特发性炎性肌病的心脏磁共振心肌受累表型分析。

Phenotyping of myocardial involvement by cardiac magnetic resonance in idiopathic inflammatory myopathies.

机构信息

Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

Department of Medicine, Cardiovascular Division, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

出版信息

Eur Radiol. 2021 Jul;31(7):5077-5086. doi: 10.1007/s00330-020-07448-7. Epub 2021 Jan 6.

DOI:10.1007/s00330-020-07448-7

PMID:33409791

Abstract

OBJECTIVES

Cardiac dysfunction is commonly noted in patients with idiopathic inflammatory myopathies (IIMs). This study aimed to investigate the characteristics of cardiac dysfunction using cardiac magnetic resonance (CMR) in polymyositis (PM), dermatomyositis (DM) and necrotising myositis (NM).

METHODS

Fifty-one patients with IIMs and 20 matched healthy controls (HCs) were assessed using CMR examination. The clinical data, cardiac serum markers and autoimmune antibodies were determined for all patients. Cardiac involvement was identified by myocardial native T1, extracellular volume (ECV), late gadolinium enhancement (LGE) and left ventricular ejection fraction (LVEF).

RESULTS

Different subtypes of IIMs showed different patterns of LGE and varying degrees of myocardial damage. The PM subgroup showed higher native T1 (p = 0.010) and ECV (p = 0.000) than the HCs. The prevalence of LGE was comparable between the PM and DM subgroups (40.0% vs. 31.6%, p = 0.741); however, it was higher in the PM subgroup than in the NM subgroup (40% vs. 0.0%, p = 0.014). Patients with positive LGE in the PM subgroup showed a higher proportion of positive LGE (p = 0.018) and lower LVEF (p = 0.024) than those with positive LGE in the DM subgroup. In multivariate analysis, the presence of LGE could be predicted by increased NT-proBNP (p = 0.036, OR = 1.001) and anti-MDA-5 antibody positivity (p = 0.011, OR = 12.4). The risk factors associated with native T1 were NT-proBNP (p = 0.016, β = 0.353) and body mass index (BMI) (p = 0.024, β = - 0.331).

CONCLUSIONS

Distinct cardiac involvements in different subtypes of IIMs were identified using CMR. Elevated NT-proBNP and a low BMI were the risk factors associated with LGE and elevated native T1.

KEY POINTS

• The characteristics of cardiac involvement in different subtypes of IIMs could be identified with cardiac magnetic resonance. • The NT-proBNP levels could reflect focal and diffuse myocardial damage in patients with IIMs.

摘要

目的

特发性炎症性肌病（IIM）患者常伴有心脏功能障碍。本研究旨在通过心脏磁共振（CMR）研究多发性肌炎（PM）、皮肌炎（DM）和坏死性肌炎（NM）患者的心脏功能障碍特征。

方法

对 51 例 IIM 患者和 20 例匹配的健康对照者（HCs）进行 CMR 检查。对所有患者进行临床资料、心脏血清标志物和自身抗体检测。通过心肌固有 T1、细胞外容积（ECV）、延迟钆增强（LGE）和左心室射血分数（LVEF）确定心脏受累情况。

结果

不同类型的 IIM 表现出不同的 LGE 模式和不同程度的心肌损伤。PM 亚组的固有 T1（p=0.010）和 ECV（p=0.000）均高于 HCs。PM 和 DM 亚组的 LGE 发生率相似（40.0%比 31.6%，p=0.741）；然而，PM 亚组的 LGE 发生率高于 NM 亚组（40%比 0.0%，p=0.014）。PM 亚组中 LGE 阳性患者的 LGE 阳性比例较高（p=0.018），LVEF 较低（p=0.024）。多因素分析显示，LGE 阳性可由 NT-proBNP 升高（p=0.036，OR=1.001）和抗 MDA-5 抗体阳性（p=0.011，OR=12.4）预测。与固有 T1 相关的危险因素是 NT-proBNP（p=0.016，β=0.353）和体重指数（BMI）（p=0.024，β=-0.331）。