Echocardiographic study of juvenile dermatomyositis patients: new insights from speckle-tracking-derived strain

Author(s)

Diniz, Maria de Fatima Rodrigues ^[1] ; Kozu, Katia Tomie ^[2] ; Elias, Adriana Maluf ^[2] ; Lianza, Alessandro Cavalcanti ^[1] ; Sawamura, Karen Saori Shiraishi ^[1] ; Menezes, Carolina Rocha Brito ^[1] ; Ferreira, Juliana Caires de Oliveira Achili ^[2] ; Silva, Clovis Artur ^[2] ; Leal, Gabriela Nunes ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Hosp Clin, Pediat Echocardiog Lab, Inst Crianca Adolescente, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Hosp Clin, Pediat Rheumatol Unit, Inst Crianca Adolescente, Sao Paulo - Brazil

• Document type: Journal article
• Source: CLINICAL RHEUMATOLOGY; v. 40, n. 4, p. 1497-1505, APR 2021.
• Web of Science Citations: 0

Abstract

Objectives This study aimed to investigate subclinical left ventricle (LV) systolic dysfunction in juvenile dermatomyositis (JDM) using two-dimensional speckle-tracking echocardiography (2DST). Possible associations between LV deformation impairment and disease activity/cumulative damage were also evaluated. Methods Thirty-fiveconsecutive JDM patients without cardiac symptoms and 35 healthy volunteers were enrolled. Clinical data were collected from medical records, and echocardiograms were performed by a pediatric cardiologist, unaware of patients' conditions. Results Patients and controls had similar age (12.6 +/- 0.7 vs.12.5 +/- 0.6;p= 0.97) and gender (11F:24M vs.11F:24M;p= 1.0). Median of JDM duration was 4.6 (0.04-17.6) years, and only 6/35 (17%) had active disease (disease activity score (DAS > 3)). Conventional echocardiogram revealed preserved LV ejection fraction (EF) (>= 55%) in all individuals. In JDM, 2DST identified reduction of LV longitudinal {[}-22(-17.2 to -27.9) % vs. -23(-20.8 to -27.4) %;p= 0.028)] and circumferential -23.9 +/- 2.8% vs. -26.7 +/- 2.9%;p= 0.0002) strain. Lower longitudinal strain was associated with DAS >3 -19.9(-17.2 to -26.5)% vs. -22.1-18.9 to -27.9)%;p= 0.046], MDI extent > 0 {[}-19(-17.2 to -22.5)% vs. -22.1-19.2 to -27.9)%;p= 0.0008], MDI severity > 0 {[}-19(-17.2 to -22.1)% vs. -22.3(-20.3 to -27.9)%;p= 0.0001] and calcinosis{[}-20.6(-17.2 to -23)% vs. -22.3(-20.3 to -27.9)%;p= 0.03]. Lower circumferential strain was associated with MDI extent > 0 (-22.1 +/- 3.87% vs. -24.4 +/- 2.3%;p= 0.039), MDI severity > 0 (-21.7 +/- 3% vs. 24.7 +/- 2.3%;p= 0.004) and calcinosis (-22.5 +/- 3.3% vs. -24.8 +/- 2.1%;p= 0.02). There was a negative correlation between longitudinal strain and cumulative dose of prednisone (r= -0.44;p= 0.009) and methotrexate (r= -0.33;p= 0.0008). Conclusions LV 2DST detected early systolic myocardial compromise in asymptomatic pediatric JDM patients, with preserved EF. Longitudinal strain impairment was associated with disease activity and cumulative damage, whereas circumferential strain impairment was associated exclusively with cumulative damage. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants