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Yu H, Wen Q, Zhang X, Zhang H, Wu X. Cardiac involved and autopsy in two patients with systemic sclerosis: Two cases report. Heliyon 2023; 9:e15555. [PMID: 37159691 PMCID: PMC10163610 DOI: 10.1016/j.heliyon.2023.e15555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease with high mortality. One of the most common causes of death in potential SSc patients is cardiac arrest. However, the pathogenesis of cardiac death is not very clear. As far as we know, there are few autopsy reports on this subject. Our autopsy report on two fatal cases of heart injury in SSc patients revealed evidence of myocarditis, focal myocardial necrosis, and myocardial fibrosis. Our findings suggest that chronic inflammation of the heart may lead to extensive fibrosis, which could contribute to the high mortality rate observed in SSc patients. Early detection of heart injury in SSc patients using existing technology is necessary to improve patient outcomes. Future research should focus on developing more effective methods for early detection and management of heart involvement in SSc.
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Affiliation(s)
- Hang Yu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Qinwen Wen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
| | - Xiaolu Zhang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Hanqing Zhang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Xiudi Wu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
- Corresponding author.
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Vértes V, Porpáczy A, Nógrádi Á, Tőkés-Füzesi M, Hajdu M, Czirják L, Komócsi A, Faludi R. Galectin-3 and sST2: associations to the echocardiographic markers of the myocardial mechanics in systemic sclerosis - a pilot study. Cardiovasc Ultrasound 2022; 20:1. [PMID: 35042522 PMCID: PMC8764793 DOI: 10.1186/s12947-022-00272-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/05/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Progressive cardiac fibrosis is the central aspect of the myocardial involvement in systemic sclerosis (SSc). We hypothesized that circulating biomarkers of the cardiac fibrosis may be useful in the early diagnosis of the cardiac manifestation in this disease. Thus, we investigated the potential correlations between the levels of galectin-3, soluble suppression of tumorigenicity-2 (sST2) and the echocardiographic markers of the myocardial mechanics in SSc patients. METHODS Forty patients (57.3 ± 13.7 years, 36 female) were investigated. In addition to the conventional echocardiography, tissue Doppler and speckle tracking-derived strain techniques were used to assess the function of both ventricles and atria. To estimate the correlations between galectin-3 and sST2 levels and the echocardiographic variables, partial correlation method was used with age as correcting factor. RESULTS In age adjusted analysis galectin-3 level showed significant correlation with left ventricular global longitudinal strain (r = 0.460, p = 0.005); grade of left ventricular diastolic dysfunction (r = 0.394, p = 0.013); septal e' (r = - 0.369, p = 0.021); septal E/e' (r = 0.380, p = 0.017) and with the grade of mitral regurgitation (r = 0.323, p = 0.048). No significant correlation was found between sST2 levels and the echocardiographic variables. CONCLUSIONS Galectin-3 levels, but not sST2 levels show significant correlation with the parameters of the left ventricular systolic and diastolic function. Galectin-3 may be a useful biomarker for the screening and early diagnosis of SSc patients with cardiac involvement.
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Affiliation(s)
- Vivien Vértes
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Adél Porpáczy
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Ágnes Nógrádi
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Margit Tőkés-Füzesi
- grid.9679.10000 0001 0663 9479Department of Laboratory Medicine, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Máté Hajdu
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - László Czirják
- grid.9679.10000 0001 0663 9479Department of Rheumatology and Immunology, Medical School, University of Pécs, Akác u. 1, H-7632 Pécs, Hungary
| | - András Komócsi
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624, Pécs, Hungary.
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Zanatta E, Colombo C, D’Amico G, d’Humières T, Dal Lin C, Tona F. Inflammation and Coronary Microvascular Dysfunction in Autoimmune Rheumatic Diseases. Int J Mol Sci 2019; 20:ijms20225563. [PMID: 31703406 PMCID: PMC6888405 DOI: 10.3390/ijms20225563] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
Autoimmune rheumatic diseases (ARDs) form a heterogeneous group of disorders that include systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), idiopathic inflammatory myopathies (IIMs), and systemic vasculitis. Coronary microvascular dysfunction (CMD) is quite common in patients with ARDs and is linked to increased cardiovascular morbidity and mortality. Inflammation plays a crucial role in the pathogenesis of both accelerated atherosclerosis and CMD in ARDs, especially in patients affected by SLE and RA. In this regard, some studies have highlighted the efficacy of immunosuppressants and/or biologics in restoring CMD in these patients. By contrast, the role of inflammation in the pathogenesis of CMD-SSc appears to be much less relevant compared to endothelial dysfunction and microvascular ischemia, with calcium-channel blockers providing some benefits. Few studies have endeavored to assess the occurrence of CMD in IIMs and systemic vasculitis, thus warranting further investigations. The present review summarizes the current evidence on the occurrence of CMD in ARDs, focusing on the role of inflammation and possible therapeutic approaches.
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Affiliation(s)
| | - Claudia Colombo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
| | - Gianpiero D’Amico
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
| | - Thomas d’Humières
- Department of Cardiovascular Physiology, AP-HP, Henri-Mondor Teaching Hospital, 94010 Créteil, France;
| | - Carlo Dal Lin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
- Correspondence:
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Defining primary systemic sclerosis heart involvement: A scoping literature review. Semin Arthritis Rheum 2019; 48:874-887. [DOI: 10.1016/j.semarthrit.2018.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
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Zanatta E, Famoso G, Boscain F, Montisci R, Pigatto E, Polito P, Schiavon F, Iliceto S, Cozzi F, Doria A, Tona F. Nailfold avascular score and coronary microvascular dysfunction in systemic sclerosis: A newsworthy association. Autoimmun Rev 2018; 18:177-183. [PMID: 30572139 DOI: 10.1016/j.autrev.2018.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS We aimed to assess the relationship between nailfold videocapillaroscopy (NVC) abnormalities and coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD) in patients with systemic sclerosis (SSc). METHODS We studied 39 SSc patients (33 females, mean ± SD age 54 ± 12 years, median disease duration 11 years, range 6-22) and 22 controls (matched for age and sex) without any evidence of cardiovascular disease. Clinical assessment was performed by modified Rodnan skin score (mRss) and EUSTAR score. Coronary flow velocities in the left anterior descending coronary artery were measured by transthoracic echocardiography. Average peak flow velocities, CFR and microvascular resistance at baseline (BMR) and in hyperaemic (HMR) condition were assessed. CFR ≤2.5 was considered marker of CMD. Six NVC-abnormalities were evaluated by a semi quantitative scoring system: enlarged and giant capillaries (diameter > 20 μm and >50 μm, respectively), hemorrhages, disarray, capillary ramifications and loss of capillaries (avascular score). Statistic was performed using SPSS. RESULTS CFR was lower in SSc patients than in controls (2.6 ± 0.5 vs 3.3 ± 0.5). CMD was detected in 24 patients (61.5%) vs 0 controls (p < .0001). CFR was inversely correlated with NVC-avascular score (rho =-0.750, p < .0001). Avascular and capillary ramifications scores (p = .001 and p = .03, respectively), mRss (p = .003) and EUSTAR score (p = .01) were higher in patients with CMD than in those without. At multivariable analysis, avascular score was independently associated with CMD (p = .01). HMR was directly correlated with avascular score (rho = 0.416, p = .008). CONCLUSIONS In our SSc patients NVC-avascular score was associated with CMD which seems to be the result of a structural microvascular remodeling.
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Affiliation(s)
- Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Giulia Famoso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesca Boscain
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health, San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
| | - Erika Pigatto
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Barison A, Gargani L, De Marchi D, Aquaro GD, Guiducci S, Picano E, Cerinic MM, Pingitore A. Early myocardial and skeletal muscle interstitial remodelling in systemic sclerosis: insights from extracellular volume quantification using cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2015; 16:74-80. [DOI: 10.1093/ehjci/jeu167] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Farkas N, Szabo A, Lorand V, Sarlos DP, Minier T, Prohaszka Z, Czirjak L, Varju C. Clinical usefulness of measuring red blood cell distribution width in patients with systemic sclerosis. Rheumatology (Oxford) 2014; 53:1439-45. [DOI: 10.1093/rheumatology/keu022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Költő G, Faludi R, Aradi D, Bartos B, Kumánovics G, Minier T, Czirják L, Komócsi A. Impact of cardiac involvement on the risk of mortality among patients with systemic sclerosis: a 5-year follow-up of a single-center cohort. Clin Rheumatol 2013; 33:197-205. [PMID: 23942767 DOI: 10.1007/s10067-013-2358-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/24/2013] [Accepted: 07/31/2013] [Indexed: 12/16/2022]
Abstract
Cardiac involvement is among the leading causes of mortality in patients with systemic sclerosis (SSc). Previously, we demonstrated in a single-center, cross-sectional study the frequent coexistence of different forms of cardiac involvement in systemic sclerosis including pulmonary arterial hypertension (PAH), coronary artery disease (CAD), and microvascular dysfunction (MVD). The aim of the present study was to investigate the prognostic significance of cardiac involvement. One hundred twenty patients with SSc were enrolled. All cases underwent a non-invasive cardiovascular protocol. In 30 patients with suspected cardiac involvement, right heart catheterization and intra-coronary pressure-wire-supplemented coronary angiography were performed. Clinical follow-up was 5 years. Patients with CAD at the baseline showed a trend for higher cardiovascular mortality while in patients with MVD this difference was significant (26.7 % versus 9.5 %, p = 0.077 and 30 % versus 10.1 %, p < 0.05, respectively). Cardiovascular mortality of PAH cases was higher but, however, did not reach statistical significance 21.4 % versus 10.4 %, p = 0.261. Cardiovascular event-free survival was significantly lower among patients with combinations of two or three disorders (p < 0.05). Multivariate analysis of organ involvements and comorbidities showed that the diffuse cutaneous subset, the presence of kidney involvement, the velocity of the tricuspid regurgitation, as well as diabetes mellitus were independent predictors of overall mortality. MVD and CAD alone or in combination with PAH significantly affected the 5-year cardiovascular mortality. These findings highlight the prognostic importance of coronary disease in patients with SSc [ www.clinicaltrials.gov (Reg. Nr.: NCT00843102)].
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Affiliation(s)
- Gyöngyvér Költő
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
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Pintér T, Komócsi A. Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis. Interv Med Appl Sci 2012. [DOI: 10.1556/imas.4.2012.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Systemic sclerosis (SSc) is characterized by fibrosis and vascular abnormalities of skin and internal organs. Cardiac involvement includes coronary artery disease (CAD), pulmonary arterial hypertension (PAH) related right ventricular changes and microvascular disease (MVD). Aims: To characterize the distribution of cardiac alterations and to investigate the mechanisms of the microvascular impairment of SSc patients. Methods: Based on non-invasive investigations, patients were selected for right heart catheterization and intracoronary pressure-wire supplemented coronary angiography. Results: 17 SSc patients (selected from 120 cases) and 17 controls were enrolled. In the “suspected PAH” and the “suspected CAD” groups, PAH was found in 12/20 and 2/10 cases, and coronary artery stenosis in 9/20 and 6/10 cases, respectively. Patients with decreased coronary flow reserve (CFR) had accelerated flow velocity (p<0.05), but myocardial resistance index (IMR) in hyperemia did not differ from patients with normal CFR or from the controls (p=0.292 and p=0.308). The coronary flow velocity of SSc patients correlated to the IMR at baseline (r=0.56, p=0.019). Conclusions: PAH, CAD and MVD show an overlap in symptomatic SSc. The maintained vasodilatation response indicates the paucity of irreversible functional damage of the coronary arterioles. The reduced CFR, the decreased basal IMR and higher velocity pinpoint to possible compensatory vasodilatory mechanisms.
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Affiliation(s)
- Tünde Pintér
- 1 Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - András Komócsi
- 1 Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
- 2 Department of Interventional Cardiology, Heart Institute, University of Pécs, Ifjúság u. 13, H-7624, Pécs, Hungary
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Komócsi A, Vorobcsuk A, Faludi R, Pintér T, Lenkey Z, Költő G, Czirják L. The impact of cardiopulmonary manifestations on the mortality of SSc: a systematic review and meta-analysis of observational studies. Rheumatology (Oxford) 2012; 51:1027-36. [DOI: 10.1093/rheumatology/ker357] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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