| ObjectiveHeart involvement is a hallmark and characteristic target organ for autoimmune disease,particularly systemic sclerosis(SSc)and systemic lupus erythematosus(SLE).Current evidences suggest that cardiac involvement is a major comorbidity with a high morbidity and high mortality.MethodsThe purpose of this study is to analyze SSc and SLE with heart involvement by retrospective case analysis and prospective imaging study.The first part is based on China National Rheumatology Data Center(CRDC)and inpatient medical records.1.Retrospective analysis of SSc patients with myocardial involvement and SSc patients without myocardial involvement.2.Retrospective case analysis of SLE patients with LES and SLE patients without LSE.Including clinical features,organ involvement,laboratory examination and follow-up information,were statistically analyzed.In the second part,a prospective cohort study was established.Patients with SSc were prospectively and consecutively registered in outpatient department of rheumatology and immunology in Peking Union Medical College Hospital from December 2021 to August 2022.Healthy people matched with sex and age were also recruited,and myocardial nuclear magnetic resonance imaging and laboratory examination were analyzed.ResultsRetrospective Study1.In retrospective study of SSc patients with myocardial involvement.In total,21 SSc patients(17 females)with MI were enrolled.The mean age at SSc onset was 42.3 ±15.1 years old.Compared with controls,myositis(42.9%vs.14.3%,P=0.014)and elevation of CK(33.3%vs.4.8%,P=0.002)were more common in patients with MI.Of the 7 patients without cardiovascular symptoms,3/5 showed elevations in cardiac troponin-I(cTnI),6 showed elevations of N-terminal brain natriuretic peptide(NTproBNP).Eleven patients were followed up for a median period of 15.5 months and four patients developed newly occurring left ventricular ejection fraction(LVEF)<50%.2.In retrospective study of SLE with LES,a total of 20 patients with SLE and LSE were included,including 18 females,aging from 13 to 49 years old,with the average age of 31.7±9.4 years old.The duration of SLE when LSE was detected was 16.04(0185.1)months,and 19(95%)of the vegetations were located in the mitral valve.Patients with SLE with LSE were more commonly associated with cerebral infarction(45%vs.10%,=9.87,P=0.001)and antiphospholipid syndrome(APS)(50%vs.5%,=22.32,P<0.001).Patients with SLE with LSE were 19 times more likely to have APS than patients without LSE(OR(95%CI)=19.00,95%CI(4.43-81.38),P<0.01).Prospective Study1.In the prospective cohort of patients with SSc were included forty patients(mean age 47.7± 13.8 years,35 females),and 13(mean age 43.2±3.3 years,10 females)healthy subjects.Natural T1 values in the myocardium were significantly higher in SSc patients compared with healthy subjects(1305±48.3 ms vs.1273.7±35.5 ms,P=0.036).The pulmonary diffusion volume of carbon monoxide(DLCO)was significantly correlated with the previous intrinsic T1 value of myocardium(β,-0.958;95%CI,-1.822 to-0.094;P=0.031),and after adjustment for confounders(β,-1.223;95%CI,-2.155 to0.291;P=0.012).Moderate to severe decreases in DLCO(DLCO<60%)and intrinsic myocardial T1 values(β,33.189;95%CI,16.332 to 50.046;P=0.001)。2.A total of 30 patients with SSc were included in the study,including 27 females(90%),and the age of SSc onset were 46.0±2.4 years old,of which 16(53.3%)patients were classified as diffuse cutaneous systemic sclerosis(dcSSc).Correlation analysis showed a positive correlation between men(r=0.520,P=0.003)and 5-HT.The native T1 value on cardiac magnetic resonance in SSc patients were 1302.4±46.5ms,which was negatively correlated with serum 5-HT(r=-0.405,P=0.026).Gender and age were adjusted in Model 1 and gender and age reflux esophagitis in Model 2 for multiple linear regression analysis:Gender of SSc patients and 5-HT in Model 1 was(β,671.399;95%CI,534.430-808.368,P<0.001),and Model 2(β,670.398;95%CI,534.598 to 806.199,P<0.001)was significant correlation.Native T1 value was correlated with 5HT in model was(β,-1.510;95%CI,-2.238,-0.782,P<0.001),and Model 2(β,-1.474;95%CI,-2.198,-0.750,P<0.001)was significant correlation.Conclusion1.Autoimmune diseases with cardiac involvement are common.Echocardiography in patients with SLE can detect the presence of LSE at an early stage.Patients with SLE and LSE have an increased risk of APS and cerebrovascular diseases.For patients who are LA-positive,we should be vigilant against the possibility of LSE.More aggressive anti-inflammatory and anti-thrombotic treatments may be effective.2.One third of SSc patients with MI were asymptomatic were more common with myositis.Regular monitoring of CTnI,NT-proBNP and echocardiography is helpful for the diagnosis of MI during the early stages.Its prognosis is poor.3.In exploring the correlation between lung function and myocardial magnetic resonance imaging,it was found that lung function was independently related to the intrinsic T1 value of myocardium in SSc patients.Particularly,when the DLCO was moderately to severely reduced,the measured value of lung function might be a potential indicator of subclinical myocardial damage in SSc patients.4.5-HT may be related to early myocardial lesions in SSc patients,but the correlation between them needs to be confirmed by further research with expanded sample size. |
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