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Akgün G, Sözeri B, Başar EZ, Şahin N, Bayrak YE, Ulu K, Güngör HS, Doğan M, Öner T, Karacan M, Babaoğlu K, Anık Y, Sönmez HE. Cardiac evaluation of patients with juvenile dermatomyositis. Pediatr Res 2024:10.1038/s41390-024-03336-8. [PMID: 38909159 DOI: 10.1038/s41390-024-03336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/14/2024] [Accepted: 05/31/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND The present study aims to evaluate possible cardiac involvement in juvenile dermatomyositis (JDM) patients by conventional methods and cardiac magnetic resonance imaging (MRI) along with a systematic review of the literature on cardiac features in JDM. METHODS The study group consisted of JDM patients who underwent cardiac MRI. We conducted a systematic review of the published literature involving JDM patients with cardiac involvement. RESULTS In the present study, although baseline cardiologic evaluations including electrocardiography and echocardiography were within normal limits, we showed late gadolinium enhancement on cardiac MRI in 3 of 11 JDM patients. In the literature review, we identified 25 articles related to cardiac involvement in JDM. However, none of them, except one case report, included cardiac MRI of JDM patients. CONCLUSION Cardiac abnormalities have been reported among the less frequent findings in patients with JDM. Cardiovascular complications during the long-term disease course are a leading cause of morbidity and mortality in these patients. Early detection of cardiac involvement by cardiac MRI in patients with JDM and aggressive treatment of them may improve the clinical course of these patients. IMPACT The myocardium in patients with JDM may be involved by inflammation. Myocardial involvement may be evaluated by using contrast-enhanced cardiac MRI. This is the first study evaluating cardiac involvement by cardiac MRI in JDM patients. MRI may show early cardiac involvement in patients whose baseline cardiologic evaluations are within normal limits. Early detection of cardiac involvement by cardiac MRI may improve the long-term prognosis of patients with JDM.
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Affiliation(s)
- Gökmen Akgün
- Department of Pediatric Cardiology, City Hospital, Kocaeli, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Eviç Zeynep Başar
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Yunus Emre Bayrak
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Kadir Ulu
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Hüseyin Salih Güngör
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Mustafa Doğan
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Taliha Öner
- Department of Pediatric Cardiology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Karacan
- Department of Pediatric Cardiology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Yonca Anık
- Department of Radiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
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Deng W, Zhang J, Jia Z, Pan Z, Wang Z, Xu H, Zhong L, Yu Y, Zhao R, Li X. Myocardial involvement characteristics by cardiac MR imaging in neurological and non-neurological Wilson disease patients. Insights Imaging 2024; 15:24. [PMID: 38270718 PMCID: PMC10810766 DOI: 10.1186/s13244-023-01583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES To explore the characteristics of myocardial involvement in Wilson Disease (WD) patients by cardiac magnetic resonance (CMR). METHODS We prospectively included WD patients and age- and sex-matched healthy population. We applied CMR to analyze cardiac function, strain, T1 maps, T2 maps, extracellular volume fraction (ECV) maps, and LGE images. Subgroup analyzes were performed for patients with WD with predominantly neurologic manifestations (WD-neuro +) or only hepatic manifestations (WD-neuro -). RESULTS Forty-one WD patients (age 27.9 ± 8.0 years) and 40 healthy controls (age 25.4 ± 2.9 years) were included in this study. Compared to controls, the T1, T2, and ECV values were significantly increased in the WD group (T1 1085.1 ± 39.1 vs. 1046.5 ± 33.1 ms, T2 54.2 ± 3.3 ms vs. 51.5 ± 2.6 ms, ECV 31.8 ± 3.6% vs. 24.3 ± 3.7%) (all p < 0.001). LGE analysis revealed that LGE in WD patients was predominantly localized to the right ventricular insertion point and interventricular septum. Furthermore, the WD-neuro + group showed more severe myocardial damage compared to WD-neuro - group. The Unified Wilson Disease Rating Scale score was significantly correlated with ECV (Pearson's r = 0.64, p < 0.001). CONCLUSIONS CMR could detect early myocardial involvement in WD patients without overt cardiac function dysfunction. Furthermore, characteristics of myocardial involvement were different between WD-neuro + and WD-neuro - , and myocardial involvement might be more severe in WD-neuro + patients. CRITICAL RELEVANCE STATEMENT Cardiac magnetic resonance enables early detection of myocardial involvement in Wilson disease patients, contributing to the understanding of distinct myocardial characteristics in different subgroups and potentially aiding in the assessment of disease severity. KEY POINTS • CMR detects WD myocardial involvement with increased T1, T2, ECV. • WD-neuro + patients show more severe myocardial damage and correlation with ECV. • Differences of myocardial characteristics exist between WD-neuro + and WD-neuro - patients.
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Affiliation(s)
- Wei Deng
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Jie Zhang
- Department of Neurology, Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Zhuoran Jia
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Zixiang Pan
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Zhen Wang
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Huimin Xu
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | - Liang Zhong
- Duke NUS Medical School, National Heart Centre Singapore, National University of Singapore, Singapore, Singapore
| | - Yongqiang Yu
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China.
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China.
| | - Xiaohu Li
- Department of Radiology, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China.
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3
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Hui X, Jie Q. Vasculopathy in dermatomyositis. Chin Med J (Engl) 2024; 137:247-249. [PMID: 37415507 PMCID: PMC10798720 DOI: 10.1097/cm9.0000000000002788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
| | - Qian Jie
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
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4
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Weber BN, Paik JJ, Aghayev A, Klein AL, Mavrogeni SI, Yu PB, Mukherjee M. Novel Imaging Approaches to Cardiac Manifestations of Systemic Inflammatory Diseases: JACC Scientific Statement. J Am Coll Cardiol 2023; 82:2128-2151. [PMID: 37993205 DOI: 10.1016/j.jacc.2023.09.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 11/24/2023]
Abstract
Derangements in the innate and adaptive immune responses observed in systemic inflammatory syndromes contributes to unique elevated atherosclerotic risk and incident cardiovascular disease. Novel multimodality imaging techniques may improve diagnostic precision for the screening and monitoring of disease activity. The integrated application of these technologies lead to earlier diagnosis and noninvasive monitoring of cardiac involvement in systemic inflammatory diseases that will aid in preclinical studies, enhance patient selection, and provide surrogate endpoints in clinical trials, thereby improving clinical outcomes. We review the common cardiovascular manifestations of immune-mediated systemic inflammatory diseases and address the clinical and investigational role of advanced multimodality cardiac imaging.
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Affiliation(s)
- Brittany N Weber
- Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Julie J Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ayaz Aghayev
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Allan L Klein
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Paul B Yu
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
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Trybuch A, Tarnacka B. Cardiac involvement in polymyositis and dermatomyositis: diagnostic approaches. Reumatologia 2023; 61:202-212. [PMID: 37522146 PMCID: PMC10373167 DOI: 10.5114/reum/168362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 08/01/2023] Open
Abstract
Polymyositis (PM) and dermatomyositis (DM) are rare idiopathic inflammatory myopathies (IIM). Myocardial involvement in patients with IIM is an unfavorable prognostic factor and one of the most common cause of mortality in this group of patients. The purpose of this review is to present current knowledge on cardiovascular manifestations observed in IIM. Data published in English until December 2021 were selected. Clinical symptoms suggesting cardiac involvement are non-specific and require a differential diagnosis in accordance with cardiological guidelines. Troponin I is specific to cardiac injury and should be preferred to other markers to evaluate the myocardium in IIM. Abnormalities in electrocardiography are common in IIM, especially non-specific changes of the ST-T segment. In standard echocardiography left ventricular diastolic dysfunction is reported frequently. New diagnostic technologies can reveal clinically silent myocardial abnormalities. However, the prognostic value of subclinical impairment of myocardial function require further studies.
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Affiliation(s)
- Agnieszka Trybuch
- Department of Rehabilitation, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, Poland
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He Y, Liang J, Cao H, Lin J. The potential role of 18 F-FDG PET/CT in dermatomyositis with cardiac involvement: A case report. Int J Rheum Dis 2023. [PMID: 36744420 DOI: 10.1111/1756-185x.14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/02/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dermatomyositis (DM) is a chronic inflammatory muscle disease. Cardiac involvement is reported to be a main cause of death in DM but typically remains subclinical. Delayed or missed diagnosis renders more severe prognosis in DM patients. CASE SUMMARY A 69-year-old man with a 6-month history of shortness of breath, cough and characteristic cutaneous lesions was diagnosed with DM complicated with interstitial lung disease on his first admission. Within 47 days, the patient developed progressive heart failure with dyspnea. The levels of B-type natriuretic peptide and Troponin I drastically increased and the cardiac function prominently decreased. According to the result of cardiac magnetic resonance, he was finally diagnosed with DM combined with cardiac involvement. Interestingly, the abnormal cardiac metabolism on 18 F-fluorodeoxyglucose positron emission tomography / computed tomography FDG PET/CT had been found before the cardiac involvement was clinically identified. CONCLUSIONS 18 F-FDG PET/CT may play a potential role in early recognition of cardiac involvement in patients with DM, although more data is still needed.
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Affiliation(s)
- Ye He
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Junyu Liang
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Heng Cao
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jin Lin
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Mavrogeni S, Pepe A, Nijveldt R, Ntusi N, Sierra-Galan LM, Bratis K, Wei J, Mukherjee M, Markousis-Mavrogenis G, Gargani L, Sade LE, Ajmone-Marsan N, Seferovic P, Donal E, Nurmohamed M, Cerinic MM, Sfikakis P, Kitas G, Schwitter J, Lima JAC, Dawson D, Dweck M, Haugaa KH, Keenan N, Moon J, Stankovic I, Donal E, Cosyns B. Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e308-e322. [PMID: 35808990 DOI: 10.1093/ehjci/jeac134] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece.,Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 115 27 Athens, Greece
| | - A Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35122 Padua, Italy
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands
| | - N Ntusi
- University of Cape Town & Groote Schuur Hospital, City of Cape Town, 7700 Western Cape, South Africa
| | - L M Sierra-Galan
- Department of Cardiology, American British Cowdray Medical Center, 05330 Mexico City, Mexico
| | - K Bratis
- Department of Cardiology, Manchester Royal Infirmary, Manchester M13 9WL, UK
| | - J Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA 90048, USA.,Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA 90048, USA
| | - M Mukherjee
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | - L Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - L E Sade
- University of Pittsburgh, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA 15260, USA.,Department of Cardiology, Baskent University, 06790 Ankara, Turkey
| | - N Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, 2311 EZ Leiden, the Netherlands
| | - P Seferovic
- Department of Cardiology, Belgrade University, 11000 Belgrade, Serbia
| | - E Donal
- Université RENNES-1, CHU, 35000 Rennes, France
| | - M Nurmohamed
- Amsterdam Rheumatology Immunology Center, Amsterdam University Medical Centers, 1105 AZ, Amsterdam, the Netherlands
| | - M Matucci Cerinic
- Experimental and Clinical Medicine, Division of Internal Medicine and Rheumatology, Azienda Ospedaliera Universitaria Careggi, University of Florence, 50121 Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS, San Raffaele Hospital, 20132 Milan, Italy
| | - P Sfikakis
- First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, 115 27 Athens, Greece
| | - G Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - J Schwitter
- Lausanne University Hospital, CHUV, CH-1011 Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, 1015 UniL, Switzerland.,Director CMR Center of the University Hospital Lausanne, CHUV, CH-1011 Lausanne, Switzerland
| | - J A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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