Evaluation of myocarial involvement in systemic lupus erythematosus by signal-averaged electrocardiography and echocardiography

Paradiso, Michele; Gabrielli, Francesco; Masala, C; Coppotelli, L; Franco, Manuela Di; Paoletti, Vincenzo; Musca, A; Mammarella, A

doi:10.2143/ac.56.6.2005702

Cited by 24 publications

(18 citation statements)

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“…Some stud-ies suggest that depolarization abnormalities on signalaveraged ECG accompanied by echocardiographic evidence of abnormal LV filling could reflect the presence of myocardial fibrosis and could be a marker of subclinical myocardial involvement in SLE patients. 301 Cardiac involvement can manifest itself by conduction system abnormalities such as complete atrioventricular heart block. Cardiac MR and myocardial strain and strain rate can identify patients with early manifestation of SLE-induced cardiomyopathy.…”

Section: 300mentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

624

663

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CLINICAL STATEMENTS AND GUIDELINEST he intent of this American Heart Association (AHA) scientific statement is to summarize our current understanding of dilated cardiomyopathies. There is special emphasis on recent developments in diagnostic approaches and therapies for specific cardiomyopathies. Recommendations in this document are based on published studies, published practice guidelines from the American College of Cardiology (ACC)/AHA 1 and other organizations, 2,3 and the multidisciplinary expertise of the writing group. Existing evidence in epidemiology, classification, diagnosis, and management of specific cardiomyopathies is usually derived from nonrandomized observational studies, registries, case reports, or expert opinion based on clinical experience, not large-scale randomized clinical trials or systematic reviews. Therefore, in this document, rather than using the standard ACC/AHA classification schema of recommendations and level of evidence, 4 we have included key management strategies at the end of each section and categorized our recommendations according to the level of consensus. Although the format of our recommendations might resemble the ACC/AHA classification of recommendations used in the ACC/AHA practice guidelines, because of the preponderance of expert opinion or level of evidence C evidence in our document, we elected to use different terminology to provide a distinction from the practice guidelines, in which stronger levels and quality of evidence with randomized clinical trials or meta-analyses are usually present. 4 The levels of evidence follow the AHA and ACC methods of classifying the level of certainty of the treatment effect. 4 DEfINITIoN of DILATED CArDIoMyopAThyThe term dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. 5 In clinical practice, the pathogenesis of heart failure (HF) has often been placed into 2 categories: ischemic and nonischemic cardiomyopathy. The term nonischemic cardiomyopathy has been interchangeably used with DCM. Although this approach might be practical, it fails to recognize that nonischemic cardiomyopathy can include cardiomyopathies caused by volume or pressure overload (such as hypertension or valvular heart disease) that are not conventionally accepted under the definition of DCM. 1,5 Again, in general practice and clinical research trials, the term ischemic cardiomyopathy is defined as cardiomyopathy caused by ischemic heart disease. Current use of ischemic cardiomyopathy terminology implies ventricular dilation and depressed myocardial contractility caused by ischemia or infarction. CLASSIfICATIoN of CArDIoMyopAThIESThe first classification on this topic categorized cardiomyopathies as heart muscle diseases with dilated (DCM), hypertrophic, restrictive, arrhythmogenic right ventricular (ARVC), or nonclassifiable cardiomyopathy in 1980. 5 Subse...

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Section: 300mentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

624

663

View full text Add to dashboard Cite

show abstract

“…Since the presence of anti-Ro/ SSA was related with a prolonged QTc, its presence in the global context of increased sympathetic activity and higher incidence of late potentials can be a determinant factor for sudden death due to arrhythmia. The presence of late potentials in high-resolution electrocardiogram (ECG-HR) was also documented in the study of Paradiso et al 30 in which 20% of the patients had this alteration compared with only 5.5% in the control group.…”

Section: 12mentioning

confidence: 69%

Eventos arrítmicos no lúpus eritematoso sistêmico

Teixeira¹,

Borba²,

Bonfá³

et al. 2010

Rev. Bras. Reumatol.

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Cardiac involvement is present in more than half of the patients with Systemic Lupus Erythematosus (SLE). However, studies on the prevalence of arrhythmias in this disease and laboratorial correlations predictive of their development do not exist. It seems possible that the classic second mortality peak is related to arrhythmias, mainly due to the sudden nature of those deaths. Autoimmune process, atherosclerotic complications, and even adverse effects secondary to the treatment of this disorder (chloroquine cardiotoxicity) seem to be the main pathophysiological mechanisms of those disturbances. The direct participation of autoantibodies, such as anti-Ro/SSA and anti-RNP, is still controversial. All types of AV blocks (AVB), intraventricular conduction disturbances, and sick sinus syndrome have already been described in this disease. Tachycardias identified more often include sinus tachycardia, atrial fibrillation, and atrial ectopies. Long QT syndrome and the presence of late potentials in signal-averaged ECG have also been described in SLE patients and they can be associated with increased mortality rates. Cardiac toxicity secondary to chloroquine could be responsible for several types of arrhythmias. However, few cases of fascicular block evolving to complete AV block have been described. Since these adverse effects are rarely reported, the beneficial anti-inflammatory and immune properties support the use of antimalarials in this disease. A complete cardiologic evaluation should include the conduction system and must be carried out in all SLE patients to identify arrhythmias, therefore preventing symptoms and also sudden cardiac death.

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“…[14] Rosato et al found regional diastolic dysfunction by tissue doppler echocardiography in patients with systemic sclerosis (SSc) and Paradisp et al showed disturbed le ventricular lling patterns in SLE patients. [21,22] It is clear that le ventricular dysfunction is relatively frequent in in ammatory autoimmmune diseases. Myocardial dysfunction can be a result of myocarditis, myocardial brosis, vasculitis or microvascular dysfunction in these patients, but it can also be secondary to general subclinical or clinical in ammatory status.…”

Section: Discussionmentioning

confidence: 99%

Atrial Electromechanical Delay and Diastolic Dysfunction in Primary Sjögren Syndrome

Akyel¹,

Tavıl²,

Tufan³

et al. 2012

CIM

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Purpose: In this study we aimed to investigate myocardial function and atrial electromechanical properties by conventional and tissue doppler echocardiography in patients with primary Sjögren syndrome.Methods: Forty patients with Sjögren syndrome (SS) and 25 age-and sex-matched healthy volunteers were enrolled in the study. Using transthoracic echocardiography, myocardial performance index and atrial electromechanical properties were measured.Results: Basal characteristics were similar between two groups. Myocardial performance index values were disturbed in patients with Sjögren syndrome (0.41 vs. 0.32, p<0.01).ere was signi cant intraatrial (16.4±6.4, 5.0±4.5, p<0.01) and interatrial (30.6±10.1, 15.4±5.9, p<0.01) electromechanical delay in this patient group. Conclusion:Myocardial function is disturbed and there is signi cant atrial electromechanical delay in patients with primary SS. is study is the rst to show altered myocardial function and atrial electromechanical properties in primary SS.

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Evaluation of myocarial involvement in systemic lupus erythematosus by signal-averaged electrocardiography and echocardiography

Cited by 24 publications

References 0 publications

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Eventos arrítmicos no lúpus eritematoso sistêmico

Atrial Electromechanical Delay and Diastolic Dysfunction in Primary Sjögren Syndrome

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