Liu Xiao-Hang, Feng Xiao-Jin, Shi Jia-Yu, Jia Fu-Wei, Liu Ying-Xian, Zhu Yan-Lin, Li Xiao, Wang Yi-Ning, Huo Li, Wang Qian, Chen Wei
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Cardiology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China.
Ann Palliat Med. 2020 Jul;9(4):2256-2270. doi: 10.21037/apm-19-650. Epub 2020 Jul 10.
Polymyositis (PM) and dermatomyositis (DM) are autoimmune diseases characterized by inflammation of skeletal muscle, primarily manifesting as chronic muscle weakness. Extramuscular organs can also be affected. Cardiac involvement is one of the visceral organ damages whose prevalence is underestimated and is a marker of poor prognosis leading to irreversible dysfunction or even death. Although early and accurate recognition of cardiac involvement remains a key barrier to improving survival in PM/ DM patients, considerable progress has been made, and an overview will be provided in this review. The new concept of multimodality imaging, which involves an integrated approach of echocardiography (Echo), cardiac magnetic resonance and sometimes positron emission tomography (PET), can facilitate diagnosis. The development of ultrasound technology, including strain analysis, stress Echo and contrast-enhanced Echo, helps disclose early cardiac dysfunction more sensitively than conventional Echo. Cardiac magnetic resonance unveils silent, acute or chronic myocarditis in PM/DM and is used to monitor treatment efficacy due to its excellent tissue characterization. PET can be useful thanks to the appearance of new tracers that can eliminate the effects of glucose uptake by normal cardiomyocytes. The sensitivity of endomyocardial biopsy may be increased by targeted sampling with the guidance of cardiac imaging. Troponin I is specific to cardiac injury, and investigations into antibodies against cardiac tissue are being carried out. Disease-specific mechanisms and therapies are also discussed to give more insights into cardiac involvement in PM and DM.
多发性肌炎（PM）和皮肌炎（DM）是自身免疫性疾病，其特征为骨骼肌炎症，主要表现为慢性肌无力。肌肉外器官也可能受到影响。心脏受累是内脏器官损害之一，其患病率被低估，是导致不可逆功能障碍甚至死亡的不良预后指标。尽管早期准确识别心脏受累仍是提高PM/DM患者生存率的关键障碍，但目前已取得了相当大的进展，本综述将对此进行概述。多模态成像的新概念，包括超声心动图（Echo）、心脏磁共振成像，有时还包括正电子发射断层扫描（PET）的综合方法，有助于诊断。超声技术的发展，包括应变分析、负荷超声心动图和对比增强超声心动图，比传统超声心动图更能敏感地发现早期心脏功能障碍。心脏磁共振成像可揭示PM/DM患者无症状的急性或慢性心肌炎，因其出色的组织特征而用于监测治疗效果。由于新示踪剂的出现可消除正常心肌细胞摄取葡萄糖的影响，PET可能会发挥作用。在心脏成像引导下进行靶向采样，可提高心内膜活检的敏感性。肌钙蛋白I对心脏损伤具有特异性，目前正在开展针对心脏组织抗体的研究。本文还讨论了疾病特异性机制和治疗方法，以更深入了解PM和DM患者的心脏受累情况。
