Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis: A Pilot Study. (21st December 2020)

• Record Type: Journal Article
• Authors: Pussadhamma, Burabha; Tipparot, Thapanee; Chaosuwannakit, Naruemol; Mahakkanukrauh, Ajanee; Suwannaroj, Siraphop; Nanagara, Ratanavadee; Foocharoen, Chingching
• Other Names: Dessein Patrick H. Academic Editor.
• Is Part Of: International journal of rheumatology. Volume 2020(2020)
• Publication Date: 2020-12-21
• Subjects: Rheumatology -- Periodicals; Rheumatology; Rheumatology; Electronic journals; Periodicals; Periodicals; 616.723
• DOI: 10.1155/2020/8884442
• Languages: English
• ISSNs: 1687-9260

Abstract

Abstract : Background . Myocarditis is reported in systemic sclerosis (SSc); however, treatment options and outcomes are limited. Our objective was to define cardiac outcomes after moderate-dose steroid therapy in SSc patients with myocarditis. Method . An open-label study was conducted among SSc patients with myocarditis—as defined by cardiovascular magnetic resonance (CMR), disease onset <5 years, and a NYHA functional class ≥II. All enrolled patients received prednisolone (30 mg/d) which would be tapered off by week 24, and CMR was followed up at the end of treatment. Results . A total of 20 SSc patients were enrolled which 12 patients completed the study. At week 24, 8 of the 12 cases experienced improvement of myocarditis. Compared to those with no improvement, these 8 patients had significantly longer disease duration (p = 0.03 ), higher heart rate at baseline (p = 0.049 ) and week 24 (p = 0.04 ), lower left ventricular (LV) and right ventricular (RV) stroke volume at baseline (p = 0.002 and p = 0.01 ) and week 24 (p = 0.01 and p = 0.02 ), and lower LV and RV cardiac output at week 24 (p = 0.01 and p = 0.01 ). Four cases died during follow-up (3 due to cardiac complications, 1 due to renal crisis). The two who died from heart failure had very high NT-prohormone-brain natriuretic peptide (NT-proBNP) and impaired LV ejection fraction (LVEF), and the one who died from arrhythmia had very high sensitivity of cardiac Troponin-T (hs-cTnT). Conclusions . Moderate-dose steroid therapy may improve myocarditis in SSc. A proportion of patients died due to cardiac complications during treatment, particularly those with high hs-cTnT, high NT-proBNP, and impaired LVEF. This trial is registered with NCT03607071 .