Diederichsen Louise Pyndt, Simonsen Jane Angel, Diederichsen Axel Cosmus Pyndt, Kim Won Yong, Hvidsten Svend, Hougaard Mikkel, Junker Peter, Lundberg Ingrid E, Petersen Henrik, Hansen Esben Søvsø Szocska, Eskerud Karl Sannes, Kay Susan Due, Jacobsen Søren
Department of Rheumatology, Odense University Hospital, Odense, Denmark.
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
Clin Exp Rheumatol. 2015 Sep-Oct;33(5):706-14. Epub 2015 Sep 7.
Knowledge of cardiac involvement in idiopathic inflammatory myopathies (IIM) is limited, especially in the early stage of disease. The objective of the present study was to perform a controlled evaluation of cardiac abnormalities in newly diagnosed, untreated patients with idiopathic inflammatory myopathies (IIM) by means of non-invasive techniques.
Fourteen patients with IIM (8 polymyositis, 4 dermatomyositis, 2 cancer-associated dermatomyositis) and 14 gender- and age- matched healthy control subjects were investigated. Participant assessments included a cardiac questionnaire, cardiac troponin-I (TnI), electrocardiogram (standard 12-lead and 48-h Holter monitoring), echocardiography with tissue Doppler measures, cardiac magnetic resonance (CMR) imaging with T2 mapping and semi-quantitative (99m)technetium pyrophosphate ((99m)Tc-PYP) scintigraphy.
Dyspnoea was present in 8 (57%) of the patients compared to none of the controls (p<0.01). Median levels of TnI in patients and controls were 20 ng/L and 6 ng/L, respectively (p=0.06). QTc intervals were prolonged in the patient group (p=0.01). Two patients had systolic dysfunction, and one diastolic dysfunction. The myocardial (99m)Tc-PYP uptake and CMR results differed between patients and controls, albeit not with statistical significance. Overall, cardiac abnormalities were demonstrated in 9 (64%) of the patients versus 2 (14%) of the controls (p=0.02).
Cardiac abnormalities assessed by TnI, ECG or imaging modalities were significantly more common in newly diagnosed, treatment naïve patients with IIM compared to healthy control subjects. These abnormalities, although subclinical, may indicate that myocardial involvement is common in patients and calls for larger controlled studies and further investigations of the prognostic implications of this finding.
关于特发性炎性肌病（IIM）中心脏受累的认识有限，尤其是在疾病早期。本研究的目的是通过非侵入性技术对新诊断的、未经治疗的特发性炎性肌病（IIM）患者的心脏异常进行对照评估。
对14例IIM患者（8例多发性肌炎、4例皮肌炎、2例癌症相关性皮肌炎）和14例年龄及性别匹配的健康对照者进行研究。参与者评估包括心脏问卷、心肌肌钙蛋白I（TnI）、心电图（标准12导联和48小时动态心电图监测）、组织多普勒测量的超声心动图、T2 mapping的心脏磁共振（CMR）成像以及半定量的（99m）锝焦磷酸盐（（99m）Tc-PYP）闪烁显像。
8例（57%）患者出现呼吸困难，而对照组无一例出现（p<0.01）。患者和对照组的TnI中位数水平分别为20 ng/L和6 ng/L（p=0.06）。患者组的QTc间期延长（p=0.01）。2例患者出现收缩功能障碍，1例出现舒张功能障碍。患者和对照组之间的心肌（99m）Tc-PYP摄取及CMR结果有所不同，尽管无统计学意义。总体而言，9例（64%）患者出现心脏异常，而对照组为2例（14%）（p=0.02）。
与健康对照者相比，新诊断的、未接受治疗的IIM患者通过TnI、心电图或成像方式评估的心脏异常明显更为常见。这些异常尽管为亚临床状态，但可能表明患者中心肌受累常见，需要进行更大规模的对照研究以及对这一发现的预后意义进行进一步调查。
