ab1904

Glucocorticoid effects on myocardial performance in patients with systemic sclerosis

L. Antoniades¹, P.P. Sfikakis², M. Mavrikakis¹

¹Department of Therapeutics, Athens University Medical School, Alexandra Hospital, Athens; ²First Department of Propedeutic Medicine, Athens University Medical School, Laikon Hospital, Athens, Greece.

ABSTRACT
Objective
Myocardial inflammation and fibrosis are common autopsy findings in systemic sclerosis (SSc) and, although symptomatic cardiac involvement occurs less often, current therapies remain empiric and do not prevent or modify its course. In this open, uncontrolled study we assessed the short-term effects of glucocorticoid administration on myocardial performance in patients with SSc in the absence of clinically overt cardiac disease.

Methods
Resting radionuclide ventriculography with ^99mTc was performed before and 20 days after the administration of prednisolone, 20 mg daily, in 32 patients with SSc without clinically evident myocardial dysfunction at rest; 13 and 19 patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), respectively, were studied in parallel as controls.

Results
The mean left ventricular ejection fraction (LVEF) value at baseline was 59% in the SSc group; similar values were found for the SLE (61%) and RA (59%) groups. An impaired LVEF (i.e., < 50%) was found in 6 patients with SSc and in 1 patient with SLE. Prednisolone administration resulted in a significant percent improvement in the baseline LVEF (mean 18%, p = 0.0001) in the SSc group; this improvement was greater in the patients with diffuse SSc than in those with limited skin disease (27% vs 10%, p = 0.02). The improvement was most prominent in the 6 patients with an initial impaired LVEF. No significant improvement was observed in the SLE or RA control groups. The linear trend between the individual baseline LVEF values in patients with SSc and their percent changes after treatment (r² = 0.55, p: 0.00001) showed that the lower the initial LVEF, the greater the improvement caused by prednisolone. The degree of LVEF improvement was also associated with the individual erythrocyte sedimentation rate values and serum IgG concentrations at baseline. Prednisolone-induced changes in LVEF were not associated with any changes in blood pressure, heart rate, blood, plasma, or red cell volumes.

Conclusion
Glucocorticoid administration may improve myocardial performance in some patients with SSc. Although further double-blind controlled studies of the long-term effects are warranted, such treatment may be useful in those patients with SSc and documented low LVEF, if they are kept under careful observation for objective improvement.

Key words
Prednisolone, systemic sclerosis, radionuclide ventriculography, ejection fraction, cardiac involvement, systemic lupus erythematosus, rheumatoid arthritis.

Please address correspondence and reprint requests to: Petros P. Sfikakis, MD, Amaryllidos Str. no. 3, 154 52 Athens, Greece.
E-mail: psfikakis@med.uoa.gr