University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
Heart Fail Rev. 2022 Jan;27(1):93-101. doi: 10.1007/s10741-020-09990-4.
Autoimmune rheumatological disorders are known to have an increased risk for cardiovascular diseases including coronary artery disease (CAD), myocarditis, pericarditis, valvulopathy, and in consequence cardiogenic shock. Data on cardiogenic shock in rheumatological diseases are scarce; however, several reports have highlighted this specific entity. We sought to review the available literature and highlight major outcomes and the management approaches in each disease. Systematic literature search, including PubMed, Ovid/Medline, Cochrane Library, and Web of Science, was conducted between January 2000 and December 2009. We reviewed all cases reporting cardiogenic shock with rheumatologic conditions, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Takayasu's arteritis (TA), granulomatosis with polyangiitis (GPA), giant cell arteritis (GCA), and antiphospholipid syndrome (APS). We selected 45 papers reporting a total of 48 cases. Mean age was 39 ± 7.3 years and 68.8% were females. Most common rheumatologic conditions associated with cardiogenic shock were SLE (31%), GPA (23%), TA (14.6%), APA (10.4%), and RA (8.3%). Cardiogenic shock was found to be caused by eosinophilic myocarditis in 58% of cases, CAD in 19% of cases, and valvulopathy in 6% of cases. Most patient required high-dose steroids and second immunosuppressant therapy. Mechanical circulatory supported was required in 23 cases, IABP in 16 cases, and ECMO in 12 cases. Complete recovery occurred in 37 patients while 9 patients died and 2 required heart transplant. Responsible for two-thirds of cases, eosinophilic myocarditis should be suspected in young cardiogenic shock patients with underlying rheumatologic conditions. Lupus and GPA are the two most common conditions.
自身免疫性风湿性疾病已知存在心血管疾病风险增加，包括冠状动脉疾病 (CAD)、心肌炎、心包炎、心瓣膜病，并因此导致心源性休克。风湿性疾病中心源性休克的数据有限；然而，有几项报告强调了这一特定病症。我们试图回顾现有文献，并强调每种疾病的主要结局和管理方法。系统文献检索包括 PubMed、Ovid/Medline、Cochrane 图书馆和 Web of Science，检索时间为 2000 年 1 月至 2009 年 12 月。我们回顾了所有报告有风湿性疾病合并心源性休克的病例，包括系统性红斑狼疮 (SLE)、类风湿关节炎 (RA)、大动脉炎 (TA)、肉芽肿性多血管炎 (GPA)、巨细胞动脉炎 (GCA) 和抗磷脂综合征 (APS)。我们选择了 45 篇报告共 48 例的论文。平均年龄为 39±7.3 岁，女性占 68.8%。最常见的与心源性休克相关的风湿性疾病是 SLE（31%）、GPA（23%）、TA（14.6%）、APA（10.4%）和 RA（8.3%）。心源性休克的病因是嗜酸粒细胞性心肌炎占 58%、CAD 占 19%、心瓣膜病占 6%。大多数患者需要大剂量类固醇和第二种免疫抑制剂治疗。23 例需要机械循环支持，16 例需要 IABP，12 例需要 ECMO。37 例患者完全康复，9 例患者死亡，2 例需要心脏移植。由三分之二的病例引起，患有潜在风湿性疾病的年轻心源性休克患者应怀疑嗜酸粒细胞性心肌炎。狼疮和 GPA 是最常见的两种情况。
