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Cardiac dysfunction in juvenile dermatomyositis: a case-control study
  1. Thomas Schwartz1,2,
  2. Helga Sanner2,3,
  3. Trygve Husebye4,
  4. Berit Flatø2,3,
  5. Ivar Sjaastad1,2,4
  1. 1Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway
  2. 2Institute for Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Department of Rheumatology, Oslo University Hospital, Oslo, Norway
  4. 4Department of Cardiology, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Thomas Schwartz, Institute for Experimental Medical Research, Oslo University Hospital, 0407 Oslo, Norway; thomas.schwartz{at}medisin.uio.no

Abstract

Objective To compare cardiac function in patients with juvenile dermatomyositis (JDM) with matched controls, and examine associations between pathological electrocardiography (ECG), echocardiographic abnormalities and disease variables in patients with JDM.

Methods A total of 59 patients with JDM, examined a median 16.8 years (range 2–38 years) after disease onset, were compared with 59 age-matched and sex-matched controls. Echocardiography, including early diastolic transmitral flow/early diastolic tissue velocity (E/E') as a marker for diastolic dysfunction, and 12-channel ECG were performed and analysed blinded to patient information. Disease activity and damage were assessed by clinical examination at follow-up and chart review.

Results E/E' was elevated (>9.5) in 13 (22%) patients versus 0 controls (p<0.001). In all, 10 patients presented with pathological ECG compared to 4 controls (p=0.054). Previous or current hypertension was found in 12 patients versus 0 controls (p<0.001). Among the patients, pathological ECG was found in 6/13 patients with versus 4/44 without elevated E/E' (p=0.002); and systolic blood pressure was correspondingly 132±24 mm Hg versus 112±18 mm Hg in the groups (p=0.012). E/E' correlated with cumulative organ damage assessed at follow-up (rsp 0.41, p=0.001) and disease activity at 1 year (rsp 0.56, p<0.001), which also predicted pathological E/E' after controlling for age and gender. During disease course, 12% of patients with JDM developed pericarditis.

Conclusion Only patients with JDM and no controls had subclinical left ventricular diastolic dysfunction; the patients with elevated E/E' also had high prevalence of pathological ECG and hypertension. High disease activity 1-year post diagnosis predicted high E/E' at follow-up. The findings suggest that subclinical heart disease is related to the systemic nature of JDM.

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Footnotes

  • Funding The project received financial support from Dr Olga Imerslund's Foundation, Anders Jahre's Fund for the Promotion of Science, the South-Eastern Norway Regional Health Authority, The Research Council of Norway and Rakel and Otto Chr. Bruun's Fund; all Oslo, Norway.

  • Competing interests None.

  • Ethics approval This study was carried out in compliance with the declaration of Helsinki, and was approved by the Regional Ethics Committee (Helse Sør-Øst).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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