Primary Cardiac Involvement & Management
Yannick Allanore, MD, PhD, Department of Rheumatology, Cochin Hospital, Paris Descartes University, France ended the session emphasizing the importance of the heart to life expectancy in patients with SSc and the high risk of morality in SSc due to cardiac death.
Saying that heart disease is quite common in patients with SSc, Dr. Allanore emphasized the importance of regular systematic assessment targeting subclinical involvement, which is the most common type of involvement. He also stressed the importance of educating patients in the warning symptoms of heart disease, including increased dyspnea, chest pain and palpitations, and said the assessment of these symptoms should be a part of the routine clinical assessment for heart disease in these patients.
He recommended that patients undergo the following at least yearly: electrocardiogram (ECG) and natriuretic peptides, 24 h-Holter in case of abnormal ECG and/or symptoms, and Doppler echocardiography by a trained cardiologist.
For treatment, he said that systemic and long-term use of vasodilators, such as calcium channel blockers, can be used to manage vasculopathy. To treat left ventricular systolic dysfunction, he said that angiotensin-converting enzyme (ACE) inhibitors are usually recommended. However, he said the big challenge that remains for cardiologists is how to treat left heart diastolic dysfunction. Although no evidence shows any benefit with any current drugs, he said some data suggest a benefit with calcium channel blockers.
Mary Beth Nierengarten is a freelance medical journalist in St. Paul, Minn.
Second Chance
If you missed this session, Fibrotic Complications of Scleroderma, it’s not too late. Catch it on SessionSelect: http://acr.peachnewmedia.com/store/provider/provider09.php.
References
- Merkel PA, Silliman NP, Clements PJ, et al. Patterns and predictors of change in outcome measures in clinical trials in scleroderma: An individual patient meta-analysis of 629 subjects with diffuse cutaneous systemic sclerosis. Arthritis Rheum. 2012;64(10):3420–3429.
- Maurer B, Graf N, Michel BA, et al. Prediction of worsening of skin fibrosis in patients with diffuse cutaneous systemic sclerosis using the EUSTAR database. Ann Rheum Dis. 2014; Jun 30. pii: annrheumdis-2014-205226. doi: 10.1136/annrheumdis-2014-205226. [Epub ahead of print].
