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Sugiyama K, Kobayashi H, Kobayashi Y, Yokoe I, Takei M, Kitamura N. Association of cardiac magnetic resonance-detected myocardial abnormalities with disease characteristics and brain natriuretic peptide levels in systemic sclerosis without cardiac symptoms. Int J Rheum Dis 2019; 22:1016-1022. [PMID: 30924296 DOI: 10.1111/1756-185x.13540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to evaluate the association between myocardial abnormalities and left ventricular (LV) geometry as assessed using cardiac magnetic resonance imaging (CMRI) in systemic sclerosis (SSc) patients without cardiac symptoms. METHODS SSc patients without cardiac symptoms or cardiovascular risk factors underwent contrast CMRI. CMRI were assessed for structural and functional LV parameters and myocardial fibrosis based on myocardial late gadolinium enhancement (LGE). The correlation between brain natriuretic peptide (BNP) levels and LGE status was evaluated. RESULTS Among 49 patients, 27 (55%) showed LGE positivity. The most common identified LGE pattern was a linear pattern. LGE was not consistent with coronary artery distribution. There was no difference in ejection fraction between those with and without LGE. LV morphological changes were observed in 29% of SSc patients. An abnormal LV structure was detected in 44% and 14% of patients in the LGE+ and LGE- groups, respectively. The BNP levels were higher by 57% in the LGE+ group than in the LGE-group. Receiver operating characteristic analysis showed that BNP levels reliably detected myocardial abnormalities (area under the curve, 0.72; 95% confidence interval 0.58-0.88). CONCLUSIONS Myocardial abnormalities were common in SSc patients without cardiac symptoms. We suggest that LV morphological changes may have resulted from myocardial abnormalities. BNP may be useful as a screening tool for the detection of myocardial abnormalities in SSc patients.
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Affiliation(s)
- Kaita Sugiyama
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hitomi Kobayashi
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Isamu Yokoe
- Division of Internal Medicine, Kyoundo Hospital, Tokyo, Japan
| | - Masami Takei
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noboru Kitamura
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Cacciatore C, Riviere S, Cohen A, Gatfosse M, Ederhy S, Fain O, Mekinian A. Sclérodermie systémique : efficacité des immunoglobulines intraveineuses pour l’atteinte cardiaque sévère ? Rev Med Interne 2018; 39:594-596. [DOI: 10.1016/j.revmed.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/28/2017] [Accepted: 12/28/2017] [Indexed: 01/22/2023]
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Coirier V, Lescoat A, Fournet M, Cazalets C, Coiffier G, Jouneau S, Chabanne C, Jégo P. [Screening for pulmonary arterial hypertension in patients with systemic sclerosis: Comparison of DETECT algorithm to decisions of a multidisciplinary team, in a competence centre]. Rev Med Interne 2017; 38:502-507. [PMID: 28545856 DOI: 10.1016/j.revmed.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis and detecting PAH efficiently remains challenging. The DETECT study has offered in 2013 a composite screening tool for PAH. The objective of our study was to compare the indication of right heart catheterisation (RHC) as suggested by the DETECT algorithm with the decisions of a multidisciplinary team. METHODS This prospective monocentric non-interventional study consecutively included systemic sclerosis patients when data required to apply DETECT algorithm were available. We evaluate the number of RHC as requested by this algorithm and confronted it with the indications of RHC suggested by a multidisciplinary group blinded for the result of DETECT algorithm. RESULTS In total, 117 systemic sclerosis patients were included. When DETECT algorithm was applied to all patients, RHC was suggested by this algorithm for 70 patients, whereas only 15 indications were required by the multidisciplinary group; among those patients only 7 had PAH. When DETECT algorithm was applied only to the 42 patients with DLCO<60% and disease duration of more than 3 years, RHC was suggested for 31 patients whereas only 13 were indicated by the multidisciplinary group; among those patients only 7 had PAH. CONCLUSION The DETECT algorithm is able to efficiently detect all PAH patients finally diagnosed by our multidisciplinary team. However, it increases by 3 the number of RHC that should be performed.
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Affiliation(s)
- V Coirier
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
| | - A Lescoat
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
| | - M Fournet
- Service de cardiologie, CHU de Rennes, 35203 Rennes, France
| | - C Cazalets
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - G Coiffier
- Service de rhumatologie, CHU de Rennes, 35203 Rennes, France
| | - S Jouneau
- Service de pneumologie, CHU de Rennes, 35203 Rennes, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
| | - C Chabanne
- Service de cardiologie, CHU de Rennes, 35203 Rennes, France
| | - P Jégo
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
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Fernández Morales A, Iniesta N, Fernández-Codina A, Vaz de Cunha J, Pérez Romero T, Hurtado García R, Simeón-Aznar CP, Fonollosa V, Cervera R, Espinosa G. Cardiac tamponade and severe pericardial effusion in systemic sclerosis: report of nine patients and review of the literature. Int J Rheum Dis 2016; 20:1582-1592. [PMID: 27943614 DOI: 10.1111/1756-185x.12952] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM To describe the clinical characteristics, treatment and outcome of patients with systemic sclerosis (SSc) developing severe pericardial effusion or cardiac tamponade. METHODS SSc patients with severe pericardial effusion or cardiac tamponade from three Spanish hospitals were collected. In addition, a computer-assisted (PubMed, MEDLINE) search of the literature to identify all cases of cardiac tamponade or severe pericardial effusion associated with SSc reported in English, French and Spanish from 1987 through September 2015 was performed. RESULTS We included 40 patients (nine cases from the Spanish hospitals and 31 cases from the literature review). Most patients (87%) were female with a mean age at pericardial involvement of 49.3 ± 15.2 years (range: 18-80 years), and 22 (55%) patients had the diffuse cutaneous subtype. Twenty-five (63%) patients presented with cardiac tamponade and the remaining 15 (37%) as severe or massive pericardial effusion. Pericardial involvement was previous or simultaneous to SSc diagnosis in 13 (32.5%) cases. In most cases (88.9%) pericardial fluid analysis disclosed an exudate. Half the patients received steroids and 35% needed surgical treatment. Five (12.5%) patients died due to cardiac tamponade, three of them during the acute phase and the remaining two, 2 and 9 months later, respectively. CONCLUSIONS Although cardiac tamponade or severe pericardial effusion is an infrequent complication in SSc patients, it can be the first manifestation of disease associated with the diffuse cutaneous subset. No specific treatment for this complication is known.
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Affiliation(s)
| | - Nerea Iniesta
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | | | | | | | | | | | - Vicent Fonollosa
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
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González-Cambeiro MC, Abu-Assi E, Abumuaileq RRY, Raposeiras-Roubín S, Rigueiro-Veloso P, Virgós-Lamela A, Díaz-Castro O, González-Juanatey JR. Systemic sclerosis: A rare cause of heart failure? Rev Port Cardiol 2015; 34:617.e1-5. [DOI: 10.1016/j.repc.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 02/21/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022] Open
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González-Cambeiro MC, Abu-Assi E, Abumuaileq RRY, Raposeiras-Roubín S, Rigueiro-Veloso P, Virgós-Lamela A, Díaz-Castro O, González-Juanatey JR. Systemic sclerosis: A rare cause of heart failure? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Launay D, Savale L, Berezne A, Le Pavec J, Hachulla E, Mouthon L, Sitbon O, Lambert B, Gaudric M, Jais X, Stephan F, Hatron PY, Lamblin N, Vignaux O, Cottin V, Farge D, Wallaert B, Guillevin L, Simonneau G, Mercier O, Fadel E, Dartevelle P, Humbert M, Mussot S. Lung and heart-lung transplantation for systemic sclerosis patients. A monocentric experience of 13 patients, review of the literature and position paper of a multidisciplinary Working Group. Presse Med 2014; 43:e345-63. [DOI: 10.1016/j.lpm.2014.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/23/2014] [Indexed: 12/14/2022] Open
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Brillet P, Mama N, Nunes H, Uzunhan Y, Abbad S, Brauner M. Sémiologie tomodensitométrique de l’atteinte pulmonaire des connectivites. ACTA ACUST UNITED AC 2009; 90:1854-68. [DOI: 10.1016/s0221-0363(09)73288-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Biełous-Wilk A, Poreba M, Staniszewska-Marszałek E, Poreba R, Podgórski M, Kałka D, Jagielski D, Rusiecki L, Pilecki W, Baran E, Andrzejak R, Sobieszczańska M. Electrocardiographic evaluation in patients with systemic scleroderma and without clinically evident heart disease. Ann Noninvasive Electrocardiol 2009; 14:251-7. [PMID: 19614636 DOI: 10.1111/j.1542-474x.2009.00306.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease. METHODS A group of 27 patients with SSc were subjected to standard electrocardiography (ECG) examination and 24-hour Holter monitoring. Analysis of HRV in time and frequency domains, HRT, and echocardiography were also performed. RESULTS Holter monitoring revealed a larger number of premature supraventricular contractions (PSVCs), as well as premature ventricular contractions (PVCs) in the patients with systemic scleroderma, as compared with the control group. Moreover, the SSc patients showed decreased parameters of time and frequency domains, as referred to the controls, especially during night hours. In four patients, abnormal HRT values were present. On echocardiography, only slight changes were found, however in five patients left ventricle diastolic dysfunction was diagnosed. CONCLUSIONS The noninvasive electrocardiographic methods seems to be useful for detecting early heart involvement in course of SSc and could be recommended for routine used in clinical practice. Significance of HRT analysis in patients with SSc needs further elucidation.
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Affiliation(s)
- Anna Biełous-Wilk
- Department of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland
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Granel B, Bernard F, Chevillard C. Genetic susceptibility to systemic sclerosis from clinical aspect to genetic factor analyses. Eur J Intern Med 2009; 20:242-52. [PMID: 19393491 DOI: 10.1016/j.ejim.2008.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/18/2008] [Accepted: 07/07/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Systemic sclerosis is a rare autoimmune disease mainly characterized by vascular alteration and fibrosis involving skin but also visceral organs such as lungs, digestive tract, and heart. This disease leads to high morbidity and mortality. Its pathogenesis remains unclear, but recent attention has focus on genetic factors. OBJECTIVE We first recall the main manifestations associated with systemic sclerosis and leading to its diagnosis and prognosis. Then we propose an overview on human genetics studies, as a number of genetic loci have been identified that appear to be associated with the disease. METHODS Articles concerning association studies with candidate genes encoding for extracellular matrix proteins, cytokines, growth factors, chemokines, and proteins involved in vascular tone and immune regulations are presented and discussed. RESULTS/CONCLUSION Systemic sclerosis is a multigenic complex disorder. Genetic associations are observed in distinct phenotypes such as the diffuse cutaneous form or the limited form, or in association with specific autoantibody pattern. Promising candidate genes are those involved in pathways that lead to the vascular damage and fibrosis. A better knowledge of crucial mediators involved in systemic sclerosis could in the future provide new therapeutic strategies to control the disease.
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