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

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 (99m) Tc-pyrophosphate ((99m) Tc-PYP) scintigraphy.

RESULTS

Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% versus 0%; P = 0.02) and longer QRS and QT intervals (P = 0.007 and P < 0.0001, respectively). In multivariate analysis, factors associated with LVDD were age (P = 0.001), disease duration (P = 0.004), presence of myositis-specific or -associated autoantibodies (P = 0.05), and high cardiac (99m) Tc-PYP uptake (P = 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.

The diagnosis and management of hairy-cell leukaemia

Over a 4-year period 203 patients with various types of leukaemia were treated by the Haematology Unit at the Johannesburg Hospital. Ten of them were suffering from the condition known as hairy-cell leukaemia or leukaemic reticulo-endotheliosis. They were all men, and ranged in age from 29 to 67 years (mean 56 years). The majority presented with pancytopenia, and there was invariably splenomegaly, while lymphadenopathy was rare. Hairy cells were identified microscopically in the peripheral blood of 7 patients and in 5 the specific cytochemical marker, tartrate-resistant acid phosphatase, was present. In addition, in a further 2 patients this feature, which was not identified in the peripheral blood, was found in the splenic cells. The bone marrow trephine biopsy specimens characteristically showed extensive lymphoid infiltration associated with a dense disordered deposition of reticulin fibres. Electron microscopical and immunological studies proved to be of doubtful diagnostic value. Splenectomy was carried out on 9 patients, and there was tumour involvement in all the spleens removed. Two patients died from septicaemia, the one before splenectomy and the other 9 months after the operation. The 8 remaining patients have had their subjective symptoms alleviated and their peripheral blood indices have been improved by splenectomy, and none has required further treatment for periods now ranging from 7 to 41 months.

Further local experience in the treatment of acute non-lymphoblastic leukaemia

Ninety-two patients suffering from various forms of acute non-lymphoblastic leukaemia were seen at the Johannesburg General Hospital between January 1972 and December 1977. Seventy-four completed at least one course of therapy, and were therefore available for evaluation. Three basic regimens were used for inducing remissions. These included daunorubicin and cytosine arabinoside (regimen 1-19 patients); larger doses of daunorubicin together with cytosine arabinoside (regimen 2-29 patients); and a combination of cyclophosphamide, vincristine, cytosine arabinoside and prednisone (regimen 3-22 patients). Regimen 3 was normally used only in older patients. Supportive measures included the use of red cell, granulocyte and platelet transfusions. Complete remission rates with the 3 regimens were 36,8%, 55,1% and 40,9% respectively, with corresponding partial remission rates of 5,2%, 0% and 18,1% respectively. The mean duration of survival in those patients who achieved remission was 10 months, 18 months and 8 months respectively. In addition, a complete remission rate of 28,6% was obtained in 14 patients, 10 of whom had relapsed while being treated with other regimens and who were later treated with an 8-drug combination (TRAMPCOL).

The Bernard-Soulier syndrome: hereditary giant platelet disease

A patient with the Bernard-Soulier or hereditary giant platelet syndrome, in whom the characteristic morphological features were present and the in vitro abnormalities of platelet aggregation were demonstrated, is reported. Although rare, this syndrome is important, since surgical procedures may be carried out under cover of infused allogeneic platelets.