Cardiac involvement in patients with polymyositis and dermatomyositis

Abstract

Aim

of the work: To evaluate cardiac involvement in a cohort of idiopathic immune myopathy (IIM) patients not known to have cardiac involvement.Patients and methods: This study included 40 IIM patients. All patients underwent electrocardiography (ECG), echocardiography (ECHO) and laboratory investigations, including muscle enzymes, myositis autoantibody panel, serum troponin-I, and pro-B-type natriuretic peptide (pro-BNP). Results: Sixty-five percent of the patients were female. The mean age was 39.5 ± 15.97 years, and mean disease duration 3.2 ± 3.6 years. Palpitations and chest pain were reported in 25 % of patients, while 7.5 % had hypertension.Raynaud’swas present in 4 patients (10 %). ECG and ECHO abnormalities, primarily left ventricular hypertrophy and diastolic dysfunction, were observed in 20 % of patients. Elevated troponin-I was found in 17.5 %, and high pro-BNP levels were detected in 32.5 %. The meanejection fraction (EF%) was 66.4 ± 7.7. Patients with ECHO abnormalities were older (54.6 ± 12.4 vs 35.7 ± 14.6 years; p = 0.002), had a higher frequency of hypertension (n = 2, 25 %) vs 1, 3.1 %; p = 0.036), and were more likely to be smokers (n = 4, 50 %) vs 4, 12.5 %; p = 0.018). Troponin-I showed an inverse correlation with EF% (r = -0.32, p = 0.046) and CRP (r = -0.38,p = 0.016). Elevated serum pro-BNP was significantly associated with Raynaud’s phenomenon (p = 0.002). Conclusion: ECG and ECHO abnormalities were notably observed in IIM patients, together with elevated troponin-I and pro-BNP levels. Old age, smoking and hypertension were significantly associated with ECHO abnormalities. Troponin-I showed an inverse correlation with EF% and CRP.Initial cardiac evaluation with baseline ECG and ECHO is recommended for all IIM patients and serum troponin-I and pro-BNP may help detect subclinical cases.