Cardiac involvement in adult and juvenile idiopathic inflammatory myopathies

Thomas Schwartz, Louise Pyndt Diederichsen, Ingrid E Lundberg, Ivar Sjaastad, Helga Sanner, Thomas Schwartz, Louise Pyndt Diederichsen, Ingrid E Lundberg, Ivar Sjaastad, Helga Sanner

Abstract

Idiopathic inflammatory myopathies (IIM) include the main subgroups polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM) and juvenile DM (JDM). The mentioned subgroups are characterised by inflammation of skeletal muscles leading to muscle weakness and other organs can also be affected as well. Even though clinically significant heart involvement is uncommon, heart disease is one of the major causes of death in IIM. Recent studies show an increased prevalence of traditional cardiovascular risk factors in JDM and DM/PM, which need attention. The risk of developing atherosclerotic coronary artery disease is increased twofold to fourfold in DM/PM. New and improved diagnostic methods have in recent studies in PM/DM and JDM demonstrated a high prevalence of subclinical cardiac involvement, especially diastolic dysfunction. Interactions between proinflammatory cytokines and traditional risk factors might contribute to the pathogenesis of cardiac dysfunction. Heart involvement could also be related to myocarditis and/or myocardial fibrosis, leading to arrhythmias and congestive heart failure, demonstrated both in adult and juvenile IIM. Also, reduced heart rate variability (a known risk factor for cardiac morbidity and mortality) has been shown in long-standing JDM. Until more information is available, patients with IIM should follow the same recommendations for cardiovascular risk stratification and prevention as for the corresponding general population, but be aware that statins might worsen muscle symptoms mimicking myositis relapse. On the basis of recent studies, we recommend a low threshold for cardiac workup and follow-up in patients with IIM.

Keywords: Atherosclerosis; Cardiovascular Disease; Dermatomyositis; Polymyositis; Treatment.

Figures

Figure 1
Figure 1
Traditional cardiovascular risk factors can cause cardiac disease in patients with IIM. Systemic and local inflammation may either have a direct effect on the myocardium or make the heart more susceptible to traditional risk factors. In the heart, disease can occur in the pericardium, coronary arteries or the myocardium, and arrhythmias can appear. Myocardial disease can result in diastolic or systolic dysfunction, and when clinical symptoms arise, the patient has developed heart failure. Myocardial disease may result in arrhythmias, or they can occur as a result of inflammation directly influencing cardiomyocyte function. Both arrhythmias and coronary artery disease, such as myocardial infarction, can directly result in heart failure.

References

    1. Solomon DH, Goodson NJ, Katz JN et al. . Patterns of cardiovascular risk in rheumatoid arthritis. Ann Rheum Dis 2006;65:1608–12. 10.1136/ard.2005.050377
    1. Symmons DP, Gabriel SE. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat Rev Rheumatol 2011;7:399–408. 10.1038/nrrheum.2011.75
    1. Badui E, Garcia-Rubi D, Robles E et al. . Cardiovascular manifestations in systemic lupus erythematosus. Prospective study of 100 patients. Angiology 1985;36:431–41. 10.1177/000331978503600705
    1. Zöller B, Li X, Sundquist J et al. . Risk of subsequent coronary heart disease in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. PLoS ONE 2012;7:e33442 10.1371/journal.pone.0033442
    1. Zöller B, Li X, Sundquist J et al. . Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. BMC Neurol 2012;12:41 10.1186/1471-2377-12-41
    1. Stern R, Godbold JH, Chess Q et al. . ECG abnormalities in polymyositis. Arch Intern Med 1984;144:2185–9. 10.1001/archinte.1984.04400020097015
    1. Sharratt GP, Danta G, Carson PH. Cardiac abnormality in polymyositis. Ann Rheum Dis 1977;36:575–8. 10.1136/ard.36.6.575
    1. Gottdiener JS, Sherber HS, Hawley RJ et al. . Cardiac manifestations in polymyositis. Am J Cardiol 1978;41:1141–9. 10.1016/0002-9149(78)90871-8
    1. Gonzalez-Lopez L, Gamez-Nava JI, Sanchez L et al. . Cardiac manifestations in dermato-polymyositis. Clin Exp Rheumatol 1996;14:373–9.
    1. Taylor AJ, Wortham DC, Burge JR et al. . The heart in polymyositis: a prospective evaluation of 26 patients. Clin Cardiol 1993;16:802–8. 10.1002/clc.4960161110
    1. Askari AD, Huettner TL. Cardiac abnormalities in polymyositis/dermatomyositis. Semin Arthritis Rheum 1982;12:208–19. 10.1016/0049-0172(82)90061-0
    1. Denbow CE, Lie JT, Tancredi RG et al. . Cardiac involvement in polymyositis: a clinicopathologic study of 20 autopsied patients. Arthritis Rheum 1979;22:1088–92. 10.1002/art.1780221007
    1. Haupt HM, Hutchins GM. The heart and cardiac conduction system in polymyositis-dermatomyositis: a clinicopathologic study of 16 autopsied patients. Am J Cardiol 1982;50:998–1006. 10.1016/0002-9149(82)90408-8
    1. Wang H, Liu HX, Wang YL et al. . Left ventricular diastolic dysfunction in patients with dermatomyositis without clinically evident cardiovascular disease. J Rheumatol 2014;41:495–500. 10.3899/jrheum.130346
    1. Lu Z, Wei Q, Ning Z et al. . Left ventricular diastolic dysfunction—early cardiac impairment in patients with polymyositis/dermatomyositis: a tissue Doppler imaging study. J Rheumatol 2013;40:1572–7. 10.3899/jrheum.130044
    1. Schwartz T, Sanner H, Husebye T et al. . Cardiac dysfunction in juvenile dermatomyositis: a case-control study. Ann Rheum Dis 2011;70:766–71. 10.1136/ard.2010.137968
    1. Schwartz T, Sanner H, Gjesdal O et al. . In juvenile dermatomyositis, cardiac systolic dysfunction is present after long-term follow-up and is predicted by sustained early skin activity. Ann Rheum Dis 2014;73:1805–10. 10.1136/annrheumdis-2013-203279
    1. Diederichsen LP, Simonsen JA, Diederichsen AC et al. . Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities. Arthritis Care Res (Hoboken) 2016;68:1012–20. 10.1002/acr.22772
    1. Rosenbohm A, Buckert D, Gerischer N et al. . Early diagnosis of cardiac involvement in idiopathic inflammatory myopathy by cardiac magnetic resonance tomography. J Neurol 2015;262:949–56. 10.1007/s00415-014-7623-1
    1. Buchpiguel CA, Roizemblatt S, Pastor EH et al. . Cardiac and skeletal muscle scintigraphy in dermato- and polymyositis: clinical implications. Eur J Nucl Med 1996;23:199–203. 10.1007/BF01731845
    1. Diederichsen LP, Simonsen JA, Diederichsen AC et al. . Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies. Clin Exp Rheumatol 2015;33:706–14.
    1. Diederichsen LP, Diederichsen AC, Simonsen JA et al. . Traditional cardiovascular risk factors and coronary artery calcification in adults with polymyositis and dermatomyositis: a Danish multicenter study. Arthritis Care Res (Hoboken) 2015;67:848–54. 10.1002/acr.22520
    1. Lundberg IE. The heart in dermatomyositis and polymyositis. Rheumatology (Oxford) 2006;45(Suppl 4):iv18–21. 10.1093/rheumatology/kel311
    1. Gupta R, Wayangankar SA, Targoff IN et al. . Clinical cardiac involvement in idiopathic inflammatory myopathies: a systematic review. Int J Cardiol 2011;148:261–70. 10.1016/j.ijcard.2010.08.013
    1. Marie I. Morbidity and mortality in adult polymyositis and dermatomyositis. Curr Rheumatol Rep 2012;14:275–85. 10.1007/s11926-012-0249-3
    1. Dankó K, Ponyi A, Constantin T et al. . Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases. Medicine (Baltimore) 2004;83:35–42. 10.1097/01.md.0000109755.65914.5e
    1. Sultan SM, Ioannou Y, Moss K et al. . Outcome in patients with idiopathic inflammatory myositis: morbidity and mortality. Rheumatology (Oxford) 2002;41:22–6. 10.1093/rheumatology/41.1.22
    1. Bohan A, Peter JB, Bowman RL et al. . Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore) 1977;56:255–86. 10.1097/00005792-197707000-00001
    1. Rose AL, Walton JN. Polymyositis: a survey of 89 cases with particular reference to treatment and prognosis. Brain 1966;89:747–68. 10.1093/brain/89.4.747
    1. Airio A, Kautiainen H, Hakala M. Prognosis and mortality of polymyositis and dermatomyositis patients. Clin Rheumatol 2006;25:234–9. 10.1007/s10067-005-1164-z
    1. Dobloug GC, Garen T, Brunborg C et al. . Survival and cancer risk in an unselected and complete Norwegian idiopathic inflammatory myopathy cohort. Semin Arthritis Rheum 2015;45:301–8. 10.1016/j.semarthrit.2015.06.005
    1. Taborda AL, Azevedo P, Isenberg DA. Retrospective analysis of the outcome of patients with idiopathic inflammatory myopathy: a long-term follow-up study. Clin Exp Rheumatol 2014;32:188–93.
    1. Limaye V, Hakendorf P, Woodman RJ et al. . Mortality and its predominant causes in a large cohort of patients with biopsy-determined inflammatory myositis. Intern Med J 2012;42:191–8. 10.1111/j.1445-5994.2010.02406.x
    1. Hochberg MC, Feldman D, Stevens MB. Adult onset polymyositis/dermatomyositis: an analysis of clinical and laboratory features and survival in 76 patients with a review of the literature. Semin Arthritis Rheum 1986;15:168–78. 10.1016/0049-0172(86)90014-4
    1. Huber AM, Mamyrova G, Lachenbruch PA et al. . Early illness features associated with mortality in the juvenile idiopathic inflammatory myopathies. Arthritis Care Res (Hoboken) 2014;66:732–40. 10.1002/acr.22212
    1. de Moraes MT, de Souza FH, de Barros TB et al. . Analysis of metabolic syndrome in adult dermatomyositis with a focus on cardiovascular disease. Arthritis Care Res (Hoboken) 2013;65:793–9. 10.1002/acr.21879
    1. de Souza FH, Shinjo SK. The high prevalence of metabolic syndrome in polymyositis. Clin Exp Rheumatol 2014;32:82–7.
    1. Wang H, Tang J, Chen X et al. . Lipid profiles in untreated patients with dermatomyositis. J Eur Acad Dermatol Venereol 2013;27:175–9. 10.1111/j.1468-3083.2011.04437.x
    1. Wang H, Cai Y, Cai L et al. . Altered lipid levels in untreated patients with early polymyositis. PLoS ONE 2014;9:e89827 10.1371/journal.pone.0089827
    1. Coyle K, Rother KI, Weise M et al. . Metabolic abnormalities and cardiovascular risk factors in children with myositis. J Pediatr 2009;155:882–7. 10.1016/j.jpeds.2009.06.009
    1. Eimer MJ, Brickman WJ, Seshadri R et al. . Clinical status and cardiovascular risk profile of adults with a history of juvenile dermatomyositis. J Pediatr 2011;159:795–801. 10.1016/j.jpeds.2011.05.015
    1. Schwartz T, Sjaastad I, Flatø B et al. . In active juvenile dermatomyositis, elevated eotaxin and MCP-1 and cholesterol levels in the upper normal range are associated with cardiac dysfunction. Rheumatology (Oxford) 2014;53:2214–22. 10.1093/rheumatology/keu256
    1. Choy E, Ganeshalingam K, Semb AG et al. . Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatology (Oxford) 2014;53:2143–54. 10.1093/rheumatology/keu224
    1. Gustafsson JT, Svenungsson E. Definitions of and contributions to cardiovascular disease in systemic lupus erythematosus. Autoimmunity 2014;47:67–76. 10.3109/08916934.2013.856005
    1. Nagueh SF, Smiseth OA, Appleton CP et al. . Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016;29:277–314. 10.1016/j.echo.2016.01.011
    1. Odabasi Z, Yapundich R, Oh SJ. Polymyositis presenting with cardiac manifestations: report of two cases and review of the literature. Clin Neurol Neurosurg 2010;112:160–3. 10.1016/j.clineuro.2009.10.007
    1. Ohata S, Shimada T, Shimizu H et al. . Myocarditis associated with polymyositis diagnosed by gadolinium-DTPA enhanced magnetic resonance imaging. J Rheumatol 2002;29:861–2.
    1. Sharma K, Orbai AM, Desai D et al. . Brief report: antisynthetase syndrome-associated myocarditis. J Card Fail 2014;20:939–45. 10.1016/j.cardfail.2014.07.012
    1. Lynch PG. Cardiac involvement in chronic polymyositis. Br Heart J 1971;33:416–19. 10.1136/hrt.33.3.416
    1. Rasmussen LH, Madsen HN, Ladefoged SD. Creatine phosphokinase MB and lactate dehydrogenase isoenzyme 1 in polymyositis. Scand J Rheumatol 1985;14:427–30. 10.3109/03009748509102049
    1. Peregud-Pogorzelska M, Kazmierczak J, Brzosko M. Rhythm disturbances in the form of atrial tachycardia in a female patient with polymyositis—a case report. Angiology 2006;57:391–4. 10.1177/000331970605700319
    1. Sénéchal M, Créte M, Couture C et al. . Myocardial dysfunction in polymyositis. Can J Cardiol 2006;22:869–71. 10.1016/S0828-282X(06)70306-3
    1. Rechavia E, Rotenberg Z, Fuchs J et al. . Polymyositic heart disease. Chest 1985;88:309–11. 10.1378/chest.88.2.309
    1. Behan WM, Aitchison M, Behan PO. Pathogenesis of heart block in a fatal case of dermatomyositis. Br Heart J 1986;56:479–82. 10.1136/hrt.56.5.479
    1. Afzal A, Higgins RS, Philbin EF. Heart transplant for dilated cardiomyopathy associated with polymyositis. Heart 1999;82:e4 10.1136/hrt.82.4.e4
    1. Mavrakanas TA, Lobrinus A, Berdagué P et al. . Severe mitral valve regurgitation in polymyositis. J Clin Rheumatol 2012;18:367–9. 10.1097/RHU.0b013e31826d1e2c
    1. Wang H, Liu H, Yu X et al. . Left ventricle diastolic function in patients with polymyositis. Int J Cardiol 2013;168:4311–12. 10.1016/j.ijcard.2013.04.185
    1. Vinereanu D, Nicolaides E, Tweddel AC et al. . “Pure” diastolic dysfunction is associated with long-axis systolic dysfunction. Implications for the diagnosis and classification of heart failure. Eur J Heart Fail 2005;7:820–8. 10.1016/j.ejheart.2005.02.003
    1. Baicu CF, Zile MR, Aurigemma GP et al. . Left ventricular systolic performance, function, and contractility in patients with diastolic heart failure. Circulation 2005;111:2306–12. 10.1161/01.CIR.0000164273.57823.26
    1. Ungprasert P, Suksaranjit P, Spanuchart I et al. . Risk of coronary artery disease in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis of observational studies. Semin Arthritis Rheum 2014;44:63–7. 10.1016/j.semarthrit.2014.03.004
    1. Tisseverasinghe A, Bernatsky S, Pineau CA. Arterial events in persons with dermatomyositis and polymyositis. J Rheumatol 2009;36:1943–6. 10.3899/jrheum.090061
    1. Lai YT, Dai YS, Yen MF et al. . Dermatomyositis is associated with an increased risk of cardiovascular and cerebrovascular events: a Taiwanese population-based longitudinal follow-up study. Br J Dermatol 2013;168:1054–9. 10.1111/bjd.12245
    1. Linos E, Fiorentino D, Lingala B et al. . Atherosclerotic cardiovascular disease and dermatomyositis: an analysis of the Nationwide Inpatient Sample survey. Arthritis Res Ther 2013;15:R7 10.1186/ar4135
    1. Rai SK, Choi HK, Sayre EC et al. . Risk of myocardial infarction and ischaemic stroke in adults with polymyositis and dermatomyositis: a general population-based study. Rheumatology (Oxford) 2016;55:461–9. 10.1093/rheumatology/kev336
    1. Vincze M, Dér H, Kerekes G et al. . Decreased flow-mediated dilatation with increased arterial stiffness and thickness as early signs of atherosclerosis in polymyositis and dermatomyositis patients. Clin Rheumatol 2014;33:1635–41. 10.1007/s10067-014-2561-y
    1. Maradit-Kremers H, Nicola PJ, Crowson CS et al. . Cardiovascular death in rheumatoid arthritis: a population-based study. Arthritis Rheum 2005;52:722–32. 10.1002/art.20878
    1. Mavrogeni S, Douskou M, Manoussakis MN. Contrast-enhanced CMR imaging reveals myocardial involvement in idiopathic inflammatory myopathy without cardiac manifestations. JACC Cardiovasc Imaging 2011;4:1324–5. 10.1016/j.jcmg.2011.05.009
    1. Mavrogeni S, Bratis K, Karabela G et al. . Myocarditis during acute inflammatory myopathies: evaluation using clinical criteria and cardiac magnetic resonance imaging. Int J Cardiol 2013;164:e3–4. 10.1016/j.ijcard.2012.09.109
    1. Sado DM, Kozor R, Corr L et al. . Global myocardial edema in antisynthetase syndrome detected by cardiovascular magnetic resonance mapping techniques. Circulation 2016;133:e25–6. 10.1161/CIRCULATIONAHA.115.017430
    1. Barth Z, Nomeland Witczak B, Schwartz T et al. . In juvenile dermatomyositis, heart rate variability is reduced, and associated with both cardiac dysfunction and markers of inflammation: a cross-sectional study median 13.5 years after symptom onset. Rheumatology (Oxford) 2016;55:535–43. 10.1093/rheumatology/kev376
    1. Xhyheri B, Manfrini O, Mazzolini M et al. . Heart rate variability today. Prog Cardiovasc Dis 2012;55:321–31. 10.1016/j.pcad.2012.09.001
    1. Sallum AM, Pivato FC, Doria-Filho U et al. . Risk factors associated with calcinosis of juvenile dermatomyositis. J Pediatr (Rio J) 2008;84:68–74. 10.2223/JPED.1746
    1. Labirua-Iturburu A, Selva-O'Callaghan A, Vincze M et al. . Anti-PL-7 (anti-threonyl-tRNA synthetase) antisynthetase syndrome: clinical manifestations in a series of patients from a European multicenter study (EUMYONET) and review of the literature. Medicine (Baltimore) 2012;91:206–11. 10.1097/MD.0b013e318260977c
    1. Lega JC, Reynaud Q, Belot A et al. . Idiopathic inflammatory myopathies and the lung. Eur Respir Rev 2015;24:216–38. 10.1183/16000617.00002015
    1. Hervier B, Meyer A, Dieval C et al. . Pulmonary hypertension in antisynthetase syndrome: prevalence, aetiology and survival. Eur Respir J 2013;42:1271–82. 10.1183/09031936.00156312
    1. Cavagna L, Nuño L, Scirè CA et al. . Clinical spectrum time course in anti Jo-1 positive antisynthetase syndrome: results from an international retrospective multicenter study. Medicine (Baltimore) 2015;94:e1144 10.1097/MD.0000000000001144
    1. Nakanishi N, European Society of Cardiology, European Respiratory Society. 2009 ESC/ERS pulmonary hypertension guidelines and connective tissue disease. Allergol Int 2011;60:419–24. 10.2332/allergolint.11-RAI-0362
    1. Mann DL, Zipes DP, Libby P et al. . Braunwald's heart disease: a textbook of cardiovascular medicine. 10th edn Saunders, 2014.
    1. Hughes M, Lilleker JB, Herrick AL et al. . Cardiac troponin testing in idiopathic inflammatory myopathies and systemic sclerosis-spectrum disorders: biomarkers to distinguish between primary cardiac involvement and low-grade skeletal muscle disease activity. Ann Rheum Dis 2015;74:795–8. 10.1136/annrheumdis-2014-206812
    1. Lewington S, Whitlock G, Clarke R et al. . Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007;370:1829–39. 10.1016/S0140-6736(07)61778-4
    1. Choy E, Sattar N. Interpreting lipid levels in the context of high-grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Ann Rheum Dis 2009;68:460–9. 10.1136/ard.2008.101964
    1. Amezaga UM, Suarez-Almazor ME. Lipid paradox in rheumatoid arthritis: changes with rheumatoid arthritis therapies. CurrRheumatolRep 2012;14:428–37.
    1. Gullestad L, Ueland T, Vinge LE et al. . Inflammatory cytokines in heart failure: mediators and markers. Cardiology 2012;122:23–35. 10.1159/000338166
    1. Zweifel M, Matozan K, Dahinden C et al. . Eotaxin/CCL11 levels correlate with myocardial fibrosis and mast cell density in native and transplanted rat hearts. Transplant Proc 2010;42:2763–6. 10.1016/j.transproceed.2010.05.152
    1. Ghirardello A, Borella E, Beggio M et al. . Myositis autoantibodies and clinical phenotypes. Auto Immun Highlights 2014;5:69–75. 10.1007/s13317-014-0060-4
    1. Rider LG, Shah M, Mamyrova G et al. . The myositis autoantibody phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine (Baltimore) 2013;92:223–43. 10.1097/MD.0b013e31829d08f9
    1. Christopher-Stine L, Casciola-Rosen LA, Hong G et al. . A novel autoantibody recognizing 200-kd and 100-kd proteins is associated with an immune-mediated necrotizing myopathy. Arthritis Rheum 2010;62:2757–66. 10.1002/art.27572
    1. Charles-Schoeman C, Amjadi SS, Paulus HE et al. . Treatment of dyslipidemia in idiopathic inflammatory myositis: results of the International Myositis Assessment and Clinical Studies Group survey. Clin Rheumatol 2012;31:1163–8. 10.1007/s10067-012-1986-4
    1. Erbel R, Möhlenkamp S, Moebus S et al. . Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 2010;56:1397–406. 10.1016/j.jacc.2010.06.030
    1. Andrus B, Lacaille D. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. J Am Coll Cardiol 2014;63:2886 10.1016/j.jacc.2014.02.606
    1. Jindal G, Singh S, Suri D et al. . Recurrent ventricular tachycardia in a child with juvenile dermatomyositis—an unusual association. Int J Rheum Dis 2012;15:e26–7. 10.1111/j.1756-185X.2012.01701.x
    1. Allanore Y, Vignaux O, Arnaud L et al. . Effects of corticosteroids and immunosuppressors on idiopathic inflammatory myopathy related myocarditis evaluated by magnetic resonance imaging. Ann Rheum Dis 2006;65:249–52. 10.1136/ard.2005.038679
    1. Touma Z, Arayssi T, Kibbi L et al. . Successful treatment of cardiac involvement in dermatomyositis with rituximab. Joint Bone Spine 2008;75:334–7. 10.1016/j.jbspin.2007.05.011
    1. Danieli MG, Gelardi C, Guerra F et al. . Cardiac involvement in polymyositis and dermatomyositis. Autoimmun Rev 2016;15:462–5. 10.1016/j.autrev.2016.01.015
    1. Erlacher P, Lercher A, Falkensammer J et al. . Cardiac troponin and beta-type myosin heavy chain concentrations in patients with polymyositis or dermatomyositis. Clin Chim Acta 2001;306:27–33. 10.1016/S0009-8981(01)00392-8
    1. Aggarwal R, Lebiedz-Odrobina D, Sinha A et al. . Serum cardiac troponin T, but not troponin I, is elevated in idiopathic inflammatory myopathies. J Rheumatol 2009;36:2711–14. 10.3899/jrheum.090562
    1. Schwarzmeier JD, Hamwi A, Preisel M et al. . Positive troponin T without cardiac involvement in inclusion body myositis. Hum Pathol 2005;36:917–21. 10.1016/j.humpath.2005.06.009
    1. Cox FM, Delgado V, Verschuuren JJ et al. . The heart in sporadic inclusion body myositis: a study in 51 patients. J Neurol 2010;257:447–51. 10.1007/s00415-009-5350-9

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