ECHOCARDIOGRAPHIC EVALUATION OF CARDIAC DYSFUNCTION IN JUVENILE DERMATOMYOSITIS PATIENTS.

Background:-Cardiac involvement is common in adult polymyositis (PM) and dermatomyositis(DM). Similarly, pediatric patients with juvenile dermatomyositis (JDM) can be affected. Echocardiography is a valuable tool to assess cardiac dysfunction and to detect subtle signs of cardiac damage in these patients. Objective:-The aim of this study was to assess left ventricular diastolic and systolic function in patients with JDM by echocardiography and to determine whether cardiac function and/or pathological ECG correlated with disease activity parameters. Subjects and methods:- We evaluated 30 patients fulfilling the criteria for dermatomyositis including 7 males, and 23 females (6-27 years age) and compared them to thirty age and sex matched healthy control subjects (5.5-28 years age). Disease activity was measured by disease activity score (DAS) for JDM. Cumulative organ damage was measured by the Myositis Damage Index (MDI). A 12-channelel ectrocardiography (ECG) and echocardiographic assessment of conventional systolic and diastolic LV functions as well as tissue Doppler imaging (TDI). Long axis strain and E’ were used to reflect systolic and diastolic function respectively. Results:-Our results showed significant difference between patients and controls as regard pathological ECG findings (26.6% in patients vs 3.3% in controls) and it correlated with disease duration. Echocardiography of patients with juvenile JDM showed significant difference between patients and controls as regard long axis strain, E’, and E/E’.There were no significant difference between patients and controls as regard other left ventricle dimensions and ejection fraction. Our results showed significant correlation between echocardiographic findings of systolic and diastolic dysfunction (long axis strain and E’), and clinical parameters including patient age, disease duration, DAS, MDI, prednisolone dose , and not with systolic blood pressure and CHAQ/HAQ. Conclusion:-Patients with JDM showed subclinical systolic and diastolic cardiac dysfunction detected by echocardiography and this correlated well with disease activity.