The Characteristic Of Cardiac Involvement In Idiopathic Inflammatory Myopathies

BackgroundIdiopathic inflammatory myopathy(idiopathic inflammatory myopathies,IIMs)is a group of systemic autoimmune diseases characterized by skeletal myositis.Heart damage is a common organ involvement in adult IIMs,and it is one of the main causes of death in patients.It has been found that patients with different kinds of myositis antibodies(including specific autoantibodies(MSAs)and myositis-associated autoantibodies(MAAs))have different clinical symptoms.As ideal biomarkers,these antibodies can not only be used to identify different subtypes of myositis,but also provide important clues for exploring the potential immunopathogenic mechanism of IIMs.Although some antibodies have been reported to be closely related to heart damage,there is still a lack of systematic studies and the potential predictive value of myositis antibodies for cardiac involvement in IIMs is not clear.Abnormal electrocardiogram and echocardiography are important manifestations of cardiac damage in patients with IIMs,and the examination methods are economical and convenient.This study will mainly analyze and evaluate the characteristics of cardiac damage inpatients with IIMs from the aspects of abnormal ECG and echocardiography.ObjectiveTo summarize the types and clinical characteristics of cardiac damage in the patients with idiopathic inflammatory myopathies,and to explore the evaluation value of myositis antibody for concomitant cardiac damage and possible risk factors for cardiac damage.The purpose of this study was to summarize the types of cardiac damage and related clinical characteristics in patients with idiopathic inflammatory myopathies,and to analyze the risk factors of cardiac damage and the predictive value of myositis antibody in IIMs associated with cardiac damage.Methods1.Retrospective analysis was performed on 253 adult cases with idiopathic inflammatory myopathies in the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2019.The following clinical data were collected:age,sex,course of disease,myositis classification,clinical manifestations,relevant laboratory and imaging data.2.According to the results of electrocardiogram and echocardiography,the patients were divided into the heart injury group(195 cases)and the non-heart injury group(58 cases).The incidence rates of various heart injury types were statistically analyzed,and the differences in the positive rates of each IIMs subtype combined with heart injury were compared.3.Analyze the characteristics of cardiac injury in patients with different myositis antibody positivity.4.SPSS software was used for statistical analysis,P<0.05 was considered statistically significant.Results1.Among the 253 patients with idiopathic inflammatory myopathy included in this study,the incidence of heart damage was 77.1%.The main types of cardiac damage were arrhythmia(12.6%),myocardial ischemia/infarction(14.2%),myocardial damage(69.2%),pulmonary hypertension(5.5%),pericarditis(4.7%),and valvular disease(8.7%).2.The main manifestations of cardiac damage in IIMs patients were palpitations,discomfort in the anterior cardiac area,chest pain,syncope,cyanosis,and edema of both lower limbs.Of the patients with heart damage,the majority of patients(76.9%)had no obvious heart-related symptoms.Except for hair loss(P=0.033),there was no statistical difference between the two groups in lung symptoms,limb muscle symptoms,joint swelling and pain,fever and other clinical manifestations(P>0.05).Dry mouth/dry eyes and hair loss were associated with decreased diastolic function(r=0.139,?2=4.97,P=0.026;r=0.134,?2=7.368,P=0.011)and was also associated with myocardial damage(r=0.136,?2=7.368,P=0.030;r=0.171,?2=7.587,P=0.010).Patients with heart damage had higher cholesterol(4.46 ± 1.26 vs 3.94 ± 0.94,P=0.002)and lower LDL(2.82±1.05 vs 2.46±0.72,P=0.007)than those without heart damage.Pulmonary hypertension(P=0.001),pericarditis(P=0.018),and valvular disease(P=0.013)were associated with increased CRP,while valvular disease was associated with increased ESR(P=0.006).3.The patients with different positive myositis autoantibodies had different characteristics of heart damage.Anti-Ro52 antibody was significantly correlated with myocardial ischemia/infarction(P=0.043),myocardial damage(P=0.029),and decreased diastolic function(P=0.037).Anti-ARS antibody was significantly correlated with pulmonary hypertension(P=0.014)and pericarditis(P=0.002).There was a significant correlation between anti-Jo-1 antibody and pulmonary hypertension(P=0.021).There was no significant correlation between anti-MDA-5 antibodies and all types of myocardial damage(P>0.05).4.A multivariate analysis showed that age and cholesterol levels were risk factors for heart damage in IIM patients.ConclusionCardiac damage is a common complication in idiopathic inflammatory myopathies,and the clinical symptoms are hidden and the type of damage is complex,so we should pay attention to it and take effective means to evaluate the cardiac damage of patients in the early stage.In addition,anti-Ro52 antibody,anti-ARS antibody and anti-Mi-2 antibody increase the risk of heart damage in IIMs.Clinical attention should be paid to the screening of such patients.