procedure becomes more and more important for reproducibility and comparability of the results.
在类风湿关节炎和其他胶原病患者中观察到心脏表现。超声心动图是检测心脏形态和功能病变的首选方法。从病理生理学角度来看，这些患者的心内膜和心肌的炎症改变是可以解释的。此外，在胶原病患者中，凝血系统被激活，内皮反应性降低。因此，可以预期心脏瓣膜处会形成血栓，继而导致狭窄和/或反流，以及由于冠状动脉血管舒张反应降低而引起的缺血性局部室壁运动障碍。在关于类风湿关节炎和其他胶原病患者的文献中，心包积液和肺动脉高压是最常被描述的情况。然而，由于患者群体的变异性，超声心动图分析更为复杂。为了检测疾病的早期变化，有必要对瓣膜缺陷进行量化，并分析静息和应激状态下的室壁运动及灌注情况。在这些患者中成功进行诊断性超声心动图检查的前提条件是了解组织多普勒和对比超声心动图等现代超声心动图技术，以及对类风湿关节炎和其他胶原病患者的临床经验。超声心动图诊断程序的标准化对于结果的可重复性和可比性变得越来越重要。
