[The heart damage in patients with psoriatic arthritis]. / Porazhenie serdtsa u bol'nykh psoriaticheskim artritom.

AIM: To examine the rate and features of heart damage in psoriatic arthritis (PA) patients and find out whether some parameters of PA are associated with cardiac involvement. MATERIAL AND METHODS: The study enrolled 370 PA patients aged 15 to 72 years with the disease history 1 to 44 years having different variants of the articular and skin syndromes. The patients have undergone various tests including chest x-ray, ECG, echocardiography. RESULTS: Myocarditis, adhesive pericarditis, valvular defects (mitral, aortic and combined mitral-aortic were diagnosed in 15.9, 18.2 and 5.7% of PA patients, respectively). Aortitis was detected in 51.3% patients with advanced sacroileitis and alkylosing spondylarthritis. Alterations in the heart were associated with spinal lesions, other systemic manifestations, activity of the disease and, in a lesser degree, with carriage of HLA-B27. CONCLUSION: Cardiac syndrome in PA is characterized by marked heterogeneity and is one of basic systemic manifestations of this disease. Latent PA aortatis can be detected at echocardiography.

[Survival and prognostic factors of death risk in antiphospholipid syndrome: results of 8-year follow-up]. / Vyzhivaemost' i prognosticheskie faktory riska smerti pri antifosfolipidnom sindrome: rezul'taty 8-letnego nabliudeniia,

AIM: To evaluate survival and mortality in antiphospholipid syndrome (APS) as well as prognostic factors of APS deterioration. MATERIAL AND METHODS: We retrospectively studied 248 case histories of patients admitted to the Institute of Rheumatology for 8 years. Primary APS was diagnosed in 35 patients, SLE + APS (according to criteria of ACR, 1982)--in 122 patients and SLE without APS--in 91 patients. Mean age was 31.2 +/- 15.0 years (range from 14 to 63), median length of follow-up from the time of diagnosis was 11.9 +/- 5.4 years. During 8 year period all the patients annually and the latest 5 years at least twice a year were examined for the presence of IgG and IgM-anticardiolipin antibodies (aCL) and lupus anticoagulant (LA). Thrombotic events were verified with special techniques. RESULTS: Thirty-eight patients (15%) died during the follow-up period. Mean age of the decreased was 35.4 +/- 12.2 years (range 21-52 years) and the disease duration 8.6 +/- 8.2 years (range 0.6-20), the median length of the survival from the time of the diagnosis was 6.2 +/- 4.3 years. The 8-year survival for SLE patients without APS was 98%, for those with SLE + APS-75% and for patients with primary APS-83%. The presence of APS in SLE patients was significantly associated with high mortality (chi 2 = 12.3, freedom = 4, p = 0.006). Cox regression analysis revealed that the activity of the disease at onset, arterial thrombosis, especially recurrent, thrombocytopenia, valvular disease of the heart, capillaritis, digital necrosis and nephritis were independent risk factors for mortality (p < 0.05). CONCLUSION: Thus, long-term follow-up is necessary for patients with antiphospholipid antibodies especially with APS which lowers survival of SLE patients. Such patients need early corrective therapy to prevent thrombotic events.

[Cardiological aspects of the antiphospholipid syndrome. Part I. Valvular lesions in the primary and secondary antiphospholipid syndrome and systemic lupus erythematosus]. / Kardiologicheskie aspekty antifosfolipidnogo sindroma. Chast' I. Klapannye porazheniia serdtsa pri pervichnom i vtorichnom antifosfolipidnom sindrome i sistemnoi krasnoi volchanke.

AIM: To assess prevalence of cardiac valvular lesions in patients with primary (P) antiphospholipid syndrome (APLS) and systemic lupus erythematosus (SLE) with and without secondary APLS. MATERIAL AND METHODS: Patients with PAPLS (n=56, 15 men and 41 women), SLE and APLS (n=88, 23 men, 65 women) and SLE without APLS (n=51, 19 men, 32 women) were followed up for 9 years. Serological markers of APLS were anticardiolipin antibodies and lupus anticoagulant. RESULTS: Prevalence of various heart defects was the highest in PAPLS (43%) compared with SLE with APLS (c2=5.6, p=0.001) and SLE without APLS (c2=9.3, p=0.0002). In secondary APLS prevalence of valvular involvement was 27% what was substantially more than in SLE without APLS (4%) (c2=7.2, p=0.0007). Changes of mitral valve cusps and mitral regurgitation were found in 33, 41 and 50% of patients with SLE, SLE with APLS and PAPLS, respectively. Pronounced mitral regurgitation and valve defects were significantly more frequent in patients with any APLS compared with those with SLE without APLS. Thickening of aortic cusps was significantly more frequent in patients with PAPLS compared with patients with SLE (with and without APLS). Changes of tricuspid valve were significantly more frequent in patients with any APLS. Progression of valvular pathology was observed in 2 patients with SLE and APLS after 4 and 5 years of follow up. During 9 years thrombotic complications developed in 8 patients with APLS and valvular lesions (6 strokes, 2 retinal thromboses). CONCLUSION: An association exists between presence of APLS and various cardiac valvular lesions. Lesions of aortic valve are associated with PAPLS: Development of valvular pathology in patients with SLE and PAPLS during follow up dictates the necessity to monitor echocardiographical parameters and titers of anticardiolipin antibodies.

Endocarditis with left atrial thrombus formation in Behçet's disease mimicking myxoma.

A 51-year-old male patient with Behçet's disease had a large echogenic mass in the left atrium mimicking myxoma, documented by echocardiography. Postoperative pathological examination revealed left atrial thrombus, deep ulcerations of mitral valve leaflets with signs of active endocarditis. Cardiac evaluation with echocardiography should be considered in patients with Behçet's disease.

[The nature of the cardiac pathology in ankylosing spondylarthritis (Bechterew's disease)]. / Kharakter serdechnoi patologii pri ankiloziruiushchem spondiloartrite (bolezni Bekhtereva).

Specific characteristics and localization of histomorphological alterations observed in Bechterew's disease (BD) cause specific features in clinical pattern of the disease. Combined cardiological examination of 49 BD patients revealed in them: valvular disease (6 cases), aortal insufficiency (8.2%), left ventricular dilatation (12%), mitral prolapse (16.3%), aortal dilatation (14%). Two-dimensional echocardiography registered typical subaortic protrusion in 3 out of 30 examinees. At ECG examination of 46 patients atrioventricular block was registered in 4, bundle-branch block in 7, affected conductivity in 10 patients. In complicating amyloidosis one can observe a typical picture of amyloid cardiac infiltration.

[Acute rheumocarditis in young men]. / Ostryi revmokardit u molodykh muzhchin.

A study was made of the characteristic features of rheumocarditis in 200 young recruits. Rheumocarditis developed within the first 2-3 days since the onset of migrating polyarthritis and high fever. In many cases, it was accompanied by rhythm and conduction disorders as well as by a moderate increase of the left heart in combination with intracardiac hemodynamic disturbances. In 42 patients (21%), myocardial injury was coupled with mitral valve lesion. Injury to the pericardium was recorded in 20 patients (10%); fibrinous pericarditis was diagnosed in 15 patients, exudative pericarditis in 5 patients. Injury to all 3 heart membranes was ascertained in 5 patients (2.5%) (according to echocardiography). Thus, the clinical and instrumental manifestations of rheumocarditis made it possible to diagnose marked carditis symptoms almost in all the patients (in 96%). Unmarked carditis was only discovered in 7 patients. The above-mentioned characteristics of rheumocarditis in young men may be due to the intensity of the action of streptococcal infection on the heart structures within the first days of the disease as well as due to the action of immunopathological processes. Besides, a definite role may be played by the foregoing physical load.

[The results of a retrospective examination of patients with acute rheumatic fever]. / Rezul'taty retrospektivnogo obsledovaniia bol'nykh ostroi revmaticheskoi likhoradkoi.

The authors describe the results obtained during retrospective examinations of 45 subjects who suffered from acute rheumatic fever 10-14 years before. Of these, 19 subjects were treated with prednisolone in the acute disease period, 16 with indomethacin, and 8 subjects with voltaren. The examinations were mostly randomized (30 subjects); no differences in the anti-inflammatory effect were discovered. Heart disease was found in 9 persons (20%). Of these, 6 were treated with prednisolone, 2 with indomethacin, and 1 with voltaren. The disease relapses were recorded in 4 of them, the signs of valvulitis in the past were shown only by 2 persons (echocardiographically). 12 persons (27%) had mitral valve prolapse which had not been diagnosed on the first admission to the hospital, with any clinical signs of hypermotility lacking. In 18 persons (40%) having no valve lesions (disease, prolapse), an x-ray examination revealed a slight increase of the heart size, estimated as a manifestation of postmyocardial cardiosclerosis. Thus, it has been shown that modern anti-inflammatory therapy does not prevent the development of heart disease. Apparently, its onset is related to specific proneness in some of the patients.

[The clinico-echocardiographic signs of rheumocarditis in acute rheumatism in adults and their dynamics under the influence of antirheumatic therapy]. / Kliniko-ékhokardiograficheskie priznaki revmokardita pri ostrom revmatizme u vzroslykh i ikh dinamika pod vliianiem antirevmaticheskoi terapii.

Of 45 patients with acute rheumatic fever 23 manifested enlargement of the left ventricle. Of these, 14 patients had it combined with an increase in the stroke volume, the syndrome of load with the left ventricular volume. These alterations disappeared or lessened by the end of the treatment. They did not correlate with lesions of the valvular apparatus and were likely to be consequent to the underlying inflammatory process. In patients with the syndrome of load with the left ventricular volume, myocardial contractility was, as a rule, increased or normal, indicating that myocardial contractility remained at a satisfactory level at the initial disease period. Comparative studies of the therapeutic effect of corticosteroids and nonsteroidal drugs (indomethacin and voltaren) have demonstrated that they exert a similar effect on the clinicofunctional signs of rheumatic carditis.

[Aortal defects in systemic lupus erythematosus]. / Aortal'nye porroki pri sistemnoi krasnoi volchanke.

Five patients with significant lupus erythematosus (SLE) are described. The use of ECG, PCG and ultracardiosonography made it possible to verify the diagnosis of aortal valvular disease. On recognition of the damage to the aortal valves the question arises as to the genesis of its occurrence: does it occur because of the lupoid process proper or superaddition of bacterial endocarditis? The similar signs of SLE and bacterial endocarditis are described as are differential and diagnostic criteria. The main mechanisms by which the aortal valvular disease develops in SLE are depicted. Four out of the 5 patients described had bilateral sacroileitis and were not HIA-B27 carriers.

[Rheumatoid arthritis with systemic manifestations: its diagnosis and clinical aspects]. / Revmatoidnyi artrit s sistemnymi proiavleniiami: diagnostika i klinika.

A total of 104 patients with rheumatoid arthritis (RA) with systemic manifestations were investigated on the basis of a joint program in the Institute of Rheumatology, AMS, USSR, and in the Polyclinic Medical Institute (Leipzig), GDR. RA systemic manifestations were described, their diagnostic signs presented. Modern instrumental methods for the detection of RA manifestations before the development of their clinical picture (echocardiography, computed tomography, electrophysiological methods for a study of the peripheral nervous system) were assessed. Analysis of correlations between various RA manifestations and laboratory findings permitted the detection of peculiarities of the onset and a course of disease in the study group. The results will contribute to the early detection of systemic RA manifestations.

[Use of a computer-assisted electrocardiograph for electrocardiographic control of pulse therapy]. / Primenenie komp'iuternogo elektrokardiografa dlia elektrokardiograficheskogo kontrolia pul's-terapii.

A study was made of the effect produced by a short course of treatment with large doses of corticosteroids and cyclophosphamide on the ECG in patients with different rheumatic diseases before, during and after pulse therapy. The study was performed with the aid of a computer-aided electrocardiograph IKS 6000. No changes were recorded on the part of automatism and conduction of the heart muscle. Twenty-nine patients (85%) manifested changes in the amplitude of the T waves during pulse therapy. Of them 16 demonstrated a reduction whereas 13 an increase in the amplitude of the T waves. Out of 8 patients, who received cyclophosphamide in addition to hormones, 6 showed a decrease in the amplitude of the waves, which attested to the effect of the treatment on myocardial metabolism.

[Echocardiographic study of heart function in systemic scleroderma]. / Ekhokardiograficheskoe izuchenie sostoianiia serdtsa pri sistemnoi sklerodermii.

Echocardiographic investigation of 65 patients with systemic scleroderma showed that the left ventricular sizes and indices of central hemodynamics were frequently lowered in them; an increase in sizes was observed mainly in the patients with stage II-III of disease. In 3/4 of the same patients pericarditis was revealed; on the whole, it was detected in 26 (40%) examinees. One patient had changes which were typical of asymmetric obstructive cardiopathy. In location of the valvular apparatus signs of mitral stenosis were found in one patient, those of mitral insufficiency in one patient and those of aortic insufficiency in one patient. Signs of mitral prolapse were noted in 7 (10.9%) patients, i.e. twice more frequently than in the entire population. Echocardiography made it possible to specify the nature of cardiac pathology and brought to light some additional features of the involvement of different heart membranes in systemic scleroderma.