Evidence map›Paper›PMID 35782249›Full record

ArticleQuantitative imaging in medicine and surgery2022

Relative basal myocardial weakness: differentiating dermatomyositis and polymyositis with cardiac involvement from viral myocarditis using speckle-tracking echocardiography and quantification of myocardial work.

Xiaohang Liu, Fan Jin, Tianchen Guo, Qian Wang, Ligang Fang, Wei Chen

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Article in Quantitative imaging in medicine and surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Xiaohang Liu *Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Fan Jin *Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Tianchen GuoDepartment of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Qian WangDepartment of Rheumatology and Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ligang FangDepartment of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Wei ChenDepartment of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Both viral infection and autoimmune diseases like dermatomyositis (DM) and polymyositis (PM) can cause myocarditis and inflammatory cardiomyopathy. It is of great importance to identify underlying etiologies and initiate appropriate treatment. This study aimed to describe the pattern of regional longitudinal strain (LS) and myocardial work in PM/DM patients with cardiac involvement and investigate the usefulness of the pattern to differentiate PM/DM from acute viral myocarditis (AVM) in the clinical setting. Methods: A total of 46 PM/DM patients with cardiac involvement, 24 patients with AVM, and 30 healthy control participants (HCs) were included. Regional myocardial work and strain analyses were performed using two-dimensional (2D) echocardiography to calculate relative basal LS and myocardial work parameters and investigate their value for differential diagnosis. Results: PM and DM are characterized by a pattern of basal myocardial weakness with LS (basal, mid, and apical segments: -15.0±4.4, -17.1±4.7, and -21.4±6.5, respectively), myocardial work index (basal, mid, and apical segments: 1,193±432, 1,272±394, and 1,431±451, respectively), and constructive work (basal, mid, and apical segments: 1,512±422, 1,628±413, and 1,912±433, respectively) that show a base-to-apex gradient in which the myocardium at the base is more severely injured that that of the apex. On cardiovascular magnetic resonance, the positive rate of late gadolinium enhancement was also significantly higher in the basal segments (64%) than the mid (44%) and apical (28%) segments (P=0.038). A relative basal LS of 0.43, defined using the equation [average basal LS/(average mid LS + average apical LS)], had an area under curve (AUC) of 0.88 with high sensitivity (88%) and specificity (78%) to differentiate PM/DM from AVM. Using multivariate logistic regression analysis, relative basal injury of myocardium and creatine kinase elevation were strongly correlated with proximal skeletal muscle weakness according to manual muscle testing (P=0.036 and P=0.010, respectively). Conclusions: Similar to the typical proximal muscle weakness of limbs, PM/DM patients also presented with regionally decreased LS and myocardial work of the basal myocardium. A "basal weakness" pattern is easily recognizable and can be used to accurately differentiate PM/DM with cardiac involvement from AVM.

Indexed as

dermatomyositis and polymyositis (DM and PM)echocardiographic strain analysismyocardial workRelative basal myocardial weaknessviral myocarditis

Identifiers

PMID35782249
PMCPMC9246726

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