1
|
Giucă A, Galloo X, Meucci MC, Butcher SC, Popescu BA, Jurcuț R, Săftoiu A, Jurcuț C, Groșeanu L, Mușetescu AE, Ahmed S, De Vries-Bouwstra J, Bax JJ, Ajmone Marsan N. Association between Left Atrial Function and Survival in Systemic Sclerosis. J Cardiovasc Dev Dis 2024; 11:310. [PMID: 39452281 PMCID: PMC11508788 DOI: 10.3390/jcdd11100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/26/2024] [Accepted: 10/04/2024] [Indexed: 10/26/2024] Open
Abstract
Systemic sclerosis (SSc) is a multisystemic autoimmune disorder in which cardiac involvement is frequent and portends negative prognosis. Left ventricular (LV) diastolic dysfunction is one of the most common cardiac alterations in these patients, and left atrial (LA) reservoir strain (ƐR) measurement using speckle tracking echocardiography has been proposed as a novel parameter for a better assessment of LV diastolic function. Therefore, the aim of this study was to test the prognostic value of ƐR in a large multicenter cohort of SSc patients. In total, 311 SSc patients (54 ± 14 years, 85% female) were included from two different centers. Echocardiography was performed at the time of first visit, including ƐR measurement. Over a median follow-up of 132 (interquartile range: 110 to 157) months, 67 (21.5%) patients experienced the outcome of all-cause mortality. Spline curve analysis identified an optimal cut-off value of 30% for ƐR, and patients with ƐR ≤ 30% showed a 10-year cumulative survival rate of 71% as compared to 88% for patients with ƐR > 30% (log-rank p < 0.001). At the multivariable Cox regression analysis, ƐR was independently associated with the endpoint (HR 1.830; 95% confidence interval (CI) 1.031-3.246; p = 0.039) together with age (HR 1.071, 95% CI 1.043 to 1.099; p < 0.001), sex (female) (HR 0.444, 95% CI 0.229 to 0.861; p = 0.016), and diffusing lung capacity for carbon monoxide (HR 0.969 95% CI 0.956 to 0.982; p < 0.001). ƐR is of independent prognostic value in SSc and might help optimizing risk stratification in these patients.
Collapse
Affiliation(s)
- Adrian Giucă
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (A.G.); (X.G.); (M.C.M.); (S.C.B.); (J.J.B.)
- “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street 258, 022328 Bucharest, Romania; (B.A.P.); (R.J.)
- Department of Internal Medicine, Craiova University of Medicine and Pharmacy, Petru Rares 2, 200349 Craiova, Romania
| | - Xavier Galloo
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (A.G.); (X.G.); (M.C.M.); (S.C.B.); (J.J.B.)
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Avenue du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (A.G.); (X.G.); (M.C.M.); (S.C.B.); (J.J.B.)
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati 31, 00168 Rome, Italy
| | - Steele C. Butcher
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (A.G.); (X.G.); (M.C.M.); (S.C.B.); (J.J.B.)
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, 197 Wellington Street, Perth, WA 6000, Australia
| | - Bogdan Alexandru Popescu
- “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street 258, 022328 Bucharest, Romania; (B.A.P.); (R.J.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Eroii Sanitari Bvd no. 8, 050474 Bucharest, Romania; (A.S.); (L.G.)
| | - Ruxandra Jurcuț
- “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street 258, 022328 Bucharest, Romania; (B.A.P.); (R.J.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Eroii Sanitari Bvd no. 8, 050474 Bucharest, Romania; (A.S.); (L.G.)
| | - Adrian Săftoiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Eroii Sanitari Bvd no. 8, 050474 Bucharest, Romania; (A.S.); (L.G.)
- Department of Gastroenterology and Hepatology, Elias University Emergency Hospital, Marasti Bvd 17, 011461 Bucharest, Romania
| | - Ciprian Jurcuț
- Department of Internal Medicine, “Carol Davila” Central Military Emergency University Hospital, Calea Plevnei 134, 010825 Bucharest, Romania;
| | - Laura Groșeanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Eroii Sanitari Bvd no. 8, 050474 Bucharest, Romania; (A.S.); (L.G.)
- Department of Rheumatology, “Sf. Maria” Clinical Hospital, Ion Mihalache Bvd 37–39, 011172 Bucharest, Romania
| | - Anca Emanuela Mușetescu
- Department of Rheumatology, Craiova University of Medicine and Pharmacy, Petru Rares 2, 200349 Craiova, Romania;
| | - Saad Ahmed
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.A.); (J.D.V.-B.)
| | - Jeska De Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.A.); (J.D.V.-B.)
| | - Jeroen J. Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (A.G.); (X.G.); (M.C.M.); (S.C.B.); (J.J.B.)
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; (A.G.); (X.G.); (M.C.M.); (S.C.B.); (J.J.B.)
| |
Collapse
|
2
|
De Luca G, Matucci-Cerinic M, Mavrogeni SI. Diagnosis and management of primary heart involvement in systemic sclerosis. Curr Opin Rheumatol 2024; 36:76-93. [PMID: 37962165 DOI: 10.1097/bor.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW In systemic sclerosis (SSc) primary heart involvement (pHI) is frequent, even though often unrecognized due to its occult nature and to the lack of a specific diagnostic algorithm. The purpose of this review is to report the state of the art of the evidence in the current literature, as well as the overall diagnostic modalities and therapeutic strategies for primary heart involvement in SSc. RECENT FINDINGS SSc-pHI is defined by the presence of cardiac abnormalities that are predominantly attributable to SSc rather than other causes and/or complications; it may be sub-clinical and must be confirmed through diagnostic investigations. Novel electrocardiographic analysis and cardiac magnetic resonance (CMR) with mapping techniques have been recently proposed, showing a great utility in the early identification of SSc-pHI and in the noninvasive characterization of myocardial tissue. Immunosuppressive therapy emerged as fundamental to curb myocardial inflammation, and recent preclinical and clinical data support the role of antifibrotic drugs to treat SSc-pHI. SUMMARY our review will help clinicians to properly integrate the available diagnostic modalities for the assessment of SSc-pHI. The ultimate goal is to propose a feasible diagnostic algorithm for the early identification of patients with SSc-pHI, and a schematic therapeutic approach to manage SSc-pHI.
Collapse
Affiliation(s)
- Giacomo De Luca
- Vita-Salute San Raffaele University
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Healthcare, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| |
Collapse
|
3
|
Wangkaew S, Prasertwitayakij N, Intum J, Euathrongchit J. Predictors and survival of cardiomyopathy determined by echocardiography in Thai patients with early systemic sclerosis: an inception cohort study. Sci Rep 2023; 13:6983. [PMID: 37117322 PMCID: PMC10147617 DOI: 10.1038/s41598-023-34110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023] Open
Abstract
Available data including the incidence, predictors and long-term outcome of early systemic sclerosis patients associated with suspected cardiomyopathy(SSc-CM) is limited. Therefore, we aimed to study the incidence, predictors and survival of SSc-CM. An inception cohort study was conducted for early SSc patients seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, from January 2010 to December 2019. All patients were determined for clinical manifestations and underwent echocardiography and HRCT at enrollment and then annually. SSc-CM was determined and classified using echocardiography. 135 early SSc patients (82 female,108 DcSSc) were enrolled. With the mean follow-up period of 6.4 years, 32 patients developed SSc-CM. The incidence of SSc-CM was 5.3 per 100-person years. The multivariate Cox regression analysis showed that baseline anti-topoisomerase I-positive (Hazard ratio[HR] 4.86, p = 0.036), dysphagia (HR 3.35, p = 0.001), CK level ≥ 500 U/L(HR 2.27, p = 0.045) and low oxygen saturation (HR 0.82, p = 0.005) were predictors of SSc-CM. The survival rates after SSc-CM diagnosis at 1, 5 and 10 years were 90.3%, 73.1%, and 56.1%, respectively. In this study cohort, the incidence of SSc-CM was 5.3 per 100-person years, and tended to have low survival. The presence of anti-topoisomerase I antibody, dysphagia, CK level ≥ 500 U/L, and low oxygen saturation were independent baseline predictors for developing SSc-CM.
Collapse
Affiliation(s)
- Suparaporn Wangkaew
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Narawudt Prasertwitayakij
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jirapath Intum
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
4
|
Sclerodermic Cardiomyopathy—A State-of-the-Art Review. Diagnostics (Basel) 2022; 12:diagnostics12030669. [PMID: 35328222 PMCID: PMC8947572 DOI: 10.3390/diagnostics12030669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune disorder with unknown triggering factors, and complex pathophysiologic links which lead to fibrosis of skin and internal organs, including the heart, lungs, and gut. However, more than 100 years after the first description of cardiac disease in SSc, sclerodermic cardiomyopathy (SScCmp) is an underrecognized, occult disease with important adverse long-term prognosis. Laboratory tests, electrocardiography (ECG) and cardiovascular multimodality imaging techniques (transthoracic 2D and 3D echocardiography, cardiac magnetic resonance (CMR), and novel imaging techniques, including myocardial deformation analysis) provide new insights into the cardiac abnormalities in patients with SSc. This state-of-the-art review aims to stratify all the cardiac investigations needed to diagnose and follow-up the SScCmp, and discusses the epidemiology, risk factors and pathophysiology of this important cause of morbidity of the SSc patient.
Collapse
|
5
|
Naranjo M, Hassoun PM. Systemic Sclerosis-Associated Pulmonary Hypertension: Spectrum and Impact. Diagnostics (Basel) 2021; 11:911. [PMID: 34065226 PMCID: PMC8161029 DOI: 10.3390/diagnostics11050911] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a catastrophic complication of one of the most common and devastating autoimmune diseases. Once diagnosed, it becomes the leading cause of mortality among this patient population. Screening modalities and risk assessments have been designed and validated by various organizations and societies in order to identify patients early in their disease course and promptly refer them to expert centers for a hemodynamic assessment and formal diagnosis. Moreover, several large multicenter clinical trials have now included patients with SSc-PAH to assess their response to therapy. Despite an improved understanding of the condition and significant advances in supportive and targeted therapy, outcomes have remained far from optimal. Therefore, rigorous phenotyping and search for novel therapies are desperately needed for this devastating condition.
Collapse
Affiliation(s)
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW In this review, the authors discuss systemic sclerosis-associated interstitial lung disease (SSc-ILD) with a focus on recent developments in diagnosis, surveillance, and management. RECENT FINDINGS With advances in the management of SSc, the importance of ILD has been increasingly recognized and is the leading cause of mortality. Early detection is essential, and a combination of lung function testing and chest imaging are key tools in diagnosis and surveillance. The foundation of treatment is immunomodulation with recent studies identifying several potential new agents. The use of therapies targeting pro-fibrotic pathways have demonstrated significant effects on lung function decline and represent the latest advance in therapy for SSc-ILD. SUMMARY Recent studies support the use of newer therapies in SSc-ILD including antifibrotic agents. The identification and management of comorbidities is important, and lung transplantation is a viable option for patients with advanced disease.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW This review provides a risk-stratified and evidence-based management for subsets of systemic sclerosis (SSc) patients in the first five years from disease onset. RECENT FINDINGS Cardiopulmonary disease remains the primary cause of mortality in SSc patients. Morbidity and mortality in SSc-associated pulmonary arterial hypertension have improved with combination treatment, in either an upfront or sequential treatment pattern. Traditional therapies for interstitial lung disease (SSc-ILD) have targeted those with clinically significant and progressive ILD with immunosuppression. New data suggest a possible paradigm shift, introducing immunosuppressive therapy to patients before they develop clinically significant or progressive ILD. The year 2019 saw the approval of the first FDA-approved therapy for SSc-associated interstitial lung disease, using an antifibrotic agent previously approved for idiopathic pulmonary fibrosis. To date, only autologous hematopoietic stem cell transplant has demonstrated a mortality benefit for SSc-ILD, albeit in a narrow spectrum of SSc-ILD patients. SUMMARY SSc is a highly heterogeneous autoimmune disease typified by varying clinical trajectories. Its management may be stratified within the first five years by subclassifying patients based on factors that have important prognostic significance: skin distribution and autoantibody status.
Collapse
Affiliation(s)
- David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
8
|
Hung G, Mercurio V, Hsu S, Mathai SC, Shah AA, Mukherjee M. Progress in Understanding, Diagnosing, and Managing Cardiac Complications of Systemic Sclerosis. Curr Rheumatol Rep 2019; 21:68. [PMID: 31813082 PMCID: PMC11151284 DOI: 10.1007/s11926-019-0867-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE REVIEW Systemic sclerosis (scleroderma) is a complex autoimmune disease that commonly involves the cardiovascular system. Even if often subclinical, cardiac involvement is considered a poor prognostic factor as it is a leading cause of death in scleroderma patients. We review the cardiac manifestations of scleroderma, the diagnostic methods useful in detection, and current advances in therapeutic management. RECENT FINDINGS Beside the routine exams for the assessment of cardiac status (including EKG, standard echocardiography, provocative tests) novel techniques such as myocardial strain imaging on echocardiography, cardiac magnetic resonance imaging, invasive hemodynamic assessment, and endomyocardial biopsy have been demonstrated to be useful in understanding the cardiac alterations that typically affect scleroderma patients. Recent application of novel cardiac detection strategies is providing increased insight into the breadth and pathogenesis of cardiac complications of scleroderma. Further studies coupling exercise provocation, invasive and imaging assessment, and mechanistic studies in scleroderma cardiac tissue are needed to develop the optimal approach to early detection of cardiac disease in scleroderma and targeted therapies.
Collapse
Affiliation(s)
- George Hung
- Division of Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA.
| |
Collapse
|
9
|
Ross L, Prior D, Proudman S, Vacca A, Baron M, Nikpour M. Defining primary systemic sclerosis heart involvement: A scoping literature review. Semin Arthritis Rheum 2019; 48:874-887. [PMID: 30170705 DOI: 10.1016/j.semarthrit.2018.07.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinically evident primary heart involvement due to systemic sclerosis (SHI) is considered a poor prognostic factor and is a leading cause of systemic sclerosis (SSc) related death. Yet, there remains no consensus definition of SHI and poor understanding of the natural history and risk factors for the development of SHI. METHODS We performed a scoping literature review of published articles with a primary focus of SHI to capture previously used definitions of SHI and items used to measure SHI. Any factors reported to be associated with an increased risk of SHI were recorded. RESULTS Of the 2436 records identified in a search of MEDLINE, EMBASE and PubMed databases, 295 were included in the final scoping review. Analysis of the literature revealed studies of variable quality, generally low patient numbers and highly heterogeneous definitions of SHI within studies. There is no clear consensus from the literature as to the scope of SHI and the prognostic significance of sub-clinical investigation abnormalities commonly detected. CONCLUSION The lack of a standardised definition of SHI remains a significant unmet need in SSc. The results of this review will assist in the development of consensus classification criteria to enable more accurate quantification of the burden of SHI, identification of factors associated with increased risk of developing SHI, and evaluation of the efficacy of any novel therapeutic strategies.
Collapse
Affiliation(s)
- Laura Ross
- Department of Medicine at St Vincent's Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Department of Rheumatology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - David Prior
- Department of Medicine at St Vincent's Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Department of Cardiology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia.
| | - Alessandra Vacca
- Unit of Rheumatology, University Hospital of Cagliari, S.S. 554, bivio per Sestu, 09042 Monserrato (CA), Italy..
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, 5750 Côtes-des-Neiges Rd, Montreal, QC H3S 1Y9, Canada.
| | - Mandana Nikpour
- Department of Medicine at St Vincent's Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Department of Rheumatology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| |
Collapse
|
10
|
Iida H, Hanaoka H, Okada Y, Kiyokawa T, Takakuwa Y, Yamada H, Okazaki T, Ozaki S, Yamaguchi K, Nakajima Y, Kawahata K. A low perfusion-metabolic mismatch in 99m Tl and 123 I-BMIPP scintigraphy predicts poor prognosis in systemic sclerosis patients with asymptomatic cardiac involvement. Int J Rheum Dis 2019; 22:1008-1015. [PMID: 30729690 DOI: 10.1111/1756-185x.13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/12/2018] [Accepted: 01/13/2019] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the prognostic factors of cardiac death or cardiac failure using cardiac scintigraphy, echocardiography (UCG), and magnetic resonance imaging (MRI) in asymptomatic systemic sclerosis (SSc) patients. METHODS We retrospectively evaluated SSc patients who had undergone cardiac scintigraphy using 99m thallium (99m Tl) and 123 I-β-methyl-P-iodophenyl-pentadecanoic acid (123 I-BMIPP), UCG, and cardiac MRI. We calculated the mismatch score in scintigraphy by subtracting the uptake of 123 I-BMIPP from that of 99m Tl. Patients were divided into two groups according to whether they survived with no cardiac failure or subsequently proceeded to cardiac failure or death during the study period. We identified prognostic factors by analyzing 99m Tl and 123 I-BMIPP uptake, mismatch scores, UCG findings, and cardiac delayed enhancement on MRI. We also evaluated pathological evidence of myocardial fibrosis. RESULTS Of 33 SSc cases, 11 proceeded to cardiac failure or death. There was no significant difference in UCG or MRI findings between the two groups. Low mismatch score in cardiac scintigraphy was the only predictive factor of cardiac failure or death by multivariate analysis (odds ratio, 6.48; 95% confidence interval, 1.22-423.2; P = 0.01). When patients were grouped according to high or low mismatch scores based on a cut-off using receiver operating characteristics curve analysis, the cumulative incidence of cardiac failure or death was higher in the low mismatch group than in the high mismatch group (P = 0.02). The percentage of fibrosis was significantly higher in deceased cases compared to surviving cases. CONCLUSIONS Low mismatch score in cardiac scintigraphy was associated with cardiac death or cardiac failure in SSc patients.
Collapse
Affiliation(s)
- Harunobu Iida
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hironari Hanaoka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukinori Okada
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomofumi Kiyokawa
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukiko Takakuwa
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidehiro Yamada
- Medical Center of Rheumatic Disease, Seirei Yokohama Hospital, Yokohama, Japan
| | - Takahiro Okazaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenichiro Yamaguchi
- Department of Proton Therapy and Tumor Imaging, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kimito Kawahata
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
11
|
Abstract
The heart is one of the major organs commonly involved in systemic sclerosis (SSc). Myocardial fibrosis has been identified in a high percentage of these patients. Most SSc patients with cardiac involvement (CI) are subclinical, especially early on in the course of their disease. To accurately identify CI and improve diagnosis and treatment, imaging techniques should be implemented on a regular basis following diagnosis. In this review, we discuss the up-to-date pathophysiologic basis of CI, the cardiac manifestations, and the diagnostic methods that have been published in the literature. Recent studies have shown that tissue Doppler imaging is a promising evaluation technique in the bedside detection of CI. Cardiovascular magnetic resonance is an operator-independent method used for detecting SSc CI. It is an especially useful tool in the early stages of the disease when patients may be asymptomatic. At present, it is the most promising imaging technique for the diagnosis, follow-up, and response to therapy in clinical practice.
Collapse
|
12
|
Shimizu K, Tsujino I, Sato T, Sugimoto A, Nakaya T, Watanabe T, Ohira H, Ito YM, Nishimura M. Performance of computed tomography-derived pulmonary vasculature metrics in the diagnosis and haemodynamic assessment of pulmonary arterial hypertension. Eur J Radiol 2017; 96:31-38. [DOI: 10.1016/j.ejrad.2017.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/17/2017] [Indexed: 12/20/2022]
|
13
|
Ramalho AR, Costa S, Silva F, Donato P, Franco F, Pêgo GM. Autoimmune myocarditis in systemic sclerosis: an unusual form of scleroderma heart disease presentation. ESC Heart Fail 2017; 4:365-370. [PMID: 28772040 PMCID: PMC5542725 DOI: 10.1002/ehf2.12139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/23/2016] [Accepted: 12/30/2016] [Indexed: 01/13/2023] Open
Abstract
Primary cardiac involvement in systemic sclerosis is common, often subclinical, and is associated with significant mortality. We report the case of a patient who developed autoimmune myocarditis at an early stage of systemic sclerosis, who completely recovered from cardiac dysfunction under optimal medical therapy for heart failure and immunosuppression. This challenging case aims at increasing awareness around the fact that the heart is a target organ of scleroderma disease. It also highlights the importance of screening and early diagnosis of cardiac involvement, because a timely treatment may impact the quality of life of these patients and improve their prognosis.
Collapse
Affiliation(s)
- Ana Rita Ramalho
- Coimbra Hospital and University Center, Cardiology Department, Coimbra, Portugal
| | - Susana Costa
- Coimbra Hospital and University Center, Cardiology Department, Coimbra, Portugal
| | - Francisco Silva
- Coimbra Hospital and University Center, Imaging Department, Coimbra, Portugal
| | - Paulo Donato
- Coimbra Hospital and University Center, Imaging Department, Coimbra, Portugal
| | - Fátima Franco
- Coimbra Hospital and University Center, Cardiology Department, Coimbra, Portugal
| | | |
Collapse
|
14
|
Fernández-Codina A, Simeón-Aznar CP, Pinal-Fernandez I, Rodríguez-Palomares J, Pizzi MN, Hidalgo CE, Guillén-Del Castillo A, Prado-Galbarro FJ, Sarria-Santamera A, Fonollosa-Plà V, Vilardell-Tarrés M. Cardiac involvement in systemic sclerosis: differences between clinical subsets and influence on survival. Rheumatol Int 2017; 37:75-84. [PMID: 26497313 PMCID: PMC11669078 DOI: 10.1007/s00296-015-3382-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/07/2015] [Indexed: 11/30/2022]
Abstract
Cardiac involvement (CI) is a known complication of SSc associated with increased mortality. Our objective was to describe a cohort of patients with SSc and CI and to assess the differences between cutaneous subsets regarding their presentation and survival. Three hundred and ninety-three Spanish patients from a single center, diagnosed with SSc, were retrospectively studied for evidence of CI using noninvasive and invasive tests from 1976 to 2011. Clinical, epidemiological, immunological and therapeutic features of patients with CI were compared to those without it and within the different cutaneous subsets of SSc. CI was present in 173 (44 %) patients. Mitral regurgitation (67 %), conduction alterations (45 %) and left ventricle diastolic dysfunction (40 %) were the most common findings. Pericardial involvement and heart failure were more frequent in diffuse SSc (dcSSc) than in limited or sine scleroderma SSc. CI accounted for 20 % of deaths, and it was an independent mortality risk factor (HR 2.1, P = 0.02), but once CI was established, classical dcSSc mortality risk factors determined mortality. Patients with dcSSc developed CI faster than limited (HR 1.9, P = 0.003) or sine SSc patients (HR 2.5, P = 0.002), specially during the first year after SSc onset. We found statistically significant differences between the 3 SSc subsets in the presentation of pericardial involvement and heart failure. CI increased the mortality and appeared at a higher rate, especially during the first year after SSc onset. Screening for heart involvement should be performed at diagnosis and during follow-up.
Collapse
Affiliation(s)
- Andreu Fernández-Codina
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Carmen Pilar Simeón-Aznar
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Iago Pinal-Fernandez
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Rodríguez-Palomares
- Cardiology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Nazarena Pizzi
- Nuclear Medicine Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Eve Hidalgo
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Alfredo Guillén-Del Castillo
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | | | | | - Vicent Fonollosa-Plà
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Miquel Vilardell-Tarrés
- Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| |
Collapse
|
15
|
A Marked Response to Immunosuppressive Intervention for Abruptly Occurring Cardiac Complications in a Case of Juvenile Systemic Sclerosis Overlapped with Dermatomyositis. Case Rep Pediatr 2017; 2017:1479012. [PMID: 28316854 PMCID: PMC5339528 DOI: 10.1155/2017/1479012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/17/2017] [Accepted: 01/29/2017] [Indexed: 11/18/2022] Open
Abstract
Juvenile-onset systemic sclerosis (jSSc) is a rare condition, having unique characteristic features compared to adult-onset SSc. Although cardiac involvement (CI) is known as a leading cause of mortality overall in SSc, the importance of CI in jSSc has not been emphasized. Here we present a 13-year-old female with jSSc overlapped with dermatomyositis (DM) complicated CI. She developed skin thickness and induration, Raynaud's phenomenon, digital pitting scars in fingertips, and skeletal myositis. Oral prednisolone and pulse methotrexate treatment led to the improvement of skin findings; however two weeks after the initiation she suddenly presented with muscle pain and dyspnea within a few days. Cardiac investigations then showed pericardiac effusion and diastolic dysfunction due to significant biventricular hypertrophy causing heart failure. As pericardiac effusion and exacerbation of skeletal myositis were evident, steroid pulse therapy was initiated. Unexpectedly, not only the myositis but also the CI including diastolic dysfunction was improved. She thereafter followed a favorable clinical course without reactivation of the CI or cardiac fibrosis. As a conclusion, close attention to CI must be paid in jSSc patients, especially when skeletal muscle involvement is evident and immunosuppressive therapy may be effective for CI in jSSc in cases where it occurs abruptly.
Collapse
|
16
|
Allanore Y, Komocsi A, Vettori S, Hachulla E, Hunzelmann N, Distler J, Avouac J, Gobeaux C, Launay D, Czirjak L, Kahan A, Meune C. N-terminal pro-brain natriuretic peptide is a strong predictor of mortality in systemic sclerosis. Int J Cardiol 2016; 223:385-389. [DOI: 10.1016/j.ijcard.2016.08.246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 01/31/2023]
|
17
|
Zhang L, Zhu YL, Li MT, Gao N, You X, Wu QJ, Su JM, Shen M, Zhao LD, Liu JJ, Zhang FC, Zhao Y, Zeng XF. Lupus Myocarditis: A Case-Control Study from China. Chin Med J (Engl) 2016; 128:2588-94. [PMID: 26415795 PMCID: PMC4736867 DOI: 10.4103/0366-6999.166029] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Myocarditis is an uncommon but serious manifestation of systemic lupus erythematosus (SLE). This study aimed to investigate clinical characteristics and outcomes of lupus myocarditis (LM) and to determine risk factors of LM in hospitalized Chinese patients with SLE. Methods: We conducted a retrospective case–control study. A total of 25 patients with LM from 2001 to 2012 were enrolled as the study group, and 100 patients with SLE but without LM were randomly pooled as the control group. Univariable analysis was performed using Chi-square tests for categorical variables, and the Student's t-test or Mann–Whitney U-test was performed for continuous variables according to the normality. Results: LM presented as the initial manifestation of SLE in 7 patients (28%) and occurred mostly at earlier stages compared to the controls (20.88 ± 35.73 vs. 44.08 ± 61.56 months, P = 0.008). Twenty-one patients (84%) experienced episodes of symptomatic heart failure. Echocardiography showed that 23 patients (92%) had decreased left ventricular ejection fraction (<50%) and all patients had wall motion abnormalities. A high SLE Disease Activity Index was the independent risk factor in the development of LM (odds ratio = 1.322, P < 0.001). With aggressive immunosuppressive therapies, most patients achieved satisfactory outcome. The in-hospital mortality was not significantly higher in the LM group than in the controls (4% vs. 2%,P = 0.491). Conclusions: LM could result in cardiac dysfunction and even sudden death. High SLE disease activity might potentially predict the occurrence of LM at the early stage of SLE. Characteristic echocardiographic findings could confirm the diagnosis of LM. Early aggressive immunosuppressive therapy could improve the cardiac outcome of LM.
Collapse
Affiliation(s)
| | | | - Meng-Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100032, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Žigon P, Mrak-Poljšak K, Lakota K, Terčelj M, Čučnik S, Tomsic M, Sodin-Semrl S. Metabolic fingerprints of human primary endothelial and fibroblast cells. Metabolomics 2016; 12:92. [PMID: 27330522 PMCID: PMC4887525 DOI: 10.1007/s11306-016-1024-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/18/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Human primary cells originating from different locations within the body could differ greatly in their metabolic phenotypes, influencing both how they act during physiological/pathological processes and how susceptible/resistant they are to a variety of disease risk factors. A novel way to monitor cellular metabolism is through cell energetics assays, so we explored this approach with human primary cell types, as models of sclerotic disorders. OBJECTIVES In order to better understand pathophysiological processes at the cellular level, our goals were to measure metabolic pathway activities of endothelial cells and fibroblasts, and determine their metabolic phenotype profiles. METHODS Biolog Phenotype MicroArray™ technology was used for the first time to characterize metabolic phenotypes of diverse primary cells. These colorimetric assays enable detection of utilization of 367 specific biochemical substrates by human endothelial cells from the coronary artery (HCAEC), umbilical vein (HUVEC) and normal, healthy lung fibroblasts (NHLF). RESULTS Adenosine, inosine, d-mannose and dextrin were strongly utilized by all three cell types, comparable to glucose. Substrates metabolized solely by HCAEC were mannan, pectin, gelatin and prevalently tricarballylic acid. HUVEC did not show any uniquely metabolized substrates whereas NHLF exhibited strong utilization of sugars and carboxylic acids along with amino acids and peptides. CONCLUSION Taken together, we show for the first time that this simple energetics assay platform enables metabolic characterization of primary cells and that each of the three human cell types examined gives a unique and distinguishable profile.
Collapse
Affiliation(s)
- Polona Žigon
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Katjuša Mrak-Poljšak
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Katja Lakota
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Matic Terčelj
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
- Faculty of Pharmacy, Chair of Clinical Biochemistry, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomsic
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Snezna Sodin-Semrl
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000 Ljubljana, Slovenia
- Faculty of Mathematics, Natural Sciences and Information Technology, University of Primorska, Koper, Slovenia
| |
Collapse
|
19
|
Abstract
Significant advances have been made in understanding the genetic basis of systemic sclerosis (SSc) in recent years. Genomewide association and other large-scale genetic studies have identified 30 largely immunity-related genes which are significantly associated with SSc. We review these studies, along with genomewide expression studies, proteomic studies, genetic mouse models, and insights from rare sclerodermatous diseases. Collectively, these studies have begun to identify pathways that are relevant to SSc pathogenesis. The findings presented in this review illustrate how both genetic and genomic aberrations play important roles in the development of SSc. However, despite these recent discoveries, there remain major gaps between current knowledge of SSc, a unified understanding of pathogenesis, and effective treatment. To this aim, we address the important issue of SSc heterogeneity and discuss how future research needs to address this in order to develop a clearer understanding of this devastating and complex disease.
Collapse
|
20
|
Foocharoen C, Pussadhamma B, Mahakkanukrauh A, Suwannaroj S, Nanagara R. Asymptomatic cardiac involvement in Thai systemic sclerosis: prevalence and clinical correlations with non-cardiac manifestations (preliminary report). Rheumatology (Oxford) 2015; 54:1616-21. [DOI: 10.1093/rheumatology/kev096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Indexed: 11/13/2022] Open
|
21
|
Wang X, Lou M, Li Y, Ye W, Zhang Z, Jia X, Shi H, Zhu X, Wang L. Cardiovascular involvement in connective tissue disease: the role of interstitial lung disease. PLoS One 2015; 10:e0121976. [PMID: 25775471 PMCID: PMC4361670 DOI: 10.1371/journal.pone.0121976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to assess cardiovascular involvement in patients with connective tissue disease (CTD), and determine whether interstitial lung disease (ILD) in these patients is associated with elevated cardiovascular risk. Methods This study evaluated a retrospective cohort of 436 CTD patients admitted to a large teaching hospital in Zhejiang province, China, along with an additional 436 participants of an annual community health screening conducted in the physical examination center who served as age- and gender-matched controls. Demographic, clinical, serologic and imaging characteristics, as well as medications used by each participant were recorded. Cardiovascular involvement was defined by uniform criteria. Correlations between clinical/serologic factors and cardiovascular involvement were determined by univariate and multivariate analyses. Results CTD patients had a significantly higher cardiovascular involvement rate than controls (64.7% vs 23.4%), with higher rates of diabetes, hypertension, and hyperlipidemia, elevated systolic and diastolic pressures, C-reactive protein, total cholesterol, and low-density lipoprotein cholesterol, and lower albumin and high-density lipoprotein cholesterol (all p < 0.05). Furthermore, CTP patients with cardiovascular involvement were significantly older, had higher systolic and diastolic pressures, C-reactive protein, glucose, and uric acid, higher rates of diabetes, hypertension, and use of moderate- to high-dose glucocorticoids, and longer disease duration compared to patients without involvement (all p < 0.05). Moreover, CTD in patients with cardiovascular involvement was more likely to be complicated by ILD (p < 0.01), which manifested as a higher alveolar inflammation score (p < 0.05). In the multivariate analysis, cardiovascular involvement in CTD patients was associated with age, systolic pressure, body mass index, uric acid, disease duration > 2 years, use of moderate- to high-dose glucocorticoids, and ILD with a high alveolar inflammation score. Conclusion Cardiovascular involvement is increased in CTD patients, and is associated with ILD with a higher alveolar inflammation score. Thus, early-stage echocardiography and CT scans should be used to detect potential cardiovascular complications in these patients.
Collapse
Affiliation(s)
- XiaoBing Wang
- Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - MeiNa Lou
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yongji Li
- Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - WenJing Ye
- Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - ZhiYong Zhang
- Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xiufen Jia
- Radiology Department, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - HongYing Shi
- Department of Preventive Medicine, School of Environmental Science and Public Health, Wenzhou Medical University, Zhejiang, China
| | - XiaoChun Zhu
- Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - LiangXing Wang
- Pneumology Department, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
- * E-mail:
| |
Collapse
|
22
|
Gashouta MA, Humbert M, Hassoun PM. Update in systemic sclerosis-associated pulmonary arterial hypertension. Presse Med 2014; 43:e293-304. [DOI: 10.1016/j.lpm.2014.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/18/2014] [Indexed: 01/08/2023] Open
|
23
|
Chaisson NF, Hassoun PM. Systemic sclerosis-associated pulmonary arterial hypertension. Chest 2014; 144:1346-1356. [PMID: 24081346 DOI: 10.1378/chest.12-2396] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is the leading cause of death in systemic sclerosis (SSc) and affects up to 12% of all patients with SSc, with a 50% mortality rate within 3 years of PAH diagnosis. Compared with the idiopathic form of PAH (IPAH), patients with SSc-associated PAH (SSc-PAH) have a threefold increased risk of death and may receive a diagnosis late in the course of disease because of insidious onset and the high prevalence of cardiac, musculoskeletal, and pulmonary parenchymal comorbidities. Treatment with conventional forms of PAH therapy often yield poor results compared with IPAH cohorts; unfortunately, the exact reasons behind this remain poorly understood but likely include variations in the pathologic mechanisms, differences in cardiovascular response to increasing afterload, and inadequate strategies to detect and treat SSc-PAH early in its course. Current methods for screening and longitudinal evaluation of SSc-PAH, such as the 6-min walk test, transthoracic echocardiography, and MRI, each have notable advantages and disadvantages. We provide an up-to-date, focused review of SSc-PAH and how it differs from IPAH, including pathogenesis, appropriate screening for disease onset, and new approaches to treatment and longitudinal assessment of this disease.
Collapse
Affiliation(s)
- Neal F Chaisson
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
24
|
Sahin A, Ozkan T, Türkçapar N, Küçükşahin O, Köksoy EB, Ozturk G, Erten S, Sunguroğlu A, Turgay M, Kınıklı G. Peripheral blood mononuclear cell microchimerism in Turkish female patients with systemic sclerosis. Mod Rheumatol 2013; 24:97-105. [PMID: 24261765 DOI: 10.3109/14397595.2013.854052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate microchimerism (Mc) in peripheral blood mononuclear cells (PBMC) taken from female patients with systemic sclerosis (SSc) and healthy females. We also intended to research the association between Mc and the clinical subsets. METHODS This study included 50 females with lcSSc, 30 females with dcSSc and 40 healthy females. The Y-chromosome sequences were studied by RT-PCR in DNA obtained from PBMC. RESULTS Mc was found in 28 (35 %) patients and 8 (20 %) healthy controls as well as in 6 dcSSc patients with son(s) (27.3 %), 10 lcSSc patients with son(s) (32.3 %) and 7 control females with son(s) (18.9 %) (p > 0.05). Mc was detected in 6 nulliparous lcSSc patients (31.6 %) and in 1 nulliparous dcSSc patient (11.1 %) (p > 0.05). The mean time elapsed between the first pregnancy and the diagnosis of SSc was 3.5 (0-49) years in the Mc-positive patients and 14 (0-55) years in the negative patients (p = 0.020). The mean modified Rodnan skin scores (ModRSS) of the patients with and without Mc was 10 (4-24) and 13 (4-26), respectively (p = 0.038). The relationship between Mc and the system involvement, disease severity, autoantibody profile, number of children and age of children was not found. CONCLUSIONS Various etiological factors rather than just one play a role in the development of scleroderma. Mc is thought to be one factor that shortens the elapsed time of disease development in SSc. Mc is inversely related to the ModRSS, and no association was detected between Mc and autoantibodies or the clinical subsets.
Collapse
Affiliation(s)
- Ali Sahin
- Division of Rheumatology, Sanliurfa Education and Research Hospital , 63100 Sanliurfa , Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Heart disease, either clinically apparent or silent, is a frequent complication of systemic sclerosis (SSc, scleroderma) and may affect both patients with diffuse cutaneous and limited cutaneous SSc. The availability of more sensitive modalities has led to an increased awareness of scleroderma heart disease, which often involves the pericardium, myocardium, and cardiac conduction system. This awareness of cardiac involvement requires attention and interventions led by internists, cardiologists, and rheumatologists. Although no specific therapy exists for scleroderma heart disease, early recognition of the presence and type of scleroderma heart disease may lead to more effective management of patients with scleroderma.
Collapse
Affiliation(s)
- John L Parks
- Division of Cardiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | | | | | | |
Collapse
|
26
|
Şahin A, Özkan T, Türkçapar N, Küçükşahin O, Köksoy EB, Özturk G, Erten Ş, Sunguroğlu A, Turgay M, Kınıklı G. Peripheral blood mononuclear cell microchimerism in Turkish female patients with systemic sclerosis. Mod Rheumatol 2013. [DOI: 10.1007/s10165-013-0856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Dimitroulas T, Sandoo A, Kitas GD. Asymmetric dimethylarginine as a surrogate marker of endothelial dysfunction and cardiovascular risk in patients with systemic rheumatic diseases. Int J Mol Sci 2012. [PMID: 23202900 PMCID: PMC3497274 DOI: 10.3390/ijms131012315] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The last few decades have witnessed an increased life expectancy of patients suffering with systemic rheumatic diseases, mainly due to improved management, advanced therapies and preventative measures. However, autoimmune disorders are associated with significantly enhanced cardiovascular morbidity and mortality not fully explained by traditional cardiovascular disease (CVD) risk factors. It has been suggested that interactions between high-grade systemic inflammation and the vasculature lead to endothelial dysfunction and atherosclerosis, which may account for the excess risk for CVD events in this population. Diminished nitric oxide synthesis—due to down regulation of endothelial nitric oxide synthase—appears to play a prominent role in the imbalance between vasoactive factors, the consequent impairment of the endothelial hemostasis and the early development of atherosclerosis. Asymmetric dimethylarginine (ADMA) is one of the most potent endogenous inhibitors of the three isoforms of nitric oxide synthase and it is a newly discovered risk factor in the setting of diseases associated with endothelial dysfunction and adverse cardiovascular events. In the context of systemic inflammatory disorders there is increasing evidence that ADMA contributes to the vascular changes and to endothelial cell abnormalities, as several studies have revealed derangement of nitric oxide/ADMA pathway in different disease subsets. In this article we discuss the role of endothelial dysfunction in patients with rheumatic diseases, with a specific focus on the nitric oxide/ADMA system and we provide an overview on the literature pertaining to ADMA as a surrogate marker of subclinical vascular disease.
Collapse
Affiliation(s)
- Theodoros Dimitroulas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
- Author to whom correspondence should be addressed; E-Mail: or ; Tel.: +44-1384-244842; Fax: +44-1283-244272
| | - Aamer Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
| | - George D. Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester M15 6SZ, UK
| |
Collapse
|
28
|
Dimitroulas T, Mavrogeni S, Kitas GD. Imaging modalities for the diagnosis of pulmonary hypertension in systemic sclerosis. Nat Rev Rheumatol 2012; 8:203-13. [DOI: 10.1038/nrrheum.2012.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
29
|
Abstract
Systemic sclerosis (SSc) is commonly complicated by pulmonary arterial hypertension (PAH), which is a leading cause of death in the SSc patient population. Owing to the fact that the risk of developing pulmonary hypertension is high, screening is important, although the optimal modality remains to be defined. Furthermore, despite recent advances in therapy for PAH, the response to these interventions in patients with PAH with SSc has been discouraging. The lack of clinical response to these therapies may merely reflect the limitations of traditionally employed PAH outcome measures in SSc-PAH patients or highlight the heterogeneity of the disease manifestations within SSc. Importantly, since extrapulmonary involvement of the GI tract and kidneys by SSc limit candidacy for lung transplantation, new therapies that target abnormal cellular proliferation in the pulmonary vasculature are currently under investigation and may be particularly relevant to SSc-PAH.
Collapse
Affiliation(s)
- Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
30
|
Systemic Sclerosis: Severe Involvement of Internal Organs. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|