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Zagouras AA, Tang WHW. Myocardial Involvement in Systemic Autoimmune Rheumatic Diseases. Rheum Dis Clin North Am 2023; 49:45-66. [PMID: 36424026 DOI: 10.1016/j.rdc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Systemic autoimmune rheumatic diseases (SARDs) are defined by the potential to affect multiple organ systems, and cardiac involvement is a prevalent but often overlooked sequela. Myocardial involvement in SARDs is medicated by macrovascular disease, microvascular dysfunction, and myocarditis. Systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, eosinophilic granulomatosis with polyangiitis, and sarcoidosis are associated with the greatest risk of myocardial damage and heart failure, though myocardial involvement is also seen in other SARDs or their treatments. Management of myocardial involvement should be disease-specific. Further research is required to elucidate targetable mechanisms of myocardial involvement in SARDs.
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Affiliation(s)
- Alexia A Zagouras
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, , EC-10 Cleveland Clinic, 9501 Euclid Avenue, Cleveland, OH 44195, USA
| | - W H Wilson Tang
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, , EC-10 Cleveland Clinic, 9501 Euclid Avenue, Cleveland, OH 44195, USA; Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Casian M, Jurcut C, Dima A, Mihai A, Stanciu S, Jurcut R. Cardiovascular Disease in Primary Sjögren's Syndrome: Raising Clinicians' Awareness. Front Immunol 2022; 13:865373. [PMID: 35757738 PMCID: PMC9219550 DOI: 10.3389/fimmu.2022.865373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
In the ever evolving landscape of systemic immune mediated diseases, an increased awareness regarding the associated cardiovascular system impairment has been noted in recent years. Even though primary Sjögren’s Syndrome (pSS) is one of the most frequent autoimmune diseases affecting middle-aged individuals, the cardiovascular profile of this specific population is far less studied, at least compared to other autoimmune diseases. Traditional cardiovascular risk factors and disease specific risk factors are inextricably intertwined in this particular case. Therefore, the cardiovascular risk profile in pSS is a multifaceted issue, sometimes difficult to assess. Furthermore, in the era of multimodality imaging, the diagnosis of subclinical myocardial and vascular damage is possible, with recent data pointing that the prevalence of such involvement is higher in pSS than in the general population. Nevertheless, when approaching patients with pSS in terms of cardiovascular diseases, clinicians are often faced with the difficult task of translating data from the literature into their everyday practice. The present review aims to synthesize the existing evidence on pSS associated cardiovascular changes in a clinically relevant manner.
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Affiliation(s)
- Mihnea Casian
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,2nd Internal Medicine Department, Central Military University Emergency Hospital, Bucharest, Romania
| | - Ciprian Jurcut
- 2nd Internal Medicine Department, Central Military University Emergency Hospital, Bucharest, Romania
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Ancuta Mihai
- 2nd Internal Medicine Department, Central Military University Emergency Hospital, Bucharest, Romania.,Rheumatology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Silviu Stanciu
- Cardiac Noninvasive Laboratory, Central Military University Emergency Hospital, Bucharest, Romania.,Internal Medicine Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Ruxandra Jurcut
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
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Garcia ABA, Dardin LP, Minali PA, Trevisani VFM. Cardiovascular Effect of Physical Exercise on Primary Sjogren's Syndrome (pSS): Randomized Trial. Front Med (Lausanne) 2021; 8:719592. [PMID: 34660630 PMCID: PMC8514691 DOI: 10.3389/fmed.2021.719592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the effects of an exercise program on aerobic capacity, echocardiographic parameters, metabolic profile, quality of life and safety in patients with primary Sjogren's syndrome in a randomized trial. Methods: 60 women with pSS were evaluated from the SF-36 Short-Form Health Survey (SF-36) and EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) questionnaires. The participants performed ergospirometry and echocardiography; blood samples were collected to evaluate the metabolic profile. Patients were randomly divided into 2 groups: a training group that participated in the supervised training program and a control group. All variables were analyzed at baseline and after 28 weeks for both groups and we performed an intention-to-treat analysis. The training program consisted of 16 weeks of resistance exercises and, after, the exercise became aerobic. Patients and coaches were not blinded, contrary to the evaluators of all examinations/procedures and data analysts. Statistical analysis included Wilcoxon's rank sum test, chi-square test, and ANOVA test. P values < 0.05 were considered to be statistically significant. Results: The 2 groups were homogeneous at baseline. The training group showed a significant improvement in oxygen maximum volume (VO2max) and anaerobic threshold (AT). Comparison of the training group and control group after 28 weeks showed a significant difference relating to VO2max and in AT. We did not find statistically significant diference in echocardiographic parameters, metabolic profile and in questionnaires SF-36 and ESSDAI. Conclusions: This study showed significant improvement in aerobic capacity and glycated hemoglobin after a supervised training program in patients with pSS with safety.
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Affiliation(s)
| | - Luciana Paula Dardin
- Department of Medicine, Health-Based Evidence, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo Alexandre Minali
- Department of Medicine, Health-Based Evidence, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virginia Fernandes Moça Trevisani
- Department of Medicine, Health-Based Evidence, Universidade Federal de São Paulo, São Paulo, Brazil.,Universidade de Santo Amaro, São Paulo, Brazil
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Almasi S, Farahani B, Samiei N, Rezaei Y, Mahmoodi H, Qorbani M. Echocardiographic and Electrocardiographic Findings in Patients with Ankylosing Spondylitis without Cardiovascular Risk Factors. J Tehran Heart Cent 2021; 15:43-49. [PMID: 33552193 PMCID: PMC7825462 DOI: 10.18502/jthc.v15i2.4182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors. Methods: The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. Results: The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332). Conclusion: The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.
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Affiliation(s)
- Simin Almasi
- Rheumatology Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Farahani
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Habib Mahmoodi
- Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran.,Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Akaycan J, Hidayet Ş, Bayramoğlu A, Yolbaş S, Karaca Y, Yiğit Y, Ulutaş Z. Subclinical left ventricular dysfunction in Sjögren's syndrome assessed by four-dimensional speckle tracking echocardiography. Echocardiography 2020; 37:1803-1808. [PMID: 32951254 DOI: 10.1111/echo.14867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the left ventricular (LV) systolic strain by four-dimensional speckle tracking echocardiography (4D-STE) in order to provide the early detection of myocardial dysfunction in patients with Sjögren's syndrome (SS). METHODS Forty consecutive patients with primary SS diagnosed at the rheumatology outpatient clinic and 35 age- and sex-matched healthy volunteers were included in the study. 4DSTE was performed, and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured. 4DSTE results were compared with the healthy volunteers. RESULTS No significant differences were observed between the GRS and GCS values of the two groups. A significant difference was observed in the GLS and GAS measurements between the two groups (P = .005 for GLS, P < .001 for GAS). Positive correlation was detected between disease duration and LV-GLS and LV-GAS. CONCLUSION We demonstrated subclinical systolic dysfunction in SS patients by 4DSTE, which is a sensitive marker of ventricular dysfunction. Deterioration of the LV became more evident as duration of the disease increased. Therefore, we believe that a cardiac evaluation will be of benefit to patients with long-term SS.
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Affiliation(s)
- Jülide Akaycan
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Şıho Hidayet
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adil Bayramoğlu
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Servet Yolbaş
- Department of Rheuomatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yücel Karaca
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yakup Yiğit
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Zeynep Ulutaş
- Department of Cardiology, Elazığ Fethi Sekin City Hospıtal, Elazığ, Turkey
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Hidayet Ş, Yağmur J, Karaca Y, Bayramoğlu A, Yolbaş S, Hidayet E, Ulutaş Z, Pekdemir H. Assessment of left atrial volume and function in patients with Sjögren's syndrome using three-dimensional echocardiography. Echocardiography 2020; 37:715-721. [PMID: 32315513 DOI: 10.1111/echo.14661] [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: 02/14/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjögren's syndrome (SS). METHODS We prospectively included 42 consecutive patients with primary SS and 42 controls who were similar in terms of basal characteristics. 3DTTE was used to assess LA function. RESULTS Maximum LA volume, minimum LA volume, pre-atrial contraction LA volume, LA Active Stroke Volume (ASV), LA Total Stroke Volume (TSV), maximal left atrial volume index (LAVImax), Left atrial pre-contraction volume index, and Left atrial minimum volume index, ASV index, and TSV index were significantly higher in the SS group, and the LA Total Emptying Fraction, LA Expansion Index, and LA Passive Emptying Fraction were significantly lower. Although the active emptying fraction was higher in the SS group, the difference was not statistically significant. LAVImax was positive correlated with disease duration (r = .753). CONCLUSION Left atrial function is impaired in SS patients and serves as an early marker of subclinical cardiac involvement.
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Affiliation(s)
- Şiho Hidayet
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Jülide Yağmur
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yücel Karaca
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Bayramoğlu
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Servet Yolbaş
- Department of Rheuomatology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Emine Hidayet
- Department of Internal Medicine, Malatya Training and Research Hospital, Malatya, Turkey
| | - Zeynep Ulutaş
- Department of Cardiology, Elazığ Fethi Sekin Cıty Hospıtal, Elazığ, Turkey
| | - Hasan Pekdemir
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians. Autoimmun Rev 2018; 17:201-214. [DOI: 10.1016/j.autrev.2017.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
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Babazade R, Sun Z, Hesler BD, Sharma A, Makarova N, Dalton JE, Turan A. The Association Between Sjögren Syndrome and Adverse Postoperative Outcomes: A Historical Cohort Study Using Administrative Health Data. Anesth Analg 2016; 121:1222-30. [PMID: 26309019 DOI: 10.1213/ane.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sjögren syndrome is a chronic autoimmune disorder of the exocrine glands associated with cardiovascular events. We aimed to evaluate postoperative complications in patients with Sjögren syndrome undergoing noncardiac surgery. Specifically, we tested the primary hypothesis that patients with Sjögren syndrome have a greater risk of postoperative cardiovascular complications than those without the disease. Our secondary hypotheses were that patients with Sjögren syndrome are at greater risk of thromboembolic complications, microcirculatory complications, and mortality. METHODS We obtained censuses of 2009 to 2010 inpatient hospital discharges across 7 states. Sjögren syndrome was identified by the present-on-admission diagnosis code 710.2. Each Sjögren n syndrome discharge was propensity matched to 4 control discharges. A generalized linear model was used to compare matched Sjögren syndrome patients and controls on risk of in-hospital cardiovascular complications, thromboembolic complications, microcirculatory complications, and mortality. RESULTS Among 5.5 million qualifying discharges, our final matched sample contained 22,785 matched discharges, including 4557 with Sjögren syndrome. Sixty-six (1.45%) of the matched discharges with Sjögren syndrome and 213 (1.17%) of the matched controls had associated in-hospital cardiovascular complications. The adjusted odds ratio (99% confidence interval) was estimated at 1.14 (0.79-1.64), which was not statistically significant (P = 0.35). There were no significant differences in the odds of in-hospital thromboembolic complications (1.12 [0.82-1.53]; P = 0.36), in the odds of in-hospital microcirculatory complications (0.98 [0.77-1.26]; P = 0.86), or in the odds of in-hospital mortality (1.11 [0.76-1.61]; P = 0.49). CONCLUSIONS The presence of Sjögren syndrome does not place patients at an increased risk for postoperative complications or in-hospital mortality.
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Affiliation(s)
- Rovnat Babazade
- From the *Department of Outcomes Research, †Anesthesiology Institute, and ‡Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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Yamasaki Y, Suzuki K, Kamijima R, Asari Y, Tsuchida K, Mizushima M, Okazaki T, Akashi YJ, Ozaki S, Yamada H. Combined disease with pulmonary arterial hypertension and pulmonary venous hypertension revealed after treatment of heart failure with preserved ejection fraction in a case with primary Sjögren syndrome. Mod Rheumatol 2015; 28:193-196. [DOI: 10.3109/14397595.2015.1059989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshioki Yamasaki
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Kengo Suzuki
- Division of Cardiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Ryo Kamijima
- Division of Cardiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Yusa Asari
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Kosei Tsuchida
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Machiko Mizushima
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Takahiro Okazaki
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Shoichi Ozaki
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Hidehiro Yamada
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
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