Cardiac manifestations in dermato-polymyositis

To describe the functional and anatomic heart abnormalities of patients with dermato-polymyositis.

Thirty-two consecutive patients with dermato-polymyositis (DM/PM) were studied. Patient assessments included a questionnaire for cardiac symptoms, physical examination, muscular enzymes, standard electrocardiogram (EKG), chest radiographs, spirometry, Holter monitoring and color Doppler flow (CDF) studies. Features evaluated with CDF included left ventricular diastolic dysfunction (LVDD), hyperdynamic heart, mitral valve prolapse, and endomyocardial fibrosis.

Twenty-five patients (78%) were female. The mean age was 43 years and the mean disease duration 6 years. Twenty-six (81%) patients had dermatomyositis. Only 2 (6%) had cardiac symptoms. Spirometry was performed in 20 patients, Holter monitoring in 23 and CDF in 26 patients. Electrical disturbances detected by either EKG or Holter were present in more than half of the patients studied. LVDD was identified in 11 patients (42%) and hyperdynamic heart in 4 (15%). None of the 26 patients studied by CDF had mitral valve prolapse. No significant differences in the frequency of cardiac abnormalities, including LVDD, were observed in relation to the diagnosis of DM or PM, the presence of Raynaud's phenomenon or calcinosis, or the disease activity status at the moment of the study.

Subclinical heart abnormalities are frequent in patients with DM/PM. LVDD appears to be common. Our findings suggest that cardial assessment of patients should be performed in order to detect abnormalities requiring specific therapy.