Cardiac involvement in patients with idiopathic inflammatory myopathies (IIM) is associated with increased morbidity and mortality risk; however, little is known about the progression of cardiac dysfunction and long-term data are scarce. In the present work, we intended to prospectively study echocardiographic parameters in patients with IIM for 2 years. Twenty-eight IIM patients (41.9±1.6 years) without cardiovascular symptoms were enrolled. Patients with monophasic/polyphasic disease patterns were studied separately and compared to age-matched healthy individuals. Conventional echocardiographic and tissue Doppler imaging (TDI) parameters of systolic [LV: ejection fraction (EF), mitral annulus systolic movement (MAPSE), lateral s′) and diastolic left (mitral inflow velocities, lateral anulus velocities: e′, a′, E/e′) and right ventricular function (fractional area change: FAC, tricuspid annulus plane systolic excursion: TAPSE) were measured at the time of the diagnosis and 2 years later. Subclinical LV systolic dysfunction is characterized by reduced lateral s′ (10.4 vs. 6.4 cm/s, p<0.05), EF (62.6±0.6%, vs. 51.7±0.7%) and MAPSE (18.5±0.6 vs. 14.5±0.6 mm) could be observed in IIM patients with polyphasic disease course 2 years after diagnosis compared to controls. Furthermore, diastolic LV function showed a marked deterioration to grade I diastolic dysfunction at 2 years in the polyphasic group (lateral e′: 12.9 ±0.6, vs. 7.4±0.3 cm/s; lateral a′: 10.7±0.3, vs. 17.3±0.8 cm/s; p<0.05) supported by larger left atrium (32.1±0.6 vs. 37.8±0.6 mm; p<0.05]. TDI measurements confirmed subclinical RV systolic dysfunction in polyphasic patients 2 years after diagnosis (FAC: 45.6±1.8%, vs. 32.7±1.4%; TAPSE: 22.7±0.5, vs. 18.1±0.3 mm; p<0.05). Similar, but not significant tendencies could be detected in patients with monophasic disease patterns. Polyphasic patients showed significantly (p<0.05) worse results compared to monophasic patients regarding EF (51.7±0.7% vs. 58.1±0.6%), lateral s′ (6.4±0.4 cm/sec vs. 8.6±0.4 cm/s,), left atrium (37.8±0.6 mm vs. 33.3±0.8 mm), FAC (32.7±1.4% vs. 41.0±1.6%) and TAPSE (18.1±0.3 mm vs. 21.3±0.7 mm). Significant subclinical cardiac dysfunction could be detected in IIM patients with polyphasic disease course 2 years after diagnosis, which identifies them as a high-risk population. TDI is a useful method to detect echocardiographic abnormalities in IIM complementing conventional echocardiography and can recognize the high cardiac risk.

中文翻译：

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多相性多发性肌炎/皮肌炎的亚临床收缩期和舒张期心肌功能障碍：一项为期 2 年的纵向研究

特发性炎症性肌病 (IIM) 患者的心脏受累与发病率和死亡率风险增加有关；然而，人们对心功能不全的进展知之甚少，长期数据也很少。在目前的工作中，我们打算前瞻性研究 IIM 患者的超声心动图参数 2 年。招募了 28 名无心血管症状的 IIM 患者（41.9±1.6 岁）。单独研究具有单相/多相疾病模式的患者，并与年龄匹配的健康个体进行比较。收缩压的常规超声心动图和组织多普勒成像 (TDI) 参数 [LV: 射血分数 (EF)、二尖瓣环收缩运动 (MAPSE)、横向 s') 和左舒张 (二尖瓣流入速度、横向环速度：e'、a' , E/e'）和右心室功能（部分面积变化：FAC，三尖瓣环平面收缩期偏移：TAPSE）在诊断时和 2 年后测量。亚临床 LV 收缩功能障碍的特征是侧向 s' 降低（10.4 对 6.4 cm/s，p<0.05）、EF（62.6±0.6%，对 51.7±0.7%）和 MAPSE（18.5±0.6 对 14.5±0.6与对照组相比，在诊断后 2 年具有多相病程的 IIM 患者中可以观察到。此外，多相组 2 年时左室舒张功能显着恶化为 I 级舒张功能障碍（横向 e'：12.9 ±0.6，对比 7.4±0.3 cm/s；横向 a'：10.7±0.3，对比 17.3 ±0.8 cm/s；p<0.05）由较大的左心房支持（32.1±0.6 对 37.8±0.6 mm；p<0.05]。TDI 测量证实多相患者在诊断 2 年后出现亚临床 RV 收缩功能障碍（FAC：45.6±1.8%，对 32.7±1.4%；TAPSE：22.7±0.5，对 18.1±0.3 mm；p<0.05）。在具有单相疾病模式的患者中可以检测到类似但不显着的趋势。与单相患者相比，多相患者在 EF（51.7±0.7% 对 58.1±0.6%）、横向 s'（6.4±0.4 厘米/秒对 8.6±0.4 厘米/秒）方面表现出显着（p<0.05）更差的结果、左心房（37.8±0.6 mm vs. 33.3±0.8 mm）、FAC（32.7±1.4% vs. 41.0±1.6%）和 TAPSE（18.1±0.3 mm vs. 21.3±0.7 mm）。在诊断后 2 年多相病程的 IIM 患者中可检测到显着的亚临床心功能不全，这将他们确定为高危人群。