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Phenotyping of myocardial involvement by cardiac magnetic resonance in idiopathic inflammatory myopathies

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Abstract

Objectives

Cardiac dysfunction is commonly noted in patients with idiopathic inflammatory myopathies (IIMs). This study aimed to investigate the characteristics of cardiac dysfunction using cardiac magnetic resonance (CMR) in polymyositis (PM), dermatomyositis (DM) and necrotising myositis (NM).

Methods

Fifty-one patients with IIMs and 20 matched healthy controls (HCs) were assessed using CMR examination. The clinical data, cardiac serum markers and autoimmune antibodies were determined for all patients. Cardiac involvement was identified by myocardial native T1, extracellular volume (ECV), late gadolinium enhancement (LGE) and left ventricular ejection fraction (LVEF).

Results

Different subtypes of IIMs showed different patterns of LGE and varying degrees of myocardial damage. The PM subgroup showed higher native T1 (p = 0.010) and ECV (p = 0.000) than the HCs. The prevalence of LGE was comparable between the PM and DM subgroups (40.0% vs. 31.6%, p = 0.741); however, it was higher in the PM subgroup than in the NM subgroup (40% vs. 0.0%, p = 0.014). Patients with positive LGE in the PM subgroup showed a higher proportion of positive LGE (p = 0.018) and lower LVEF (p = 0.024) than those with positive LGE in the DM subgroup. In multivariate analysis, the presence of LGE could be predicted by increased NT-proBNP (p = 0.036, OR = 1.001) and anti-MDA-5 antibody positivity (p = 0.011, OR = 12.4). The risk factors associated with native T1 were NT-proBNP (p = 0.016, β = 0.353) and body mass index (BMI) (p = 0.024, β = − 0.331).

Conclusions

Distinct cardiac involvements in different subtypes of IIMs were identified using CMR. Elevated NT-proBNP and a low BMI were the risk factors associated with LGE and elevated native T1.

Key Points

• The characteristics of cardiac involvement in different subtypes of IIMs could be identified with cardiac magnetic resonance.

• The NT-proBNP levels could reflect focal and diffuse myocardial damage in patients with IIMs.

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Abbreviations

ARS:

Aminoacyl-tRNA synthetase

BMI:

Body mass index

CI:

Confidence interval

CK:

Creatine kinase

CK-MB:

Creatine kinase myocardial band

CMR:

Cardiac magnetic resonance

c-TnT:

Cardiac troponin T

DM:

Dermatomyositis

ECV:

Extracellular volume

HCs:

Healthy controls

IIMs:

Idiopathic inflammatory myopathies

LDL-C:

Low-density lipoprotein cholesterol

LGE:

Late gadolinium enhancement

LV:

Left ventricular

LVEDV/RVEDV:

LV/RV end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESV/RVESV:

LV/RV end-systolic volume

MAA:

Myositis-associated antibody

MDA-5:

Melanoma differentiation–associated protein 5

MSA:

Myositis-specific antibody

NM:

Necrotising myositis

NT-proBNP:

n-Terminal prohormone of brain natriuretic peptide

NXP2:

Nuclear matrix protein 2

OR:

Odds ratio

PM:

Polymyositis

ROI:

Region of interest

RV:

Right ventricular

SRP:

Signal recognition peptide

TIF1-γ:

Transcriptional intermediary factor 1 γ

β :

Coefficient

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Acknowledgements

The authors would like to thank all the participants and working personnel in this study.

Funding

This research was supported by grants from the National Natural Science Foundation of China (No. 30901339 and No. 81172869), the Application Foundation Project in Sichuan Province (No. 2016JY0021 and No. 2017JY0025); the 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (Z2018A08 and ZYJC18013), and the Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH038).

Author information

Author notes

  1. Jianhong Sun and Geng Yin contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Jianhong Sun, Geng Yin, Yang Wu & Qibing Xie

  2. Department of Medicine, Cardiovascular Division, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Yuanwei Xu, Weihao Li, Qing Zhang & Yucheng Chen

  3. Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Liuyu Yu

  4. Department of Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China

    Ke Wan

  5. Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Jiayu Sun

Authors
  1. Jianhong Sun
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  2. Geng Yin
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  3. Yuanwei Xu
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  4. Yang Wu
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  7. Ke Wan
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  9. Qing Zhang
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  11. Yucheng Chen
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Corresponding authors

Correspondence to Qibing Xie or Yucheng Chen.

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Guarantor

The scientific guarantor of this publication is Yucheng Chen, MD, Professor, Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, No.37, Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China. Tel: 86-18980602149, Fax: 86-028-85422836, Email: chenyucheng2003@126.com.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Jianhong Sun and Geng Yin had expertise in statistics; they took responsibility for the study design, the acquisition and interpretation of the data and the accuracy of statistical analysis.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.

This study was approved by the Medical Ethics Committee of Sichuan University West China Hospital.

Study subjects or cohorts overlap

The study subjects and cohorts partially overlapped with our recent publication “Xu Y, Sun J, Wan K, et al Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy. J Cardiovasc Magn Reson. 2020;22(1):22. Published 2020 Apr 9. https://doi.org/10.1186/s12968-020-00616-0”. About 80% of patients overlapped in our study. The submitted article focused on the different characteristics by CMR in different IIM subtypes and explored the relationship of cardiac involvement and serum markers. While the recent published article focused on the CMR dynamic changes in myocardial and skeletal muscles in patients with IIM.

Methodology

• cross-sectional study

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Sun, J., Yin, G., Xu, Y. et al. Phenotyping of myocardial involvement by cardiac magnetic resonance in idiopathic inflammatory myopathies. Eur Radiol 31, 5077–5086 (2021). https://doi.org/10.1007/s00330-020-07448-7

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  • DOI: https://doi.org/10.1007/s00330-020-07448-7

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