Echocardiographic Abnormalities in New-onset Polymyositis/dermatomyositis

ABSTRACT. Objective. To identify early echocardiographic abnormalities at the time of diagnosis of polymyositis (PM) and dermatomyositis (DM) and follow the echocardiographic findings during the first 3 months of therapy. Methods. We included 30 PM/DM patients (23/7) with a mean age of 42.3 ± 1.6 years and without cardiovascular symptoms. .9 ± 1.2%; tricuspid s: 13.3 ± 0.2, 9.5 ± 0.4, 10.3 ± 0.3, 11.6 ± 0.5 cm/s; control, 0, 1, and 3 mos, respectively). Measurements indicated the development of diastolic dysfunction at 3 mos (E/A: 1.4 ± 0.1, 1.29 ± 0.05, 1.03 ± 0.05, 0.92 ± 0.05; DT: 148.6 ± 3.6, 157.3 ± 5.7, 168.3 ± 6.0, 184.3 ± 6.2 ms; lateral e′: 12.8 ± 0.3, 12.1 ± 0.5, 10.2 ± 0.6, 10.8 ± 0.8 cm/s; E/e′: 5.6 ± 0.1, 5.0 ± 0.22, 6.92 ± 0.46, 7.64 ± 0.47; control, 0, 1, and 3 mos, respectively). Conclusion. TDI is a useful method to detect early cardiac abnormalities complementing the conventional echocardiographic measurements. LV and RV systolic dysfunction found in the acute phase significantly improved during the first 3 months of therapy; however, deterioration of diastolic dysfunction was also observed. Idiopathic inflammatory myopathies are rare immune-mediated chronic inflammatory diseases characterized by symmetric and progressive weakness of the proximal muscles. Among them, polymyositis (PM) and dermatomyositis (DM) are characterized by chronic inflammation, fibrosis, and damage and destruction of the muscle fibers 1 . The pathomechanism in PM involves perivascular infiltration caused by CD8+ cytotoxic T cells and macrophages, while inflammation and skin rash in DM is mediated predominantly by B cell-dependent humoral mechanisms and Th cell-mediated cytokines. Cardiac involvement in DM was first published in 1899 by Oppenheim 2 . Numerous studies have since confirmed that cardiac involvement is common and is one of the main prognostic factors in PM/DM 3,4,5,6 because extramuscular and cardiac manifestations are associated with worse prognosis. Pathologic findings of the myocardium including active myocarditis, mononuclear infiltration, focal fibrosis, vasculitis, intima proliferation, and media sclerosis of the vessels indicate that the heart is a target organ of PM/DM 7 . A metaanalysis (1975-2011; 26 publications, 1530 patients) concluded that the incidence of cardiac involvement in myositis varies between 9% and 72% 4 . The most common clinical syndrome was heart failure in 32%-77% of the patients. Left ventricular (LV) diastolic dysfunction was found in 42% of the patients, while conduction disorders occurred in 25%-38.5% and hyperkinetic LV contraction was seen in 6%-12%. Finally, the cause of death was identified as the direct consequence of heart disease in 46.3% of the patients 4 . Studies suggest that subclinica