Abstract
Objectives
Cardiac dysfunction is commonly noted in patients with idiopathic inflammatory myopathies (IIMs). This study aimed to investigate the characteristics of cardiac dysfunction using cardiac magnetic resonance (CMR) in polymyositis (PM), dermatomyositis (DM) and necrotising myositis (NM).
Methods
Fifty-one patients with IIMs and 20 matched healthy controls (HCs) were assessed using CMR examination. The clinical data, cardiac serum markers and autoimmune antibodies were determined for all patients. Cardiac involvement was identified by myocardial native T1, extracellular volume (ECV), late gadolinium enhancement (LGE) and left ventricular ejection fraction (LVEF).
Results
Different subtypes of IIMs showed different patterns of LGE and varying degrees of myocardial damage. The PM subgroup showed higher native T1 (p = 0.010) and ECV (p = 0.000) than the HCs. The prevalence of LGE was comparable between the PM and DM subgroups (40.0% vs. 31.6%, p = 0.741); however, it was higher in the PM subgroup than in the NM subgroup (40% vs. 0.0%, p = 0.014). Patients with positive LGE in the PM subgroup showed a higher proportion of positive LGE (p = 0.018) and lower LVEF (p = 0.024) than those with positive LGE in the DM subgroup. In multivariate analysis, the presence of LGE could be predicted by increased NT-proBNP (p = 0.036, OR = 1.001) and anti-MDA-5 antibody positivity (p = 0.011, OR = 12.4). The risk factors associated with native T1 were NT-proBNP (p = 0.016, β = 0.353) and body mass index (BMI) (p = 0.024, β = − 0.331).
Conclusions
Distinct cardiac involvements in different subtypes of IIMs were identified using CMR. Elevated NT-proBNP and a low BMI were the risk factors associated with LGE and elevated native T1.
Key Points
• The characteristics of cardiac involvement in different subtypes of IIMs could be identified with cardiac magnetic resonance.
• The NT-proBNP levels could reflect focal and diffuse myocardial damage in patients with IIMs.
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Abbreviations
- ARS:
-
Aminoacyl-tRNA synthetase
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- CK:
-
Creatine kinase
- CK-MB:
-
Creatine kinase myocardial band
- CMR:
-
Cardiac magnetic resonance
- c-TnT:
-
Cardiac troponin T
- DM:
-
Dermatomyositis
- ECV:
-
Extracellular volume
- HCs:
-
Healthy controls
- IIMs:
-
Idiopathic inflammatory myopathies
- LDL-C:
-
Low-density lipoprotein cholesterol
- LGE:
-
Late gadolinium enhancement
- LV:
-
Left ventricular
- LVEDV/RVEDV:
-
LV/RV end-diastolic volume
- LVEF:
-
Left ventricular ejection fraction
- LVESV/RVESV:
-
LV/RV end-systolic volume
- MAA:
-
Myositis-associated antibody
- MDA-5:
-
Melanoma differentiation–associated protein 5
- MSA:
-
Myositis-specific antibody
- NM:
-
Necrotising myositis
- NT-proBNP:
-
n-Terminal prohormone of brain natriuretic peptide
- NXP2:
-
Nuclear matrix protein 2
- OR:
-
Odds ratio
- PM:
-
Polymyositis
- ROI:
-
Region of interest
- RV:
-
Right ventricular
- SRP:
-
Signal recognition peptide
- TIF1-γ:
-
Transcriptional intermediary factor 1 γ
- β :
-
Coefficient
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Acknowledgements
The authors would like to thank all the participants and working personnel in this study.
Funding
This research was supported by grants from the National Natural Science Foundation of China (No. 30901339 and No. 81172869), the Application Foundation Project in Sichuan Province (No. 2016JY0021 and No. 2017JY0025); the 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (Z2018A08 and ZYJC18013), and the Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH038).
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Guarantor
The scientific guarantor of this publication is Yucheng Chen, MD, Professor, Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, No.37, Guo Xue **ang, Chengdu, 610041, Sichuan, People’s Republic of China. Tel: 86-18980602149, Fax: 86-028-85422836, Email: chenyucheng2003@126.com.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Dr. Jianhong Sun and Geng Yin had expertise in statistics; they took responsibility for the study design, the acquisition and interpretation of the data and the accuracy of statistical analysis.
Informed consent
Written informed consent was obtained from all subjects in this study.
Ethical approval
Institutional Review Board approval was obtained.
This study was approved by the Medical Ethics Committee of Sichuan University West China Hospital.
Study subjects or cohorts overlap
The study subjects and cohorts partially overlapped with our recent publication “Xu Y, Sun J, Wan K, et al Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy. J Cardiovasc Magn Reson. 2020;22(1):22. Published 2020 Apr 9. https://doi.org/10.1186/s12968-020-00616-0”. About 80% of patients overlapped in our study. The submitted article focused on the different characteristics by CMR in different IIM subtypes and explored the relationship of cardiac involvement and serum markers. While the recent published article focused on the CMR dynamic changes in myocardial and skeletal muscles in patients with IIM.
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• cross-sectional study
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Sun, J., Yin, G., Xu, Y. et al. Phenoty** of myocardial involvement by cardiac magnetic resonance in idiopathic inflammatory myopathies. Eur Radiol 31, 5077–5086 (2021). https://doi.org/10.1007/s00330-020-07448-7
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DOI: https://doi.org/10.1007/s00330-020-07448-7