Work

Early warning and risk assessment of cardiac involvement in dermatomyositis/polymyositis: from biomarkers to multimodal imaging

Year: 2026

Type: review

Abstract: Idiopathic inflammatory myopathies (IIM) comprise a broad spectrum of clinical and pathological subtypes, including dermatomyositis (DM), anti-synthetase syndrome, immune-mediated necrotising myopathy (IMNM), overlap myositis, inclusion-body myositis, and polymyositis (PM). Among these, DM remains well-defined, whereas PM has become increasingly rare under current classification criteria. A significant number of early studies categorised patients collectively under the term "DM/PM". Cardiac involvement is recognised as a significant cause of mortality in these patients. The reported incidence of cardiac involvement in DM/PM varies widely and is frequently subclinical. The symptoms are frequently masked by manifestations in the skeletal muscles and the skin, which makes an early diagnosis difficult using conventional examination methods. Although endomyocardial biopsy is regarded as the gold standard, its invasive nature limits its clinical application. It is therefore imperative to establish an efficient framework for early warning and precise risk assessment of cardiac involvement in DM/PM. In this review, we summarize current and emerging evidence on serum biomarkers and multimodal imaging for the early identification and risk assessment of cardiac involvement in DM/PM. These advances are built on the evolving classification system for IIM.The integration of these tools with clinical high-risk factors is intended to facilitate the construction of a comprehensive risk assessment model. This integrated approach is intended to facilitate the early detection and treatment of cardiac involvement in DM/PM patients, thereby improving their prognosis.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1987083