多肌炎和皮肌炎中的亚临床心脏功能障碍：一项斑点追踪病例对照研究
Subclinical Cardiac Dysfunction in Polymyositis and Dermatomyositis: A Speckle-tracking Case-control Study.
作者信息
Guerra Federico, Gelardi Chiara, Capucci Alessandro, Gabrielli Armando, Danieli Maria Giovanna
机构信息
From the Cardiology and Arrhythmology Clinic, and the Clinical Medicine, Clinical and Molecular Sciences Department, Marche Polytechnic University, University Hospital "Ospedali Riuniti," Ancona, Italy.
F. Guerra, MD, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Ospedali Riuniti; C. Gelardi, MD, Clinical Medicine, Clinical and Molecular Sciences Department, Marche Polytechnic University, University Hospital Ospedali Riuniti; A. Capucci, MD, Professor, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Ospedali Riuniti; A. Gabrielli, MD, Professor, Clinical Medicine, Clinical and Molecular Sciences Department, Marche Polytechnic University, University Hospital Ospedali Riuniti; M.G. Danieli, MD, PhD, Associate Professor, Clinical Medicine, Clinical and Molecular Sciences Department, Marche Polytechnic University, University Hospital Ospedali Riuniti.
出版信息
J Rheumatol. 2017 Jun;44(6):815-821. doi: 10.3899/jrheum.161311. Epub 2017 Apr 1.
OBJECTIVE
Subclinical heart disease occurs in up to 50% of patients with idiopathic inflammatory myopathies (IIM) and is difficult to detect through conventional imaging. We investigated the usefulness of global longitudinal strain (GLS) measurement to detect a subclinical systolic ventricular dysfunction in patients with IIM.
METHODS
We enrolled 28 patients with IIM and 28 matched controls in a 1:1 fashion. Standard variables for the left ventricle (LV) and right ventricle (RV) systolic and diastolic function were measured and compared between cases and controls, along with speckle-tracking GLS of the LV and RV. A possible correlation between GLS and muscle strength, disease activity, cardiovascular risk factors, and other organ systems involvement was searched.
RESULTS
Standard variables of systolic and diastolic dysfunction were similar between patients and controls. GLS was significantly lower in patients when compared with controls for both LV (-18.7 ± 4.2% vs -21.2 ± 2.1%, p = 0.006) and RV (-19.3 ± 6.3% vs -22.5 ± 3.8%, p = 0.033). Patients with IIM had a 4.9-fold increased risk for impaired left GLS [relative risk (RR) 4.9, 95% CI 1.5-15.8, p = 0.006], which involved usually basal and mid-segments of the anterior, anterior-septal, and lateral wall. Patients with IIM had a 3.4-fold increased risk for impaired right GLS (RR 3.4, 95% CI 1.1-11.7, p = 0.04) with the basal segment of the free RV wall most frequently involved. Muscle strength, disease activity, damage and duration, other organ system involvement, and previous treatment were not associated with reduced GLS.
CONCLUSION
Subclinical systolic impairment is common in patients with IIM without overt LV dysfunction. In this context, GLS is a potentially useful variable.
目的
高达50%的特发性炎性肌病（IIM）患者存在亚临床心脏病，且通过传统影像学检查难以检测出来。我们研究了整体纵向应变（GLS）测量在检测IIM患者亚临床收缩期心室功能障碍方面的效用。
方法
我们以1:1的比例纳入了28例IIM患者和28例匹配的对照。测量并比较了病例组和对照组左心室（LV）和右心室（RV）收缩及舒张功能的标准变量，以及LV和RV的斑点追踪GLS。研究了GLS与肌肉力量、疾病活动度、心血管危险因素及其他器官系统受累之间可能存在的相关性。
结果
患者和对照组之间收缩和舒张功能障碍的标准变量相似。LV（-18.7±4.2%对-21.2±2.1%，p=0.006）和RV（-19.3±6.3%对-22.5±3.8%，p=0.033）的GLS在患者中均显著低于对照组。IIM患者左GLS受损风险增加4.9倍[相对风险（RR）4.9，95%置信区间1.5 - 15.8，p=0.006]，受累部位通常为前壁、前间隔壁和侧壁的基底段及中间段。IIM患者右GLS受损风险增加3.4倍（RR 3.4，95%置信区间1.1 - 11.7，p=0.04），最常受累的是RV游离壁的基底段。肌肉力量、疾病活动度、损伤和病程、其他器官系统受累情况及既往治疗与GLS降低均无关联。
结论
在无明显LV功能障碍的IIM患者中，亚临床收缩期损害很常见。在此情况下，GLS是一个潜在有用的变量。
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