A Marked Response to Immunosuppressive Intervention for Abruptly Occurring Cardiac Complications in a Case of Juvenile Systemic Sclerosis Overlapped with Dermatomyositis

Figure 4

Nine-week time course after the initiation of treatment. Therapeutic agents, symptoms, creatine kinase (CK, shown as open black circles in graph (a)), N-terminal pro b-type natriuretic peptide (NT-proBNP, shown as open gray circles in graph (a)), left ventricular posterior wall end diastole, percent of normal (LVPWD% N, shown as closed black triangles in graph (b)) and left ventricular diastolic diameter (LVDd, shown as closed gray triangles in graph (b)), and Tei index showing left ventricular diastolic and systolic function, calculated as [isovolumic contraction time + isovolumic relaxation time]/[left ventricular ejection time] (Tei index, shown as open squares in graph (c)) are shown. Cardiac dysfunction and exacerbation of myositis occurred abruptly and were resolved after methylprednisolone pulse therapy in combination with palliative therapies for heart failure.