Objective

To determine the prevalence of echocardiographic findings and their change over time in patients with connective tissue diseases (CTDs) and to analyse which findings were associated with escalation of immunosuppressive therapy.

Method

We conducted a retrospective cohort study of consecutive hospitalized patients from a tertiary rheumatology referral centre who received transthoracic echocardiography between 1 January 2006 and 31 December 2015. We tested for associations between echocardiographic findings and treatment escalation via Fisher’s exact test; p < 0.05 was considered significant. Escalation of therapy was defined by dosage of glucocorticoids and type of disease-modifying anti-rheumatic drug. The clinical relevance of echocardiographic findings concerning change in immunosuppressive therapy was recorded.

Results

In total, 1004 patients were included (865 females), with a total of 1660 echocardiographic examinations. The most frequent findings were mitral, tricuspid, and aortic valve regurgitation (found in 36.7%, 25.4%, and 17.7% of all patients), aortic valve sclerosis (20.1%), left ventricular dysfunction (21.5%), and left atrial dilatation (19.2%). Only pericardial effusions were more frequent in cases with treatment escalation (10.9% of cases with escalated therapy vs 6.9% of cases without, p = 0.007). In 314 patients who received follow-up examinations, echocardiographic findings were found to change between examinations. Only 73 of all 1660 examinations were discussed in depth considering the treatment strategy in the hospital discharge letter.

Conclusion

Patients with CTDs exhibited a wide, dynamically changing spectrum of echocardiographic abnormalities. Most findings neither reflected disease activity nor appeared to influence the therapeutic regimen.

中文翻译：

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结缔组织病住院患者超声心动图检查结果的研究

客观的

确定结缔组织病 (CTD) 患者超声心动图检查结果的普遍性及其随时间的变化，并分析哪些检查结果与免疫抑制治疗升级相关。

方法

我们对 2006 年 1 月 1 日至 2015 年 12 月 31 日期间接受经胸超声心动图检查的三级风湿病转诊中心的连续住院患者进行了一项回顾性队列研究。我们通过 Fisher 精确检验检验了超声心动图结果与治疗升级之间的关联；p < 0.05 被认为是显着的。治疗的升级由糖皮质激素的剂量和改善疾病的抗风湿药物的类型来定义。记录了有关免疫抑制治疗变化的超声心动图结果的临床相关性。

结果

共纳入 1004 名患者（865 名女性），共进行了 1660 次超声心动图检查。最常见的发现是二尖瓣、三尖瓣和主动脉瓣关闭不全（在所有患者中分别为 36.7%、25.4% 和 17.7%）、主动脉瓣硬化（20.1%）、左心室功能障碍（21.5%）和左心房扩张(19.2%)。在治疗升级的病例中，只有心包积液更常见（10.9% 的病例升级治疗 vs 6.9% 的未升级病例，p = 0.007）。在接受后续检查的 314 名患者中，发现超声心动图检查结果在检查之间发生了变化。考虑到出院信中的治疗策略，对所有 1660 项检查中的 73 项进行了深入讨论。

结论

CTD 患者表现出广泛的、动态变化的超声心动图异常谱。大多数发现既不反映疾病活动，也不似乎影响治疗方案。