Left Ventricular Diastolic Dysfunction in Patients with Dermatomyositis Without Clinically Evident Cardiovascular Disease

Simonsen

Arthritis Care & Research

et al. 2016

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 Results. Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% versus 0%; P 5 0.02) and longer QRS and QT intervals (P 5 0.007 and P < 0.0001, respectively). In multivariate analysis, factors associated with LVDD were age (P 5 0.001), disease duration (P 5 0.004), presence of myositis-specific or -associated autoantibodies (P 5 0.05), and high cardiac 99m Tc-PYP uptake (P 5 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.

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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

Simonsen

Arthritis Care & Research

et al. 2016

“…Lu and coworkers found in patients with PM/DM that female sex, late onset, and long disease course were 3 independent risk factors in the development of LV diastolic dysfunction 9 . Moreover, Wang, et al demonstrated a significant relationship between the changes in the diastolic variables and the disease duration in patients with DM, similar to what has been shown in rheumatoid arthritis (RA) and systemic sclerosis 11 .…”

Section: Journal Of Rheumatologymentioning

confidence: 73%

“…These results mainly included early LV diastolic dysfunction 9,10,11 , which may serve as a precursor for systolic and diastolic heart failure. Lu and coworkers found in patients with PM/DM that female sex, late onset, and long disease course were 3 independent risk factors in the development of LV diastolic dysfunction 9 .…”

Section: Journal Of Rheumatologymentioning

confidence: 98%

“…Lu, et al 9 and Wang, et al 10 reported more severe diastolic dysfunction after 4.78 and 11.12 months of average disease duration in similar age groups. In a later study, Wang, et al found LV diastolic dysfunction frequently in DM patients without evident CV disease and reported an association between transmitral flow alteration and disease duration 11 . The longer disease duration seems to correlate with the persistent cardiomyocyte damage, pathologic calcification, and high concen-tration of the cytokines (e.g., vascular cell adhesion molecule, TNF-α), which may all contribute to the progress of the diastolic dysfunction 27 .…”

Section: Journal Of Rheumatologymentioning

confidence: 98%

See 1 more Smart Citation

Echocardiographic Abnormalities in New-onset Polymyositis/dermatomyositis

Peter

Balogh²,

Szilágyi³

et al. 2014

J Rheumatol

Anti‐signal recognition particle antibodies induce cardiac diastolic dysfunction via oxidative stress injury

Zhang,

Shi,

Fan

et al. 2024

Clin & Trans Imm

ObjectivesAnti‐signal recognition particle (SRP) antibodies, markers of immune‐mediated necrotising myopathy, are reportedly related to cardiac involvement; however, whether they are pathogenic to the myocardium remains unclear. We aimed, therefore, to explore the pathogenicity of anti‐SRP antibodies against the myocardium through in vivo and in vitro studies.MethodsTotal immunoglobulin G (IgG), purified from patients with positive anti‐SRP antibodies, was passively transferred into C57BL/6 mice. Cardiac function was evaluated via echocardiography and the ventricular pressure–volume loop; cardiac histological changes were analysed using haematoxylin–eosin staining, picrosirius red staining, immunofluorescence and immunohistochemistry. Additionally, reactive oxygen species (ROS) formation was evaluated by dihydroethidium (DHE) staining; mitochondrial morphology and function were evaluated using transmission electron microscopy and seahorse mitochondrial respiration assay, respectively. The myositis cohort at our centre was subsequently reviewed in terms of cardiac assessments.ResultsAfter the passive transfer of total IgG from patients with positive anti‐SRP antibodies, C57BL/6 mice developed significant left ventricular diastolic dysfunction (LVDD). Transcriptomic analysis and corresponding experiments revealed increased oxidative stress and mitochondrial damage in the hearts of the experimental mice. Cardiomyocytes exposed to anti‐SRP‐specific IgG, however, recovered normal mitochondrial metabolism after treatment with N‐acetylcysteine, an ROS scavenger. Moreover, patients positive for anti‐SRP antibodies manifested worse diastolic but equivalent systolic function compared to their counterparts after propensity score matching.ConclusionAnti‐SRP antibodies may play a pathogenic role in the development of LVDD by promoting ROS production and subsequent myocardial mitochondrial impairment. The inhibition of oxidative stress was effective in reversing anti‐SRP antibody‐induced LVDD.