Morel N, Le Guern V, Mouthon L, Piette J-C, Costedoat-Chalumeau N
Service de médecine interne, hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares d'Île-de-France, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
Rev Med Interne. 2022 Nov;43(11):645-648. doi: 10.1016/j.revmed.2022.08.003. Epub 2022 Sep 8.
Cardiac involvement in systemic lupus (SL) and antiphospholipid syndrome (APS) can be due to variables and involve different presentations. Pericarditis is the most common lupus manifestation and occurs in 16% to 25% of patients. While corticosteroids are usually very effective, colchicine may avoid steroids and prevent relapse. Myocarditis during SL is rare and often inaugural. They may manifest as chest pain, acute heart failure, arrhythmias or conduction disturbances, and may progress to dilated cardiomyopathy and/or permanent heart failure. Their prognosis is however generally good, even in the absence of treatment with cyclophosphamide for the less serious forms. Finally, coronary involvement in SL is most often due to atherosclerotic, thrombotic origin (generally in the context of associated APS), and exceptionally explained by coronary vasculitis. During APS, valve disease is frequent and usually asymptomatic. Thrombotic damage can be (1) coronary, typically manifesting as a myocardial infarction in a young subject with healthy coronary arteries, (2) much more rarely intracardiac, or (3) microcirculatory, generally as part of a catastrophic antiphospholipid syndrome (CAPS) leading to a multiorgan failure. Finally, iatrogenic cardiac manifestations can exceptionally be seen during treatment with cyclophosphamide or antimalarials characterized by conduction disorders and/or heart failure.
系统性红斑狼疮（SL）和抗磷脂综合征（APS）中的心脏受累可能由多种因素引起，且表现各异。心包炎是最常见的狼疮表现，见于16%至25%的患者。虽然皮质类固醇通常非常有效，但秋水仙碱可避免使用类固醇并预防复发。SL期间的心肌炎很少见，且常为首发症状。其表现可能为胸痛、急性心力衰竭、心律失常或传导障碍，并可能进展为扩张型心肌病和/或永久性心力衰竭。然而，即使对于病情较轻的形式未使用环磷酰胺治疗，其预后通常也较好。最后，SL中的冠状动脉受累最常见于动脉粥样硬化、血栓形成性起源（通常在合并APS的情况下），极少数情况下由冠状动脉血管炎引起。在APS期间，瓣膜疾病很常见，通常无症状。血栓性损害可表现为：（1）冠状动脉性，典型表现为冠状动脉正常的年轻患者发生心肌梗死；（2）心脏内血栓形成极为罕见；或（3）微循环性，通常是灾难性抗磷脂综合征（CAPS）的一部分，导致多器官功能衰竭。最后，在使用环磷酰胺或抗疟药治疗期间，可能会罕见地出现医源性心脏表现，其特征为传导障碍和/或心力衰竭。
