Cardiac disease in patients with inflammatory myopathy

Inflammatory myopathies (IMs) are a group of autoimmune diseases characterized by progressive symmetric muscle weakness and various extramuscular manifestations. Cardiac involvement in IM has been associated with worse outcomes, but evidence to support specific screening and management algorithms for cardiac comorbidities in IM is still limited.

For this observational study, 37 adult IM patients recruited from the rheumatology outpatient clinic at Ludwig-Maximilians-University Hospital between August 2023 and January 2025 completed a questionnaire on IM characteristics, management, clinical events, and cardiac disease. Self-reported data were verified and complemented using clinical records. The main study endpoints included the incidence of cardiomyopathy, documented cardiac arrhythmias, and myocardial infarction following the diagnosis of IM.

The median age at last follow-up was 60 years and 35.1% were male. The most common cardiac symptoms reported by study participants included dyspnoea (45.9%), congestion/oedema (40.5%), palpitations (32.4%), and chest pain (18.9%). Arterial hypertension was diagnosed in 27% after IM had been established. Supraventricular and ventricular arrhythmias were documented in 10.8% and 5.4%, respectively. Echocardiography was performed in all study participants, revealing left ventricular diastolic dysfunction in 35.1%. Severe structural heart disease and cardiac adverse events, including acute myocardial infarction, severe valvular disease, and left ventricular systolic dysfunction, were documented only in isolated cases of IM.

Cardiac symptoms, risk factors, and structural abnormalities are prevalent in a substantial proportion of patients with IM. Routine cardiologic assessment, including echocardiography, may be advisable. Further evidence from prospective longitudinal studies is needed to optimize screening algorithms and multidisciplinary management.