Glucocorticoid effects on myocardial performance in patients with systemicsclerosis

Objective Myocardial inflammation and fibrosis are common autopsy findings in systemic sclerosis (SSc) and, although symptomatic cardiac involvement o ccurs less often, current therapies remain empiric and do not prevent or mo dify, its course. In this open, uncontrolled study we assessed the short-te rm effects of glucocorticoid administration on myocardial performance in pa tients with SSc in the absence of clinically overt cardiac disease. Methods Resting radionuclide ventriculography with Tc-99m was performed bef ore and 20 days after the administration of prednisolone, 20 mg daily, in 3 2 patients with SSc without clinically evident myocardial dysfunction at re st; 13 and 19 patients with systemic lupus erythematosus (SLE) and rheumato id arthritis (RA), respectively, were studied in parallel as controls. Results The mean left ventricular ejection fraction (LVEF) value at baselin e was 59% in the SSc group; similar values were found for the SLE (61%) and RA (59%) groups. An impaired LVEF (i.e., < 50%) was found in 6 patients wi th SSc and in 1 patient with SLE. Prednisolone administration resulted in a significant percent improvement in the baseline LVEF (mean 18%, p = 0.0001 ) in the SSc group; this improvement was greater in the patients with diffu se SSc than in those with limited skin disease (27% vs 10%, p = 0.02). The improvement was most prominent in the 6 patients with an initial impaired L VEF: No significant improvement was observed in the SLE or RA control group s. The linear trend between the individual baseline LVEF values in patients with SSc and their percent changes after treatment (r(2) = 0.55 p: 0.00001 ) showed that the lower the initial LVEF the greater the improvement caused by prednisolone. The degree of LVEF improvement was also associated with t he individual erythrocyte sedimentation rate values and serum IgG concentra tions at baseline. Prednisolone-induced changes in LVEF were not associated with any changes in blood pressure, heart rate, blood, plasma, or red cell volumes. Conclusion Glucocorticoid administration may improve myocardial performance in some patients with SSc. Although further double-blind controlled studie s of the long-term effects are warranted, such treatment may be useful in t hose patients with SSc and documented low LVEF: if they are kept under care ful observation for objective improvement.