4.7 Article

Ventricular arrhythmia predicts poor outcome in polymyositis/dermatomyositis with myocardial involvement

Journal

RHEUMATOLOGY
Volume 60, Issue 8, Pages 3809-3816

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/keaa872

Keywords

polymyositis; dermatomyositis; myocardial involvement; ventricular arrhythmia; anti-mitochondrial antibody

Categories

Funding

  1. Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS) [2018-I2M-1-001]

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The presence of ventricular arrhythmia (VA) is an independent prognostic factor predicting poor outcomes in patients with polymyositis (PM) and dermatomyositis (DM) related myocardial involvement (PM/DM-MCI). Other prognostic factors include NT-proBNP levels, interstitial lung disease, and anti-cardiac remodelling therapy. Patients without VA have significantly higher event-free survival rates compared to those with VA.
Objective. Myocardial involvement (MCI) is known to increase morbidity and mortality in polymyositis (PM) and dermatomyositis (DM). This study aims to investigate whether complicating with ventricular arrhythmia (VA) predicts poor outcomes in patients with PM/DM-related myocardial involvement (PM/DM-MCI). Methods. We reviewed all PM/DM-MCI patients admitted to Peking Union Medical College Hospital from October 1997 to April 2019. VA and the other possible risk factors for the composite endpoint, including death from any cause and rehospitalization for cardiac causes, were analyzed. Results. A total of 75 PM/DM-MCI patients (44 PM and 31 DM) were enrolled, of which 27 (36%) met the composite endpoint during a median follow-up of 24 months. Independent prognostic factors for the composite endpoint include VA [HR 4.215, 95% CI (1.737, 10.230)], NT-proBNP > 3415 pg/ml [HR 2.606, 95% CI (1.203, 5.646)], interstitial lung disease [HR 2.688, 95% CI (1.209, 5.978)], and anti-cardiac remodelling therapy [HR 0.302, 95% CI (0.115, 0.792)]. The 3-year event-free survival rate of patients without VA was significantly higher than that of patients with VA (63.3% vs 40.7%, P = 0.034). Skin lesions [OR 0.163, 95% CI (0.051, 0.523)] and positive antimitochondrial antibody [OR 3.484, 95% CI (1.192, 10.183)] were independent predictors of VA. Conclusion. VA provides prognostic insights for PM/DM-MCI patients and predicts poor outcome. Polymyositis and positive antimitochondrial antibody are closely associated with the presence of VA in PM/DM-MCI.

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