CARDIAC INVOLVEMENT IN COLLAGEN DISEASES

The purpose of this study is to evaluate the early morphological and f unctional abnormalities of the heart in patients with collagen disease . The study population was free of risk factors for coronary artery di sease and without any clinically evident cardiac manifestations. In 62 patients with collagen disease (25 with progressive systemic sclerosi s, 19 with systemic lupus erythematosus, 15 with rheumatoid arthritis, three with dermatomyositis) and in 40 healthy subjects an echocardiog raphic study was performed. Echocardiographic examination from the api cal four-chamber view was performed at rest and during the end of a 3 min isometric exercise with handgrip. Global and regional ejection fra ction of the left ventricle were calculated. In the group with progres sive systemic sclerosis the left ventricular mass index was significan tly higher than in the control group (110.78 +/- 48.61 vs 82.18 +/- 28 .46 g . m-2) and the ejection fraction (53.61 +/- 7.95%) was the lowes t of all groups (control: 61.47 +/- 8.52%, systemic lupus erythematosu s: 59.04 +/- 8.58%, rheumatoid arthritis: 62.38 +/- 6.88%). Regional e jection fraction analysis revealed a major dysfunction of the proximal segment of the interventricular septum, in all groups. During isometr ic exercise, the global and regional ejection fraction did not change significantly, although differences between groups disappeared. In rhe umatoid arthritis, mitral and aortic valve leaflet separation appeared to be reduced. In the group with systemic lupus erythematosus, mild a bnormalities were noticed, although the mean age and duration of the d isease were the smallest compared with the other groups. In conclusion , patients with progressive systemic sclerosis mainly present left ven tricular hypertrophy with a reduced ejection fraction while rheumatoid arthritis patients show a predominant value dysfunction. In patients with collagen disease, without clinical signs of heart disease or risk factors for coronary artery disease, there are early morphological an d functional abnormalities probably due to the primary disease.