Evaluation of cardiac function in patients with pemphigus vulgaris before and after rituximab infusion

Abstract Background Pemphigus is an autoimmune blistering disease of the skin and mucous membranes. Immunosuppressive drugs such as rituximab have been used as treatment of this possibly fatal disease. Rituximab infusion is associated with multiple complications such as cardiac side effects. Global strain measurement (GLS) has emerged as an important index of cardiac performance that adds incremental predictive value to standard measures such as the LVEF. Method This cross-sectional and prospective study was performed on patients with pemphigus vulgaris. To evaluate cardiac function, global longitudinal strain estimation, echocardiography, and ECG examination were investigated before and after the rituximab infusion. Results Thirty-six pemphigus vulgaris patients with a mean age of 47.86 ± 12.02 years were enrolled in this study. There was a statistically significant decrease in the mean of GLS after the rituximab infusion (p-value = 0.0001). Correlation between age and LVEF changes were significantly inverse (r=-0.378, p-value = 0.023), and correlation between age and PASP changes was significantly positive (r = 0.398, p-value = 0.002), but the correlation between age and GLS change was not statistically significant. Conclusion It seems that rituximab infusion may have cardiotoxic effects, leading to subclinical cardiac dysfunction, and prone these patients to EF reduction and heart failure in the future.