Background During last decade the morbidity rates in system scleroderma (SSc) have been increased. The bridge-head of aggression in SSc is huge, since there are actually no organs without connective tissue in the human organism. It also determines a high frequency of different visceral complications in SSc. The cardiac lesions in SSc are frequent visceral manifestation of illness, very often resulting in fatal consequences. In this context we attempted to analyse the main forms of cardiac pathology in SSc.
Objectives We examined 52 patients (pts) with SSc. Among them women were predominant (38/52, 73%). The age of patients and duration of disease varied from 29 to 48 and from 2 to 9 years, the average age of patients and average duration of disease constituted 36.2 ± 1.1 and 4.6 ± 0.4 years respectively. The patients with moderate activity of pathological process (degree I and II) were absolute majority (46/52 pts, 88.4%). Visceral implications were diagnosed in 42/52 pts (80.7%), among them cardiac lesions – in 41/52 pts (78.8%).
Methods Electrocardiography (ECG), echocardiography (EchoCG).
Results ECG abnormalities were detected in 41/52 pts (78.8%). Cardiac arrhythmia was determined in 32/52 pts (61.5%). Its most frequent form was extrasystole (18/52 pts, 34.6%): ventricular (9/52 pts, 17.3%), atrial (6/52 pts, 11.5%), atrioventricular (3/52 pts, 5.8%), single (8/52 pts, 15.4%) and group (10/52 pts, 19.2%) extrasystole. Violations of conductivity were also frequent: atrial – in 18/52 pts (34.6%), ventricular – in 16/52 pts (11.5%), right bundle-branch block – in 6/52 pts (11.5%). These abnormalities correlated with duration of disease, but did not depend on activity of SSc. Among 41 patients with ECG abnormalities the decrease of voltage was detected, possibly due to expanded cardiosclerosis.
EchoCG was conducted to determine myocardial contractility. In 27/52 pts (51.9%) was diagnosed LVEF reduction on 5%, in 11/52 pts (21.2%) – on 7–8%, in 3/52 pts (5.8%) – on 10% and more. The mitral valve diseases and pericardial implications were detected in 8/52 pts (15.4%) and 11/52 pts (21.2%) respectively.
Among all these patients the phenomena of myocardial dystrophy and hypoxia, violation of conductivity, excitability and cardiac output were detected that resulted in chronic heart failure. In many cases the heart failure was latent, resulting in late diagnosis and treatment.
Conclusion Carditis was diagnosed among more than three fourth of patients with SSc. The main reason of its development seems to be system sclerosis.
Guseva NG. System scleroderma and Nenoaiiay neeaðiaaðiey and pseudosclerodermic syndromes. Moscow: Medicine, 1993: 269
Jimenez SA, Hitraya E, Varga J. Pathogenesis of scleroderma. Collagen. Rheum Dis Clin North Am. 1996;22(4):647–74
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