类风湿性关节炎心脏损害30例临床分析

类风湿性关节炎（RA）主要侵犯关节，但亦可累及心脏。我院1980年～1993年收治的121例RA患者中有心脏损害者30例（占25％）。现对其临床资料作一回顾性分析。临床资料1．一般资料：30例中男性9例，女性ZI例，年龄23～68（平均45）岁，病程＞10年25例（83．4％），5～9年4例（13．3％），M5年1例（3．3％）。2．诊断标准：30例病人均符合美国风湿病学会RA诊断标准，均具有RA活动。心脏损害除外其它原因，并在RA控制后心脏症状减轻或消失。3．临床表现心悸25例（83．4％）、气短21例NO％）、乏力ZO例（66．7％〕、心前区疼痛5例（16．5…     

大动脉炎患者心脏损害临床分析

目的总结大动脉炎（takayasu’s arteritis,TA）患者心脏损害的临床特点。方法回顾性分析北京协和医院1987年至2010年确诊的45例TA合并心脏损害住院患者的临床资料。结果 TA患者心脏损害占同期所有TA的8.6%（45/524）,45例患者中高血压心脏病16例、心肌病变12例、心脏瓣膜病变8例（主动脉瓣关闭不全6例,二尖瓣关闭不全2例）、冠状动脉病变3例、肺动脉高压右心功能衰竭2例、混合型4例。平均发病年龄21.31岁,男女比例为1：2.75。75.6%（34/45）的心脏损害患者有心脏症状。17.8%（8/45）的患者因心脏症状首发,其余82.2%患者约于TA起病后6年内出现心脏损害。除发病年龄在心脏瓣膜病变组、肺动脉高压右心功能衰竭组显著大于其他3组外,性别、临床分型、心脏症状、病情严重度、病情活动度、转归等方面,各组间差异无统计学意义（P〉0.05）。结论大动脉炎心脏损害并不少见。即使临床无心脏症状,亦应注意评估心脏受累情况。当临床遇到心肌炎、心脏瓣膜病变、冠状动脉病变或心力衰竭时,除考虑原发心脏疾病外,还应注意除外系统性疾病累及心脏的可能,譬如大动脉炎。     

大动脉炎累及心脏32例临床分析

目的 调查大动脉炎累及心脏患者的临床特点、病变分类及其性质，为临床提供参考。方法 回顾性分析同济医院1990～2002年间住院32例大动脉炎患者的临床资料，根据心脏临床症状、心电图、超声和冠状动脉造影等检查结果分析其心脏受累的类型及特点。结果 32例大动脉炎患者中有18例明显累及心脏，包括高血压心脏损害4例，主动脉瓣关闭不全8例(25．0％)，不同程度上冠状动脉的受累6例(18．8％)，伴有扩张型心肌病2例(6．3％)。结论 多发性大动脉炎累及心脏的影响除了继发性高血压心脏病外，还有冠状动脉狭窄、瓣膜病变以及心肌病变，这些均能造成心脏功能的损害，影响病人的预后，临床上应予以重视。     

类风湿关节炎心脏损害34例临床分析

目的；探讨类风湿关节炎心脏损害的特征及其临床与病理联系和早期诊断方法。方法：分析１３０例类风湿关节炎中出现心脏损害３４例的临床资料，结果：心脏损害发生率２６．２％，其中心律失常１４例（４１．２％）心肌炎９例（２６．５％），心包炎７例（２０．６％）瓣膜病变４例（１１．８％）心脏损害与原发病的活动密切相关，治疗原发病后的民脏损害减轻或消失，ＵＣＧ可早期检获心包炎及瓣膜病变，结论：类风湿关节炎累及心脏损     

系统性红斑狼疮的心脏损害

系统性红斑狼疮(systemic lupus erytlaematosus,SLE)是一种多系统损害的自身免疫性疾病.心脏的病变是SLE最重要的临床表现之一,SLE可累及心脏的各个部分,其导致心脏损害的机制与抗原抗体复合物沉积有关.可累及心包、心肌、心内膜、冠状动脉及传导系统 [1,2],而系统性红斑狼疮所导致的胸膜或心包积液、继发肾脏疾病、高血压则可能导致进一步的心脏损害,一般可表现为冠心病、心包炎、心肌炎、心内膜炎、心脏瓣膜损害和心律失常等.损害特点具有早期发生,较高的发病率和辅死率.SLE心脏受累发生率国外报道为52%～98% [3],国内报道为52%～89% [4],心血管损害目前被公认为是系统性红斑狼疮患者死亡的三个主要原因之一 [5].     

42例白塞病心脏损害患者的临床特点分析

目的分析白塞病患者心脏受累的临床特点。方法回顾性分析北京协和医院1990—2006年确诊的心脏受累的白塞病患者的临床资料。结果我院1990—2006年住院治疗的白塞病患者348例,有心脏受累的白塞病患者42例,占12．1％。心脏受累的表现主要有瓣膜病变（17例）、心绞痛（12例）、心包积液（10例）、心律失常（4例）、心腔血栓（5例）、肺动脉高压（10例）等。42例患者采用糖皮质激素治疗,33例用免疫抑制剂治疗,其他治疗还有动脉瘤患者置入带膜支架、主动脉换瓣、动脉瘤手术切除、下腔静脉血栓置网、右室血栓手术取栓等,手术换瓣或介入治疗的效果与全身白塞病的活动性有关。42例患者好转30例,占71．4％。恶化6例,占14．3％。住院死亡6例,占14．3％。logistic回归分析显示,肺动脉受累是白塞病心脏损害患者死亡的独立相关因素（P=0．03）。结论白塞病累及心脏的表现多种多样;需要换瓣手术或者介入治疗者,应在白塞病非活动期进行;肺动脉受累是有心脏受累的白塞病患者死亡的独立危险因素。     

20例老年人肺癌纵隔照射与放射性心脏病追踪观察

目的探讨老年人纵隔照射后放射性心脏损害。方法应用心电图、超声心动图及核素听诊器，观察老年人肺癌术后纵隔放疗２０例及化疗２２例的心脏并发症。放疗平均总剂量为６２．５Ｇｙ，追踪时间１８个月。结果放疗１１例（５５．０％）及化疗３例（１３．６％）有心脏损害（Ｐ值＜０．００５）。放射性损害累及心包７例、心内膜及心肌３例、心脏起搏传导系统１例及冠状动脉３例，且引起轻度心功能减退。放疗组４例死于心脏意外（包括冠心病３例及全心炎１例）。结论老年人纵隔照射后放射性心脏损害较严重，要注意冠心病危险因素如高胆固醇血症、高血压，并避免放射剂量过大     

老年人心脏瓣膜钙化的临床病理研究北大核心CSCD

目的总结已行尸体解剖老年患者中心脏瓣膜钙化的检出率,并分析临床与病理间的相关性。方法人选北京医院病理科1954年11月7日至2016年3月7日,年龄60～106岁的老年患者的系统病理解剖资料,共1047例。回顾性分析经尸检病理证实的心脏瓣膜钙化的病例,总结瓣膜钙化检出率与年龄、临床疾病及冠状动脉粥样硬化的相关性。结果（1）1047例尸检病例中,主动脉瓣钙化、二尖瓣钙化、主动脉瓣合并二尖瓣钙化及心脏瓣膜钙化检出率分别为15．2％（159例）、9．6％（101例）、5．4％（57例）、19．4％（203例）。（2）60～岁、70～岁、80～岁、90～106岁不同年龄组心脏瓣膜钙化检出率分别为6．4％（15／234）、12．8％（37／289）、22．5％（70／311）、38．0％（81／213）,趋势x^2=82．52,P〈0．01;合并病理冠状动脉狭窄或高血压、冠心病、糖尿病、慢性肾病的患者心脏瓣膜钙化检出率较高。（3）多因素回归分析,不同临床因素对发生瓣膜钙化的风险分别为年龄（OR=1．066,959CI：1．048～1．086,P〈0．01）、高血压（OR=1．223,95％CI：0．859～1．741,P〉0．05）、冠心病（OR=2．238,95％CI：1．396～3．589,P〈0．01）、糖尿病（OR=1．053,95％CI：0．700～1．586,P〉0．05）、慢性肾病（OR=0．924,95％CI：0．610～1．399,P〉0．05）。（4）与无心脏瓣膜钙化患者比较,心脏瓣膜钙化患者发生冠状动脉粥样硬化的风险增加（OR=2．983,95％CI：1．868～4．765,P〈0．01）。结论随增龄,老年人心脏瓣膜钙化发生率增加;冠心病患者具有较高的发生瓣膜钙化的风险;瓣膜钙化与冠状动脉粥样硬化相关。     

结节病心脏损害80例临床分析

目的 观察结节病患者心脏受累的临床表现,分析结节病患者的性别、年龄、病程和分期与结节病心脏受累的相关关系.方法 回顾分析我院80例结节病患者的临床资料.结果 80例结节病患者中32例(40%)有心脏损害,其中5例(15.6%)有心脏相关症状.心脏损害包括心肌损害15例(46.9%),心电图检查ST-T异常8例(25%),心包积液6例(18.8%),心律失常5例(15.6%),肺动脉高压4例(12.5%),瓣膜病2例(6.3%),病理性Q波1例(3.1%).心脏损害与无心脏损害患者间性别、病程和分期比较差异无统计学意义(P>0.05),但两组的年龄比较有统计学意义(P<0.05).结论 结节病可累及心脏各个部分,以心肌损害和心电图ST-T异常最常见.结节病累及心脏时多为无症状型.心脏损害与年龄相关.     

抗磷脂综合征的心脏病变

目的分析抗磷脂综合征合并心脏受累的临床特点、治疗和预后,提高对本病的认识。方法对72例抗磷脂综合征患者临床资料进行回顾性分析。结果72例抗磷脂综合征患者中,心脏受累患者48例,二尖瓣受累发病率最高。心脏受累与血栓事件显著相关,与部分激活的凝血活酶时间延长相关。瓣膜病变与脑梗死和器官血栓事件相关。20例有血栓事件并心脏受累的抗磷脂综合征患者接受了抗凝治疗,未再发生血栓事件。结论抗磷脂综合征累及心脏表现为瓣膜异常、冠状动脉血栓、心肌受累和肺动脉高压等,心脏受累可能与高凝状态相关。     

Pancarditis as initial presentation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a multisystem disorder with cardiac involvement in about 50% of cases, yet clinically significant lesions are less common. SLE with pancarditis at initial presentation has so far not been reported. We present a rare case of SLE with culture negative endocarditis, reversible left ventricular (LV) dysfunction and mild pericardial effusion. Treatment with steroids showed improvement in cardiac contractile function and mitral valve vegetations disappeared over 3 months. In a case of pancarditis with culture negative endocarditis, SLE as a possibility must be explored. After excluding infective endocarditis, a short trial of high dose corticosteroids effects overall improvement in carditis of SLE.     

Mitral valve prolapse in systemic lupus erythematosus

Despite a low incidence of clinical manifestations, autopsy data suggest endocardial and myocardial disease in about 50% of patients with systemic lupus erythematosus. To investigate whether mitral valve prolapse can be considered a clinical manifestation of cardiac involvement in systemic lupus erythematosus, we carried out an echocardiographic study in 51 affected subjects and 102 normals matched for age and sex. Prevalence of mitral valve prolapse was 25% in patients with systemic lupus erythematosus and 9% in healthy controls with a statistically significant difference (p less than 0.01). Neither pericardial effusion nor prolonged (more than 12 months) treatment with corticosteroids were associated with higher prevalence of mitral valve prolapse. Libman-Sacks verrucae on the mitral valve apparatus as well as focal myocardial scars affecting the papillary muscles and adjacent myocardium could be responsible for the development of the valvular dysfunction. We suggest that mitral valve prolapse can be considered a manifestation of cardiac involvement in patients with systemic lupus erythematosus.     

Anticardiolipin antibodies and cardiac involvement in systemic lupus erythematosus

Anticardiolipin antibodies (aCL) are present in 24-61% of patients (pts) with systemic lupus erythematosus (SLE). It is suggested that they may be associated with valvular abnormalities recognized on echocardiography (ECHO). To evaluate the relation of raised aCL and cardiac abnormalities we performed ECHO in 48 pts with SLE. ACL were estimated in all pts using enzyme-linked immunoabsorbent assay (ELISA), and positive result was found in 25 pts (52%), negative in 23 pts (48%). Abnormalities on ECHO were found in 18 pts in aCL(+) group vs 4 pts in aCL(-) group (68 vs 17% respectively; p < 0.01). Valvular abnormalities were present in 9 pts in aCL(+) group and in 4 ts in aCL(-) group (36 vs 17%; p = n.s.), pericardial effusion in 6 pts in aCL(+) group vs 0 pts in aCL(-) group (24 vs 0%; p < 0.05). CONCLUSION: We found association between raised aCL and general cardiac abnormalities on ECHO.     

The adjunctive role of antiphospholipid antibodies in systemic lupus erythematosus cardiac involvement

OBJECTIVE: To evaluate the prevalence of cardiac alterations by trans thoracic echocardiography (TTE) and the possible role of aPLs in determining heart damage in SLE patients. PATIENTS AND METHODS: We investigated 34 consecutive Caucasian SLE patients and 34 age and sex- matched controls. All patients underwent TTE. Lupus anticoagulant (LA) was assayed. IgG and IgM antiphospholipid antibodies against cardiolipin (aCL), phosphatidylinositol (aPI), phosphatidylserine (aPS), phosphatidic acid (aPA), and anti-Beta2-glycoprotein I antibodies (aBeta2GPI) were determined by ELISA. RESULTS: Nineteen (56%) SLE patients showed at least one cardiac abnormality (P < 0.0001 - RR 19; OR 41.8; 95% CI 5.1-342). The predominant valve dysfunctions were represented by mitral (21%) and tricuspidal (18%) regurgitation. Aortic regurgitation was observed in 12% of patients, pericardial effusion and left atrial enlargement were identified in 15% and 12% of cases, respectively. Mitral valvular strands were detected in one patient. The prevalence of cardiac abnormalities correlated with disease duration. Echocardiographic alterations were more common in aPLs positive than in aPLs negative patients (P = 0.02 - RR 2.5; OR 6.1; 95% CI 1.2-30.1). Patients with IgG-aPA, -aPI and -aPS had a higher prevalence of left atrial enlargement (P < 0.05); IgG-aPA and -aPI were significantly associated with increased interventricular septum thickness (P < 0.05). CONCLUSION: Our findings confirm that the heart is one of the main target in SLE patients. The association between aPLs and cardiac impairment suggests an adjunctive role of these autoantibodies in determining heart damage. SLE vasculopathy is a multifactorial process leading to accelerated atherosclerosis. Heart involvement over the course of disease requires a comprehensive screening and management of traditional and new cardiovascular risk factors to prevent cardiac damage, which represents the primary cause of morbidity and mortality in SLE patients.     

Cardio-pulmonary involvement in juvenile systemic lupus erythematosus

Cardio-pulmonary manifestations of systemic lupus erythematosus (SLE) are well recognized in adults. We report the occurrence of clinically significant cardio-pulmonary disease in a cohort of predominantly Caucasian children with SLE. All children with SLE attending the Royal Liverpool Children's NHS Trust between 1995 and 2003 were reviewed. Of 29 children with SLE, 27 (93%) were Caucasian. Nine (31%) had cardio-respiratory complications: cardiac only (n = 1); respiratory only (n = 4); both cardiac and respiratory manifestations (n = 4). Median (range) duration of follow-up of affected children: four years (six months to 11 years). Six out of eight (75%) presented with respiratory complications before SLE was diagnosed. Three children had pericardial effusions, one requiring pericardiocentesis for tamponade. One had cardiac conduction defects and another significant pulmonary hypertension. Respiratory complications comprised: interstitial lung disease (n = 4), with two showing evidence of pulmonary fibrosis; pleural effusions (n = 2), pulmonary haemorrhage (n = 1) and lupus pneumonitis (n = 1). Disease course was complicated by CMV infection in one child. Lung biopsy was performed in five cases. Seven were treated with cyclophosphamide with significant improvement in symptoms/lung function. Of this predominantly Caucasian paediatric cohort with SLE, 31% had significant cardio-pulmonary involvement. All children with SLE should have regular monitoring of their cardio-respiratory status.     

Pericardial effusion and mitral valve involvement in systemic lupus erythematosus. Echocardiographic study.

Echocardiography was used in 30 women and 2 men with systemic lupus erythematosus (SLE) in order to determine the incidence and severity of pericardial effusion and mitral valve involvement. 31 patients showed normal thickness of the mitral valve leaflets, only one patient showed irregular thickening of the leaflets suggesting the presence of vegetations. Mitral valve motions were normal in all patients. These results indicate that myocardial and valvular involvement in SLE is usually not severe enough to result in haemodynamic abnormalities. Pericardial effusion was found in 2 patients who were symptom free, whereas 4 of the patients with a past history suggestive of pericarditis showed no echocardiographic evidence of pericardial effusion. These suggest the transient nature of pericarditis in SLE, and the value of echocardiography as a diagnostic tool in detecting clinically inapparent lupus pericarditis.     

QT dispersion increases in patients with systemic lupus erythematosus

Although autopsy studies have documented that heart is affected in most of systemic lupus erythematosus (SLE) patients, clinical manifestations occur in less than 10%. QT dispersion, a new parameter that can be used to assess homogeneity of cardiac repolarization and autonomic function, has not been studied in SLE patients. The aim of our study was to evaluate the QT dispersion (QTd) in SLE patients without overt cardiac involvement. Eighty-three patients with a diagnosis of SLE (mean age 41±13) and age- and sex-matched 77 healthy control subjects (mean age 43±10) were enrolled in the study. All subjects had their complete history taken, laboratory examination, and transthoracic echocardiography (ECG). Patients with cardiac disease, hypertension, diabetes, or taking medications that may effect QTd or any ECG abnormalities were excluded. Resting 12-lead ECG were recorded for measurement of QTd. None of the patients and control subjects had overt cardiac involvement. The mean SLE duration was 86.5±15.4 months. QT dispersion was significantly greater in SLE patients than incontrol subjects (55.2±24.7 vs 20.7±5.3 ms, respectively; p<0.001). There was no correlation between QTd and duration of SLE, SLEDAI-K score, corticosteroid usage, and presence of anti SS-A antibody. QT dispersion is significantly increased in SLE patients without overt cardiac involvement. Our result suggests that prolonged QT dispersion can be a useful noninvasive and simple method for early detection of cardiac involvement in SLE patients.     

Abnormal findings of cardiac function in patients with systemic lupus erythematosus (author's transl)

To find out the rate of cardiac involvement among patients with systemic lupus erythematosus (SLE), 34 patients with SLE were examined by ECG, x-ray of the chest, body plethysmography, one- and two-dimensional echocardiography In addition, in 23 patients with SLE a microcatheterization of the right heart side was undertaken with measuring of the mean pulmonary artery pressure and cardiac index during exercise. Echocardiography revealed moderate abnormal findings in 62% of the patients. In particular, there was a thickening of the interventricular septum (31%), an enlargement of the right ventricle (23%), a diminution of the left ventricular fractional shortening (16%), an augmentation of the left atrium (10%) and of the left ventricle (6%). A small pericardial effusion was observed in 6% and a thickening of the left ventricular posterior wall in 3%. At micro-catheterization in 19 out of 23 patients with SLE, there was an increase of the mean pulmonary artery pressure up to abnormal values. In 5 patients, mean pulmonary pressure rose over 40 mm Hg. Most of the patients also showed an increase of the arterial pressure up to pathological values. Furthermore, most of the patients finished exercise because of muscular insufficiency or dyspnoea. Only 4 of 23 patients with SLE reached 90% of the age-corresponding maximal heart rate. The results indicate that with about 80% of all patients with SLE the cardiac capacity is reduced. In about 20% of the patients with SLE, this diminution of cardiac capacity is severe, and the necessity of medical treatment has to be discussed.     

Cardiac involvement in systemic lupus erythematosus detected by echocardiography

Cardiac involvement in patients with systemic lupus erythematosus (SLE) was assessed by full echocardiography and continuous wave Doppler in 50 consecutive patients and 50 age- and sex-matched control subjects in a prospective, blinded study. The left ventricular ejection fraction was decreased in patients compared to control subjects (61 +/- 9 vs 68 +/- 7%, p less than 0.001), whereas interventricular septum (12 +/- 3 vs 9 +/- 1 mm, p less than 0.001), and posterior wall dimension (9 +/- 2 vs 8 +/- 1 mm, p less than 0.001), left ventricular mass (186 +/- 54 vs 130 +/- 32 g, p less than 0.001) and mitral valve Doppler A:E ratio (0.8 +/- 0.2 vs 0.7 +/- 0.1, p less than 0.01) were increased. Pericardial effusion was detected in 27 patients and 5 control subjects, and valvular regurgitation was more frequent in the patients (aortic 2 vs 0; mitral 23 vs 5, p less than 0.001; tricuspid 34 vs 22, p less than 0.01 and pulmonary 28 vs 17, p less than 0.05). Mitral or aortic regurgitation was more common in patients with active SLE (60 vs 40%, difference not significant) but was not related to the duration of SLE (r = 0.02), duration of prednisone therapy (r = -0.13) or current dosage of prednisone (r = 0.01). This study demonstrates that pericardial effusion, valvular regurgitation and myocardial abnormalities are frequently present in patients with SLE.     

Cardiovascular manifestations in systemic lupus erythematosus. Prospective study of 100 patients

One hundred consecutive female patients with active systemic lupus erythematosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of cardiovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericarditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmonary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analyzed each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.