Cardiac manifestations in polymyositis

Simonsen

Arthritis Care & Research

et al. 2016

Objective. Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies. The study objective was in a controlled setting to describe cardiac abnormalities by noninvasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM) and to identify predictors for cardiac dysfunction. Methods. In a cross-sectional study, 76 patients with PM/DM and 48 matched healthy controls (HCs) were assessed by serum levels of cardiac troponin I, electrocardiography, Holter monitoring, echocardiography with tissue Doppler imaging, and quantitative cardiac Results. Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% versus 0%; P 5 0.02) and longer QRS and QT intervals (P 5 0.007 and P < 0.0001, respectively). In multivariate analysis, factors associated with LVDD were age (P 5 0.001), disease duration (P 5 0.004), presence of myositis-specific or -associated autoantibodies (P 5 0.05), and high cardiac 99m Tc-PYP uptake (P 5 0.006). In multivariate analysis of the pooled data for patients and HCs, a diagnosis of PM/DM (P < 0.0001) was associated with LVDD. Conclusion. Patients with PM or DM had an increased prevalence of cardiac abnormalities compared to HCs. LVDD was a common occurrence in PM/DM patients and correlated to disease duration. In addition, the association of LVDD with myositis-specific or -associated autoantibodies and high cardiac 99m Tc-PYP uptake supports the notion of underlying autoimmunity and myocardial inflammation in patients with PM/DM.

Section: Discussionmentioning

confidence: 99%

“…LVDD has previously been demonstrated in IIM, but prospective studies on LVDD and possible impact on survival have so far not been conducted (38)(39)(40)42). There are only a few controlled studies on PM/DM using newer echocardiographic techniques like TDI.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities

Simonsen

Arthritis Care & Research

et al. 2016

“…Lymphocytic infiltration, fibrosis of conduction system lesions, and active myocarditis are the pathologic foundation of the diseases listed above. 8,12 The presumption of enhanced left ventricular function by Gottdiener et al 15 was indicated by a reduction of afterload by arteriovenous shunting across involved skeletal muscle beds and high output state secondary, due either to increased metabolic demand of diseased skeletal muscle or to the effects of vasoactive amines released by involved muscle. It is possible that myocarditis may predispose the patient to development of congestive heart failure over a period of time or under certain circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,9,13,15 The incidence of ECG abnormalities from selected articles is from 25% to 85%. 2,3,7,13,16,17 ECG and Holter abnormalities observed in PM/DM patients include: frequent atrial or ventricular premature beats, atrial tachycardia, ventricular tachycardia, atrial fibrillation, atrioventricular conduction block, bundle branch block, abnormal Q-waves, as well as nonspecific ST-T-wave changes.…”

Section: Subclinical Heart Involvementmentioning

confidence: 99%

Cardiac Involvement in Adult Polymyositis or Dermatomyositis: A Systematic Review

Wang

et al. 2012

Clinical Cardiology

Background: To investigate the clinical features of cardiac involvement in polymyositis (PM) or dermatomyositis (DM). Hypothesis: More attention will be focused on the heart in PM/DM as we would have wished, which contribute to improve the prognosis. Methods: All articles published in English were retrieved by searching MEDLINE via PubMed (1975-2011. After selecting eligible articles according to the predefined inclusion and exclusion criteria, a systemic review was carried out. Results: A total of 26 articles were included in this study, which included 1530 patients. The incidence of cardiac involvement was 9% to 72%. Heart failure was the most frequent (32% to 77%) clinical symptom. Among the abnormal electrocardiogram and ultrasonic cardiogram, the incidence of conduction abnormalities, left ventricular diastolic dysfunction, and hyperkinetic left ventricular contraction were 25% to 38.5%, 42%, and 6% to 12%, respectively. The pathologic findings revealed myocardial inflammation, degenerative changes and necrosis similar to that in skeletal muscles. Cardiac manifestations of some patients improved after glucocorticoid and immunosuppressant treatment. Thirty-seven patients (46.3%) died as a direct result of heart disease. Conclusions: Heart abnormalities are frequent in patients with PM/DM, most of which were subclinical. The efficacy of glucocorticoids and immunosuppressants is uncertain. Cardiac involvement is a common cause of death.

“…The myositis parameters, which correlated with one another, peaked 6-10 days postinoculation but appeared to persist for at least 13 weeks. Those animals that died probably succumbed to cardiac involvement, a common complication of adult human PM/DM (39)(40)(41).…”

Section: Discussionmentioning

confidence: 99%

Viral and host genetic factors influence encephalomyocarditis virus—induced polymyositis in adult mice

Miller

Love

Biswas

et al. 1987

Arthritis & Rheumatism

Recent research findings implicate picornaviruses in the etiology of human polymyositis/dermatomyositis and suggest that genetic factors play a role in susceptibility to these diseases. We compared 2 variants of encephalomyocarditis (EMC) virus for their ability to induce polymyositis in adult mice, and evaluated what role the genetic background of the host plays in the degree of myositis induced. While BALB/c mice developed minimal myositis when infected with a diabetogenic variant (EMC‐D), the same strain inoculated with a newly isolated myopathic variant (EMC‐221A) developed viral dose—dependent elevations in muscle‐associated enzymes, bilateral limb muscle weakness, and the histopathologic changes of severe polymyositis. Mice with different genetic backgrounds showed significantly different susceptibilities to EMC‐221A. These data suggest that the severity of polymyositis induced by EMC virus is influenced by both the viral and host genomes.