Increased QT dispersion and related factors in patients with systemic sclerosis

Year 2022, , 368 - 373, 22.10.2022

Özgül Soysal Gündüz Kezban Armagan

https://doi.org/10.38053/acmj.1132856

Abstract

Introduction: Cardiac arrhythmias and sudden death may occur as a result of ventricular myocardial fibrosis or ischemia in patients with systemic sclerosis (SSc). QT prolongation and QT dispersion, which facilitate the development of ventricular fibrillation, are important cardiac problems associated with increased mortality. In this study, we aimed to investigate the prevalence of corrected QT dispersion (cQTD) and related factors in our patients with systemic sclerosis compared to healthy controls.
Material and Method: The 12-lead electrocardiograms with a rate of 25 mm/s of patients with no previous history of cardiovascular disease and controls were analyzed. cQTD was defined as the difference between the maximum QT interval and the minimum QT interval. Nailfold capillaroscopy examination was performed. Disease activity was evaluated using revised European Scleroderma Study Group activity index.
Results: Forty-nine SSc patients (45 females, mean age 53.26±10.63 years, and disease duration 8.0 (1-25) years) and 41 controls (37 females, mean age 49.29±8.02 years) were included. While the frequency of smoking was significantly higher in controls (p=0.025), erythrocyte sedimentation rate was higher in patients (p<0.001). cQTD was significantly higher in the patient group compared to the control group (65.14±17.57 ms and 42.73±10.03 ms, respectively, p<0.001). A significant positive correlation was found between erythrocyte sedimentation rate and cQTD in the patient group. We found no association between cQTD and disease activity, medications, anti-SSA/Ro positivity, capillaroscopy paterns, presence of interstitial lung disease and pulmonary arterial hypertension.
Conclusion: In our study, cQTD, which indicates an increased risk for ventricular arrhythmia and cardiovascular mortality, was found to be significantly higher in the patients compared to the controls. Determining cardiac risks with an electrocardiogram, which is a non-invasive and easily available method, is important in the follow-up of SSc patients.

Keywords

Systemic sclerosis, cardiovascular mortality, QT dispersion

References

• Denton CP, Khanna D. Systemic sclerosis. The Lancet 2017; 390: 1685-99.
• Acosta-Herrera M, López-Isac E, Martín J. Towards a better classification and novel therapies based on the genetics of systemic sclerosis. Curr Rheumatol Rep 2019; 21: 1-7.
• Todesco S, Gatta A, Glorioso S, et al. Cardiac involvement in progressive systemic sclerosis. Acta Cardiologica 1979; 34: 311-22.
• Marques-Alves P, Baptista R, Canha C, Franco F, Santos L, Pêgo M. Early manifestation of myocardial involvement in systemic sclerosis. Revista Portuguesa de Cardiologia 2019; 38: 299-303.
• Tyndall AJ, Bannert B, Vonk M, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheumatic Dis 2010; 69: 1809-15.
• Sgreccia A, Morelli S, Ferrante L, et al. QT interval and QT dispersion in systemic sclerosis (scleroderma). J Intern Med 1998; 243: 127-32.
• Rosato E, Tubani L, Gigante A. QTc interval prolongation in systemic sclerosis. Int J Cardiol 2017; 239: 34.
• Dobson CP, Kim A, Haigney M. QT variability index. Prog Cardiovasc Dis 2013; 56: 186-94.
• Nussinovitch U, Rubin S, Levy Y, Lidar M, Livneh A. QT variability index in patients with systemic sclerosis. Eur J Rheumatol 2019; 6: 179.
• Van Den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheumat 2013; 65: 2737-47.
• Czirjak L, Foeldvari I, Müller-Ladner U. Skin involvement in systemic sclerosis. Rheumatology 2008; 47: v44-v5.
• LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988; 15: 202-5.
• Valentini G, Iudici M, Walker UA, et al. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheumatic Dis 2017; 76: 270-6.
• Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome. An update. Circulation 1993; 88: 782-4.
• Steen V. The heart in systemic sclerosis. Curr Rheumatol Rep 2004; 6: 137-40.
• Ciftci O, Onat AM, Yavuz B, et al. Cardiac repolarization abnormalities and increased sympathetic activity in scleroderma. J Nat Med Assoc 2007; 99: 232.
• Massie C, Hudson M, Tatibouet S, et al. Absence of an association between anti-Ro antibodies and prolonged QTc interval in systemic sclerosis: a multicenter study of 689 patients. Semin Arthrit Rheumat 2014: Elsevier.
• Panoulas VF, Toms TE, Douglas KM, et al. Prolonged QTc interval predicts all-cause mortality in patients with rheumatoid arthritis: an association driven by high inflammatory burden. Rheumatology 2014; 53: 131-7.
• Foocharoen C, Pussadhamma B, Mahakkanukrauh A, Suwannaroj S, Nanagara R. Asymptomatic cardiac involvement in Thai systemic sclerosis: prevalence and clinical correlations with non-cardiac manifestations (preliminary report). Rheumatology 2015; 54: 1616-21.
• Okutucu S, Karakulak UN, Aksoy H, et al. Prolonged Tp-e interval and Tp-e/QT correlates well with modified Rodnan skin severity score in patients with systemic sclerosis. Cardiol J 2016; 23: 242-9.
• Rosato E, Gigante A, Liberatori M, et al. QTc interval prolongation in systemic sclerosis: correlations with clinical variables. Int J Cardiol 2015; 182: 20-2.
• Lazzerini PE, Capecchi PL, Laghi-Pasini F. Assessing QT interval in patients with autoimmune chronic inflammatory diseases: perils and pitfalls. Arch Dis Childhood; 2016.