Cardiac Involvement in Cryoglobulinemia: Clinical Characteristics, Radiological Features, and Outcomes.

Area of Science:

• Cardiology
• Rheumatology
• Hematology

Background:

• Cardiac involvement in cryoglobulinemia (CG) is a rare but potentially fatal complication.
• The clinical spectrum and management of cardiac involvement in CG remain poorly understood.

Purpose of the Study:

• To analyze the clinical characteristics, radiological features, and management outcomes of cardiac involvement in patients with CG.
• To highlight the importance of considering cardiac involvement in CG patients with unexplained cardiac symptoms.

Main Methods:

• Retrospective analysis of 11 patients with cardiac involvement among 885 CG patients.
• Review of clinical data, echocardiography, cardiac MRI, and treatment regimens.
• Assessment of treatment response, relapse rates, and survival outcomes during a median follow-up of 57 months.

Main Results:

• 1.2% of CG patients (11/885) had cardiac involvement, presenting with symptoms like dyspnea and chest tightness.
• Elevated N-terminal pro-B-type natriuretic peptide and diverse echocardiographic findings including left heart enlargement and reduced ejection fraction were common.
• B-cell targeted therapies (rituximab, bortezomib) led to initial cardiac improvement in all treated patients, but 50% relapsed, and 20% died within 4 years.

Conclusions:

• Cardiac involvement in CG presents with varied cardiac abnormalities and requires consideration in CG patients with unexplained cardiac symptoms.
• B-cell targeted therapy is effective for initial management, but high relapse rates underscore the need for early and sustained intervention.
• Proactive management strategies are crucial to mitigate the significant morbidity and mortality associated with cardiac cryoglobulinemia.