Allanore Yannick, Meune Christophe, Kahan André
Departments of Rheumatology A, France bCardiology, Paris Descartes University, Cochin Hospital, AP-HP, Paris, France.
Curr Opin Rheumatol. 2008 Nov;20(6):697-702. doi: 10.1097/BOR.0b013e328313bcf1.
Primary myocardial involvement is common in systemic sclerosis. There is strong evidence that this involvement is related to repeat focal ischemic injury causing irreversible myocardial fibrosis. Clinically evident cardiac involvement is recognized to be a poor prognostic factor; thus preclinical identification is highly encouraged.
The severity of heart involvement has been confirmed and patients having systemic sclerosis with antitopoisomerase I antibodies seem to be at higher risk. Echocardiography, coupled, if possible, to pulsed tissue Doppler, is the cornerstone of heart assessment. Myocardial perfusion may be assessed by single photon emission computed tomography. When available, cardiac magnetic resonance imaging should be considered as it allows simultaneous measurement of volumes and ventricular function, myocardial perfusion, and assessment of possible inflammation and/or fibrosis.
As a result of recent innovations, clinicians have a large panel of methods - some of these possibly reserved for research--whereas the others seem to be widely available and suitable for routine clinical practice. Indeed, conventional echocardiography, pulsed tissue Doppler, and natriuretic peptides may be used for routine assessment.
原发性心肌受累在系统性硬化症中很常见。有强有力的证据表明，这种受累与反复的局灶性缺血损伤导致不可逆的心肌纤维化有关。临床上明显的心脏受累被认为是一个不良的预后因素；因此，强烈鼓励进行临床前识别。
心脏受累的严重程度已得到证实，患有抗拓扑异构酶I抗体的系统性硬化症患者似乎风险更高。超声心动图，如果可能的话结合脉冲组织多普勒，是心脏评估的基石。心肌灌注可通过单光子发射计算机断层扫描进行评估。如果有条件，应考虑心脏磁共振成像，因为它可以同时测量容积和心室功能、心肌灌注，并评估可能的炎症和/或纤维化。
由于最近的创新，临床医生有大量的方法——其中一些可能仅用于研究——而其他一些方法似乎广泛可用且适用于常规临床实践。事实上，传统超声心动图、脉冲组织多普勒和利钠肽可用于常规评估。
