1Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 2Klinik für Rheumatologie und klinische Immunologie Lübeck, Deutschland; 3Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland
Objective: Idiopathic inflammatory myopathies (IIM) are frequently associated with cardiac involvement (2-77% depending on inclusion criteria) and have important prognostic value due to the associated increased morbidity and mortality. Normally, serum troponin concentration is used as an analysis for this purpose. We investigated echocardiographic global longitudinal strain (GLS) to detect subclinical systolic ventricular dysfunction in patients with IIM.
Methods: Echocardiographic assessment was performed in 21 patients with IIM and elevated serum troponin levels and 15 patients with IIM but normal serum troponin levels on a GE Vivid E95 echo machine. All included patients had invasive exclusion of coronary artery disease or a low pretest probability of coronary artery disease, were under 65 years of age, had normal LV and RV systolic function, no overt cardiac disease, and had no relevant comorbidities other than IIM. Left ventricular (LV) and right ventricular (RV) systolic and diastolic function were assessed and compared using 2D and 3D datasets, focusing on GLS of the LV, RV and LA. A possible correlation between echo parameters, cardiovascular risk factors and troponin levels was investigated.
Results: Standard parameters of systolic and diastolic dysfunction were similar between the two groups. the 2D and 3D GLS was significantly lower in patients with IIM and elevated serum troponin levels than in patients with normal serum troponin (2D GLS: -17.2 ± 1.0% vs -19.5 ± 0.8%, p = <0.001).
Conclusion: In patients with IIM, echocardiographic assessment with analysis of 2D and 3D GLS showed a good correlation with elevated troponin levels and may therefore be a useful modality in screening for cardiac involvement.