Kardiale Beteiligungen bei rheumatologischen Erkrankungen – eine Übersicht

Zusammenfassung

Rheumatische Erkrankungen gehen mit einem erhöhten kardiovaskulären Risiko einher, können darüber hinaus jedoch im Bereich aller kardialen Strukturen zu spezifischen entzündlichen Veränderungen führen. Symptome wie Dyspnoe, Tachykardie und Leistungsminderung stehen patientenseitig im Vordergrund, wenngleich kardiale Beteiligungen nicht selten asymptomatisch verlaufen. Diagnostisch werden neben der klinischen Untersuchung und laborchemischen Verfahren apparative Diagnostiken wie Echokardiografie und Kardio-MRT aber auch invasive Verfahren wie die Herzkatheteruntersuchung und Myokardbiopsie angewendet. Die Therapie richtet sich nach der Grunderkrankung, den betroffenen kardialen Strukturen und reicht von einer medikamentösen Therapie bis zu interventionell-operativem Vorgehen.

Abstract

Rheumatic diseases lead to increased cardiovascular risk, possibly with specific inflammatory changes in every part of the heart. Symptoms like dyspnoea, tachycardia and general impairment are frequent, but asymptomatic cardiac changes are not uncommon. Diagnostic tools range from physical examination and laboratory testing to imaging techniques like echocardiography or cardiac MRI. Invasive procedures like heart catheterisation including myocardial biopsy are additional options. Therapy depends on the underlying disease, and structural involvement and varies from medication to surgical or interventional procedures.

Schlüsselwörter

Herz - Rheumatologie - Perikarditis - Myokarditis - Echokardiografie

Key words

HeartRheumatology - Pericarditis - Myocarditis - Echokardiography

Publikationsverlauf

Artikel online veröffentlicht:
02. Dezember 2021

• Literatur

• 1 Avina-Zubieta JA, Thomas J, Sadatsafavi M. et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Annals of the rheumatic diseases 2012; 71: 1524-1529 DOI: 10.1136/annrheumdis-2011-200726.
• 2 Agca R, Heslinga SC, Rollefstad S. et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the rheumatic diseases 2017; 76: 17-28 DOI: 10.1136/annrheumdis-2016-209775.
• 3 Choi HK, Hernan MA, Seeger JD. et al. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 2002; 359: 1173-1177 DOI: 10.1016/s0140-6736(02)08213-2.
• 4 Bosello S, De Luca G, Berardi G. et al. Cardiac troponin T and NT-proBNP as diagnostic and prognostic biomarkers of primary cardiac involvement and disease severity in systemic sclerosis: A prospective study. Eur J Intern Med 2019; 60: 46-53 DOI: 10.1016/j.ejim.2018.10.013.
• 5 Ross L, Moxey J, Nikpour M. Are troponin and B-type natriuretic peptides useful biomarkers for the diagnosis of systemic sclerosis heart involvement? A systematic literature review. Semin Arthritis Rheum 2021; 51: 299-309 DOI: 10.1016/j.semarthrit.2020.10.016.
• 6 Mukherjee M, Chung SE, Ton VK. et al. Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients. Circ Cardiovasc Imaging 2016; 9 DOI: 10.1161/CIRCIMAGING.115.003792.
• 7 Mavrogeni SI, Kitas GD, Dimitroulas T. et al. Cardiovascular magnetic resonance in rheumatology: Current status and recommendations for use. Int J Cardiol 2016; 217: 135-148 DOI: 10.1016/j.ijcard.2016.04.158.
• 8 Turesson C, O'Fallon WM, Crowson CS. et al. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. The Journal of rheumatology 2002; 29: 62-67
• 9 Edwards MH, Leak AM. Pericardial effusions on anti-TNF therapy for rheumatoid arthritis—a drug side effect or uncontrolled systemic disease?. Rheumatology 2008; 48: 316-317 DOI: 10.1093/rheumatology/ken463.
• 10 Ahlers MJ, Lowery BD, Farber-Eger E. et al. Heart Failure Risk Associated With Rheumatoid Arthritis-Related Chronic Inflammation. Journal of the American Heart Association 2020; 9: e014661 DOI: 10.1161/jaha.119.014661.
• 11 Bulkley BH, Roberts WC. Ankylosing spondylitis and aortic regurgitation. Description of the characteristic cardiovascular lesion from study of eight necropsy patients. Circulation 1973; 48: 1014-1027 DOI: 10.1161/01.cir.48.5.1014.
• 12 Bergfeldt L, Insulander P, Lindblom D. et al. HLA-B27: an important genetic risk factor for lone aortic regurgitation and severe conduction system abnormalities. The American journal of medicine 1988; 85: 12-18 DOI: 10.1016/0002-9343(88)90497-4.
• 13 Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best practice & research Clinical rheumatology 2018; 32: 369-389 DOI: 10.1016/j.berh.2019.01.002.
• 14 Kohler BM, Lorenz HM, Blank N. IL1-blocking therapy in colchicine-resistant familial Mediterranean fever. European journal of rheumatology 2018; 5: 230-234 DOI: 10.5152/eurjrheum.2018.18036.
• 15 Hu QY, Zeng T, Sun CY. et al. Clinical features and current treatments of adult-onset Still’s disease: a multicentre survey of 517 patients in China. Clin Exp Rheumatol 2019; 37: 52-57
• 16 Dall'Ara F, Frassi M, Tincani A. et al. A retrospective study of patients with adult-onset Still’s disease: is pericarditis a possible predictor for biological disease-modifying anti-rheumatic drugs need?. Clinical rheumatology 2016; 35: 2117-2123 DOI: 10.1007/s10067-015-3164-y.
• 17 Blank N, Lorenz HM. Idiopathic Pericarditis-an Autoinflammatory Disease?. Curr Rheumatol Rep 2019; 21: 18 DOI: 10.1007/s11926-019-0820-2.
• 18 Adler Y, Charron P, Imazio M. et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). European heart journal 2015; 36: 2921-2964 DOI: 10.1093/eurheartj/ehv318.
• 19 Artom G, Koren-Morag N, Spodick DH. et al. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis. European heart journal 2005; 26: 723-727 DOI: 10.1093/eurheartj/ehi197.
• 20 Dein E, Douglas H, Petri M. et al. Pericarditis in Lupus. Cureus 2019; 11: e4166 DOI: 10.7759/cureus.4166.
• 21 Miner JJ, Kim AH. Cardiac manifestations of systemic lupus erythematosus. Rheum Dis Clin North Am 2014; 40: 51-60 DOI: 10.1016/j.rdc.2013.10.003.
• 22 Ibrahim AM, Siddique MS. Libman Sacks Endocarditis. In: StatPearls. Treasure Island (FL): 2021
• 23 Hung G, Mercurio V, Hsu S. et al. Progress in Understanding, Diagnosing, and Managing Cardiac Complications of Systemic Sclerosis. Curr Rheumatol Rep 2019; 21: 68 DOI: 10.1007/s11926-019-0867-0.
• 24 Rodriguez-Reyna TS, Morelos-Guzman M, Hernandez-Reyes P. et al. Assessment of myocardial fibrosis and microvascular damage in systemic sclerosis by magnetic resonance imaging and coronary angiotomography. Rheumatology (Oxford) 2015; 54: 647-654 DOI: 10.1093/rheumatology/keu350.
• 25 Hinchcliff M, Desai CS, Varga J. et al. Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol 2012; 30: S30-S37
• 26 Fayed H, Coghlan JG. Pulmonary Hypertension Associated with Connective Tissue Disease. Semin Respir Crit Care Med 2019; 40: 173-183 DOI: 10.1055/s-0039-1685214.
• 27 Melissaropoulos K, Bogdanos D, Dimitroulas T. et al. Primary Sjogren’s Syndrome and Cardiovascular Disease. Curr Vasc Pharmacol 2020; 18: 447-454 DOI: 10.2174/1570161118666200129125320.
• 28 Wang LJ, Wei YL, Zhang ZL. [A Sjogren’s syndrome patient with prominent aortic valve involvement: a case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2017; 49: 1087-1089
• 29 Tsuji M, Nakatani T, Nojiri T. et al. A case of Sjogren's syndrome with valvular diseases. Jpn Heart J 1986; 27: 137-143 DOI: 10.1536/ihj.27.137.
• 30 Kono M, Aoyagi S, Okazaki T. et al. Aortic Stenosis in a Patient With Sjogren's Syndrome. Int Heart J 2016; 57: 251-253 DOI: 10.1536/ihj.15-349.
• 31 Akaycan J, Hidayet S, Bayramoglu A. et al. Subclinical left ventricular dysfunction in Sjogren's syndrome assessed by four-dimensional speckle tracking echocardiography. Echocardiography 2020; 37: 1803-1808 DOI: 10.1111/echo.14867.
• 32 Watanabe T, Takahashi Y, Hirabayashi K. et al. Acute fulminant myocarditis in a patient with primary Sjogren's syndrome. Scand J Rheumatol 2019; 48: 164-165 DOI: 10.1080/03009742.2018.1514068.
• 33 Levin MD, Zoet-Nugteren SK, Markusse HM. Myocarditis and primary Sjogren’s syndrome. Lancet 1999; 354: 128-129 DOI: 10.1016/s0140-6736(99)02251-5.
• 34 Golan TD, Keren D, Elias N. et al. Severe reversible cardiomyopathy associated with systemic vasculitis in primary Sjogren’s syndrome. Lupus 1997; 6: 505-508 DOI: 10.1177/096120339700600605.
• 35 Ungprasert P, Wannarong T, Panichsillapakit T. et al. Cardiac involvement in mixed connective tissue disease: a systematic review. Int J Cardiol 2014; 171: 326-330 DOI: 10.1016/j.ijcard.2013.12.079.
• 36 Kumar MS, Smith M, Pischel KD. Case report and review of cardiac tamponade in mixed connective tissue disease. Arthritis Rheum 2006; 55: 826-830 DOI: 10.1002/art.22227.
• 37 Katz A, Bena J, Chatterjee S. Antisynthetase Syndrome: Prevalence of Serositis in Autoantibody Subsets. Arthritis Rheumatol 2018; 70
• 38 Lilleker JB, Vencovsky J, Wang G. et al. The EuroMyositis registry: an international collaborative tool to facilitate myositis research. Annals of the rheumatic diseases 2018; 77: 30-39 DOI: 10.1136/annrheumdis-2017-211868.
• 39 Gupta R, Wayangankar SA, Targoff IN. et al. Clinical cardiac involvement in idiopathic inflammatory myopathies: A systematic review. International Journal of Cardiology 2011; 148: 261-270
• 40 Mavrogeni S, Bratis K, Karabela G. et al. Myocarditis during acute inflammatory myopathies: Evaluation using clinical criteria and cardiac magnetic resonance imaging. International Journal of Cardiology 2013; 164: e3-e4
• 41 Doubelt I, Cuthbertson D, Carette S. et al. Clinical Manifestations and Long-Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America. ACR open rheumatology 2021; DOI: 10.1002/acr2.11263.
• 42 Agard C, Barrier JH, Dupas B. et al. Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan. Arthritis Rheum 2008; 59: 670-676 DOI: 10.1002/art.23577.
• 43 Prieto-González S, Arguis P, García-Martínez A. et al. Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Annals of the rheumatic diseases 2012; 71: 1170-1176 DOI: 10.1136/annrheumdis-2011-200865.
• 44 Yang L, Zhang H, Jiang X. et al. Clinical Manifestations and Longterm Outcome for Patients with Takayasu Arteritis in China. The Journal of rheumatology 2014; 41: 2439-2446 DOI: 10.3899/jrheum.140664.
• 45 Kusano KF, Satomi K. Diagnosis and treatment of cardiac sarcoidosis. Heart 2016; 102: 184-190 DOI: 10.1136/heartjnl-2015-307877.
• 46 Serei VD, Fyfe B. The Many Faces of Cardiac Sarcoidosis. Am J Clin Pathol 2020; 153: 294-302 DOI: 10.1093/ajcp/aqz169.
• 47 Terasaki F, Azuma A, Anzai T. et al. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis- Digest Version. Circ J 2019; 83: 2329-2388 DOI: 10.1253/circj.CJ-19-0508.
• 48 Urabe Y, Fujii T, Kurushima S. et al. Pigs-in-a-blanket coronary arteries: a case of immunoglobulin G4-related coronary periarteritis assessed by computed tomography coronary angiography, intravascular ultrasound, and positron emission tomography. Circ Cardiovasc Imaging 2012; 5: 685-687 DOI: 10.1161/CIRCIMAGING.112.975946.
• 49 Debonnaire P, Bammens B, Blockmans D. et al. Multimodality imaging of giant coronary artery aneurysms in immunoglobulin g4-related sclerosing disease. J Am Coll Cardiol 2012; 59: e27 DOI: 10.1016/j.jacc.2011.06.085.
• 50 Patel NR, Anzalone ML, Buja LM. et al. Sudden cardiac death due to coronary artery involvement by IgG4-related disease: a rare, serious complication of a rare disease. Arch Pathol Lab Med 2014; 138: 833-836 DOI: 10.5858/arpa.2012-0614-CR.
• 51 Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. IgG4-related cardiovascular disease. The emerging role of cardiovascular imaging. Eur J Radiol 2017; 86: 169-175 DOI: 10.1016/j.ejrad.2016.11.012.
• 52 Ishida M, Miyamura T, Sato S. et al. Pulmonary arterial hypertension associated with IgG4-related disease. Intern Med 2014; 53: 493-497 DOI: 10.2169/internalmedicine.53.0154.
• 53 Kamisawa T, Okazaki K. Diagnosis and Treatment of IgG4-Related Disease. Curr Top Microbiol Immunol 2017; 401: 19-33 DOI: 10.1007/82_2016_36.
• 54 Berti A, Ferrarini M, Ferrero E. et al. Cardiovascular manifestations of Erdheim-Chester disease. Clin Exp Rheumatol 2015; 33: S-155-S-163
• 55 Goyal G, Heaney ML, Collin M. et al. Erdheim-Chester disease: consensus recommendations for evaluation, diagnosis, and treatment in the molecular era. Blood 2020; 135: 1929-1945 DOI: 10.1182/blood.2019003507.