title: Cardiac involvement in mixed connective tissue disease: a systematic review.
abstract: OBJECTIVE
  To report the clinical characteristic of cardiac disease in patients with mixed connective tissue disease (MCTD).
  
  
  METHODS
  We identified published case series that reported cardiac manifestations of patients with MCTD by searching the PubMed database using the search terms "mixed connective tissue disease". We identified 11 case series that met our eligibility criteria.
  
  
  RESULTS
  616 patients were included. Prevalence of cardiac involvement varied from 13% to 65% depending on patient selection and method used for detection. Pericarditis was the most common cardiac diagnosis with a prevalence of 30% and 43% in two prospective studies. Non-invasive cardiac tests, including electrocardiogram and echocardiogram, detected subclinical cardiac abnormalities in 6%-38% of patients. These abnormalities included conduction abnormalities, pericardial effusion and mitral valve prolapse. Diastolic dysfunction and accelerated atherosclerosis were well-documented in a case-control study. Three prospective studies revealed an overall mortality of 10.4% over the period of follow-up of 13-15 years. 20% of the mortality was directly attributable to cardiac cause.
  
  
  CONCLUSIONS
  Cardiac involvement was common among patients with MCTD though the involvement was often clinically inapparent. Non-invasive cardiac tests might have a role for subclinical disease screening for early diagnosis and timely treatment as cardiac involvement was one of the leading causes of mortality.
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA. Electronic address: Patompong.Ungprasert@bassett.org.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thapat
authors.initials: T
authors.lastname: Wannarong
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Theppharit
authors.initials: T
authors.lastname: Panichsillapakit
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Raddatz
mesh_terms: D000818:Animals; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008947:Mixed Connective Tissue Disease / Q000175:diagnosis* / Q000453:epidemiology*; D009205:Myocarditis / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies
keywords: Cardiac involvement; Mixed connective tissue disease; Myocarditis; Pericardial effusion; Pericarditis; Systematic review