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Echokardiographische Funktionsdiagnostik bei Patienten mit rheumatoider Arthritis und Kollagenosen

Diagnosis of myocardial function by echocardiography in patients with rheumatoid arthritis and connective tissue diseases

  • BEITRAG ZUM SCHWERPUNKTTHEMA
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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Patienten mit rheumatoider Arthritis und Kollagenosen weisen mit unterschiedlicher Häufigkeit kardiale Manifestationen auf. Die Echokardiographie ist die Methode der ersten Wahl zur Erfassung pathologischer morphologischer und funktioneller Befunde am Herzen. Pathophysiologisch lassen sich bei diesen Patienten sowohl entzündliche Veränderungen an Endo- und Perimyokard erklären. Aufgrund der Aktivierung des Gerinnungssystems und der Beeinflussung des Gefäßendothels sind bei diesen Patienten auch thrombotische Auflagerungen an den Klappen mit entsprechenden Klappenfunktionsstörungen sowie Ischämie- induzierte regionale Kinetikstörungen durch Reaktivitätseinschränkungen der Koronarien zu erwarten. In der Literatur wird bei Patienten mit rheumatoider Arthritis und Kollagenosen am häufigsten das Vorliegen eines Perikardergusses und einer pulmonalarteriellen Hypertonie beschrieben. Die echokardiographische Untersuchung umfasst aufgrund der Komplexität der rheumatologischen Erkrankungen zusätzlich die Detektion morphologischer Besonderheiten, die Schweregrad-Einschätzung von Klappenfunktionsstörungen sowie die Analyse von Kinetik und Perfusion in Ruhe und bei Stress-Untersuchungen—speziell mittels Gewebedoppler und Kontrastechokardiographie. Um durch die Echokardiographie pathologische Befunde am Herzen im Frühstadium zu diagnostizieren, ist sowohl die Kenntnis der Pathophysiologie des Herzens bei rheumatoider Arthritis und Kollagenosen notwendig, als auch die Kenntnis der modernen echokardiographischen Techniken. Eine Standardisierung des echokardiographischen Untersuchungsgangs sollte zur Reproduzierbarkeit der Befunde vorausgesetzt werden.

Summary

Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients with collagenoses, the coagulation system is activated and the reactivity of the endothelium is reduced. Thus, thrombus formation at the heart valves with consecutive stenosis and/or regurgitations as well as ischemia-induced regional wall motion defects due to reduced vasodilator response of the coronary arteries can be expected. In the literature in patients with rheumatoid arthritis and other collagenoses, pericardial effusion and pulmonary hypertension are most frequently described. The echocardiographic analysis, however, is more complex due to the variability of the patient cohort. Quantification of valve defects and the analysis of wall motion and perfusion at rest and during stress is necessary to detect early changes of the diseases. The prerequisites for successful diagnostic echocardiography in these patients are the knowledge of modern echocardiographic techniques like tissue Doppler and contrast echocardiography and clinical experience with patients with rheumatoid arthritis and other collagenoses. The standardization of the echocardiographic diagnostic procedure becomes more and more important for reproducibility and comparability of the results.

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  1. Medizinische Universitätsklinik und Poliklinik, Abteilung Kardiologie/Angiologie, Johannisallee 32, 04103, Leipzig, Germany

    A. Hagendorff & D. Pfeiffer

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  1. A. Hagendorff
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  2. D. Pfeiffer
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Correspondence to A. Hagendorff.

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Hagendorff, A., Pfeiffer, D. Echokardiographische Funktionsdiagnostik bei Patienten mit rheumatoider Arthritis und Kollagenosen. Z. Rheumatol. 64, 239–248 (2005). https://doi.org/10.1007/s00393-005-0734-4

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  • DOI: https://doi.org/10.1007/s00393-005-0734-4

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