Cardiac involvement in collagen diseases

The purpose of this study is to evaluate the early morphological and functional abnormalities of the heart in patients with collagen disease. The study population was free of risk factors for coronary artery disease and without any clinically evident cardiac manifestations. In 62 patients with collagen disease (25 with progressive systemic sclerosis, 19 with systemic lupus erythematosus, 15 with rheumatoid arthritis, three with dermatomyositis) and in 40 healthy subjects an echocardiographic study was performed. Echocardiographic examination from the apical four-chamber view was performed at rest and during the end of a 3 min isometric exercise with handgrip. Global and regional ejection fraction of the left ventricle were calculated In the group with progressive systemic sclerosis the left ventricular mass index was significantly higher than in the control group (110.78 ± 48.61 vs 82.18 ± 28.46g. m−2) and the ejection fraction (53.61 ± 7.95%) was the lowest of all groups (control: 61.47 ± 8.52%, systemic lupus erythematosus: 59.04 ± 8.58%, rheumatoid arthritis: 62.38 ± 6.88%). Regional ejection fraction analysis revealed a major dysfunction of the proximal segment of the interventricular septum, in all groups. During isometric exercise, the global and regional ejection fraction did not change significantly, although differences between groups disappeared. In rheumatoid arthritis, mitral and aortic valve leaflet separation appeared to be reduced. In the group with systemic lupus erythematosus, mild abnormalities were noticed, although the mean age and duration of the disease were the smallest compared with the other groups. In conclusion, patients with progressive systemic sclerosis mainly present left ventricular hypertrophy with a reduced ejection fraction while rheumatoid arthritis patients show a predominant valve dysfunction. In patients with collagen disease, without clinical signs of heart disease or risk factors for coronary artery disease, there are early morphological and functional abnormalities probably due to the primary disease.