Clinical Analysis of Heart Manifestations in Patients with Polymyositis or Dermatomyositis_West China Medical Journal

Authors：

DONGJian-ling ,  YANGJing , DENGDai-hua , LISi-yin , LIMin

Department of Rheumatology, the Central Hospital of Mianyang, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

YANGJing, Email: yangjing6525@163.com

Keywords：

Polymyositis; Dermatomyositis; Heart disease; Interstitial lung disease

DOI：

10.7507/1002-0179.20150463

Video：

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Objective To analyze the incidence of heart disease, its clinical manifestations and risk factors in patients with polymyositis (PM) and dermatomyositis (DM). Method We collected the clinical data of 138 PM (n=78) and DM (n=60) patients treated between January 2008 and March 2014, among whom there were 64 males and 74 females with an average age of (48.5±19.6) years old, and an average disease course of (84.5±6.9) months. We analyzed their incidence of heart disease, its clinical manifestations and the risk factors. Subsequently, we adopted single-factor analysis to analyze such factors as age, gender, disease course, kinds of disease, creatine kinase (CK), CK-MB, CK-MB/CK, troponin T, antinuclear antibodies, anti-SSA antibody, erythrocyte sedimentation rate, C-reactive protein, disease activity score, muscle force, pulmonary interstitial lesions and pulmonary artery hypertension. Results There were 59 (42.7%) patients with heart disease, 48 (34.8%) with abnormal electrocardiogram, and 52 (37.7%) with abnormal color Doppler ultrasound results. Logistics multiple factors regression analysis found that the course of the disease (OR=1.669, P=0.010), myositis disease activity score (OR=7.456, P<0.001), pulmonary interstitial lesions (OR=4.568, P=0.014) were risk factor for heart disease in PM/DM patients. Conclusions Long disease course duration, high myositis activity score and pulmonary interstitial lesions are strong predictors for heart damage in PM/DM patients.

Citation： DONGJian-ling, YANGJing, DENGDai-hua, LISi-yin, LIMin. Clinical Analysis of Heart Manifestations in Patients with Polymyositis or Dermatomyositis. West China Medical Journal, 2015, 30(9): 1613-1617. doi: 10.7507/1002-0179.20150463 Copy

1.	Dalakas MC, Hohleld R. Polymyositis and dermatomyositis[J]. Lancet, 2003, 362(9388):971-982.
2.	Dankó K, Ponyi A, Constantin T, et al. Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features:a longitudinal study of 162 cases[J]. Medicine (Baltimore), 2004, 83(1):35-42.
3.	Askari AD. The heart in polymyositis and dermatomyositis[J]. Mt Sinai J Med, 1988, 55(6):479-482.
4.	Bohan A, Peter JB. Polymyositis and dermatomyositis[J]. N Engl J Med, 1975, 292(7):344-347, 403-407.
5.	佟勝全, 周新福, 張奉春. 多發性肌炎或皮肌炎心臟損害的臨床分析[J]. 中華風濕病學雜志, 2005, 9(10):605-608.
6.	Ruperto N, Ravelli A, Pistorio A, et al. The provisional Paediatric Rheumatology International Trials Organisation/American College of Rheumatology/European League Against Rheumatism Disease activity core set for the evaluation of response to therapy in dermatomyositis:a prospective validation study[J]. Arthritis Rheum, 2008, 59(1):4-13.
7.	汪漢, 蔡琳. 多發性肌炎/皮肌炎的心臟病變[J]. 心血管病學進展, 2015, 36(3):332-337.
8.	Bazzani C, Cavazzana I, Ceribelli A, et al. Cardiological features in idiopathic inflammatory myopathies[J]. J Cardiovasc Med (Hagerstown), 2010, 11(12):906-911.
9.	Van Gelder H, Charles-Schoeman C. The heart in inflammatory myopathies[J]. Rheum Dis Clin North Am, 2014, 40(1):1-10.
10.	Zhang L, Wang GC, Ma L, et al. Cardiac involvement in adult polymyositis or dermatomyositis:a systematic review[J]. Clin Cardiol, 2012, 35(11):686-691.
11.	Gupta R, Wayangankar SA, Targoff IN, et al. Clinical cardiac involvement in idiopathic inflammatory myopathies:a systematic review[J]. Int J Cardiol, 2011, 148(3):261-270.
12.	Alle Deveza LM, Miossi R, de Souza FH, et al. Electrocardiographic changes in dermatomyositis andpolymyositis[J/OL]. Rev Bras Reumatol, 2014.[2015-09-01]. http://www.sciencedirect.com/science/article/pii/S225550211400203X.
13.	Lu Z, Wei Q, Ning Z, et al. Left ventricular diastolic dysfunction-early cardiac impairment in patients with polymyositis/dermatomyositis:a tissue Doppler imaging study[J]. J Rheumatol, 2013, 40(9):1572-1577.
14.	Wang H, Liu HX, Wang YL, et al, Left ventricular diastolic dysfunction in patients withdermatomyositis without clinically evident cardiovasculardisease[J]. J Rheumatol, 2014, 41(3):495-500.
15.	左川, 魏翾娣, 葉亞麗, 等. 皮肌炎、多發性肌炎合并心臟損害的危險因素分析[J]. 四川大學學報:醫學版, 2013, 44(5):801-804, 809.
16.	Ji SY, Zeng FQ, Guo Q, et al. Predictive factors and unfavourable prognostic factors of interstitial lung disease in patients with polymyositis or dermatomyositis:a retrospective study[J]. Chin Med J (Engl), 2010, 123(5):517-522.
17.	劉芳, 蒲傳強. 多發性肌炎合并心臟損害的臨床特點[J]. 臨床神經病學雜志, 2005, 18(2):97-99.
18.	Kiely PD, Bruckner FE, Nisbet JA, et al. Serum skeletal troponin I in inflammatory muscle disease:relation to creatine kinase, CKMB and cardiac troponin I[J]. Ann Rheum Dis, 2000, 59(9):750-751.

1. Dalakas MC, Hohleld R. Polymyositis and dermatomyositis[J]. Lancet, 2003, 362(9388):971-982.
2. Dankó K, Ponyi A, Constantin T, et al. Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features:a longitudinal study of 162 cases[J]. Medicine (Baltimore), 2004, 83(1):35-42.
3. Askari AD. The heart in polymyositis and dermatomyositis[J]. Mt Sinai J Med, 1988, 55(6):479-482.
4. Bohan A, Peter JB. Polymyositis and dermatomyositis[J]. N Engl J Med, 1975, 292(7):344-347, 403-407.
5. 佟勝全, 周新福, 張奉春. 多發性肌炎或皮肌炎心臟損害的臨床分析[J]. 中華風濕病學雜志, 2005, 9(10):605-608.
6. Ruperto N, Ravelli A, Pistorio A, et al. The provisional Paediatric Rheumatology International Trials Organisation/American College of Rheumatology/European League Against Rheumatism Disease activity core set for the evaluation of response to therapy in dermatomyositis:a prospective validation study[J]. Arthritis Rheum, 2008, 59(1):4-13.
7. 汪漢, 蔡琳. 多發性肌炎/皮肌炎的心臟病變[J]. 心血管病學進展, 2015, 36(3):332-337.
8. Bazzani C, Cavazzana I, Ceribelli A, et al. Cardiological features in idiopathic inflammatory myopathies[J]. J Cardiovasc Med (Hagerstown), 2010, 11(12):906-911.
9. Van Gelder H, Charles-Schoeman C. The heart in inflammatory myopathies[J]. Rheum Dis Clin North Am, 2014, 40(1):1-10.
10. Zhang L, Wang GC, Ma L, et al. Cardiac involvement in adult polymyositis or dermatomyositis:a systematic review[J]. Clin Cardiol, 2012, 35(11):686-691.
11. Gupta R, Wayangankar SA, Targoff IN, et al. Clinical cardiac involvement in idiopathic inflammatory myopathies:a systematic review[J]. Int J Cardiol, 2011, 148(3):261-270.
12. Alle Deveza LM, Miossi R, de Souza FH, et al. Electrocardiographic changes in dermatomyositis andpolymyositis[J/OL]. Rev Bras Reumatol, 2014.[2015-09-01]. http://www.sciencedirect.com/science/article/pii/S225550211400203X.
13. Lu Z, Wei Q, Ning Z, et al. Left ventricular diastolic dysfunction-early cardiac impairment in patients with polymyositis/dermatomyositis:a tissue Doppler imaging study[J]. J Rheumatol, 2013, 40(9):1572-1577.
14. Wang H, Liu HX, Wang YL, et al, Left ventricular diastolic dysfunction in patients withdermatomyositis without clinically evident cardiovasculardisease[J]. J Rheumatol, 2014, 41(3):495-500.
15. 左川, 魏翾娣, 葉亞麗, 等. 皮肌炎、多發性肌炎合并心臟損害的危險因素分析[J]. 四川大學學報:醫學版, 2013, 44(5):801-804, 809.
16. Ji SY, Zeng FQ, Guo Q, et al. Predictive factors and unfavourable prognostic factors of interstitial lung disease in patients with polymyositis or dermatomyositis:a retrospective study[J]. Chin Med J (Engl), 2010, 123(5):517-522.
17. 劉芳, 蒲傳強. 多發性肌炎合并心臟損害的臨床特點[J]. 臨床神經病學雜志, 2005, 18(2):97-99.
18. Kiely PD, Bruckner FE, Nisbet JA, et al. Serum skeletal troponin I in inflammatory muscle disease:relation to creatine kinase, CKMB and cardiac troponin I[J]. Ann Rheum Dis, 2000, 59(9):750-751.

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