Comparison of non-invasive assessment of arrhythmias, conduction disturbances and cardiac autonomic tone in systemic sclerosis and systemic lupus erythematosus

Bienias, Piotr; Ciurzyński, Michał; Kisiel, Bartłomiej; Chrzanowska, Anna; Ciesielska, Katarzyna; Siwicka, Maria; Kalińska-Bienias, Agnieszka; Saracyn, Marek; Lisicka, Monika; Radochońska, Joanna; Pruszczyk, Piotr

doi:10.1007/s00296-018-4207-x

Cited by 14 publications

(9 citation statements)

References 36 publications

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“…As we have reported in our previous publications, HRV parameters associated with sympathetic activity (SDNN and SDANN) were significantly reduced in SLE patients, while the parameter associated with vagal activity (RMSSD) was not. 4 Similar observations in SLE patients were obtained during HRT analysis. In SLE, only the TS value (mainly associated with the sympathetic activity) was impaired, while the TO value was not (mainly associated with the vagal activity).…”

Section: Resultssupporting

confidence: 74%

“…However, conclusions of these prior studies explaining the repolarization abnormalities in SLE are not consistent. 3–9,24,25 Until now, no results of the measurement of QT-derived intervals in 24-hour Holter monitoring in SLE have been available in the literature. Therefore, we decided to evaluate these parameters and compare them to each other in both the standard ECG as well as in 24-hour ambulatory monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are no data on evaluation of various ventricular repolarization parameters using ambulatory Holter monitoring. 3–9 In general, the standard ECG shows a very short period of heart electrical activity. Thus, 24-hour Holter monitoring appears to reveal potential ventricular repolarization abnormalities better.…”

Section: Introductionmentioning

confidence: 99%

“…10 In fact, despite frequently reported prolongation of the QT interval using the standard ECG in SLE patients, ventricular arrhythmias and sudden cardiac arrest in those patients are relatively rare. 4,11 On the other hand, in their meta-analysis, Balloca et al. revealed that all-cause cardiovascular death was observed in 4.1% of cases during the eight-year follow-up of approximately 17,000 SLE patients.…”

Section: Introductionmentioning

confidence: 99%

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Influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in electrocardiographic assessment of patients with systemic lupus erythematosus

Bienias

Ciurzyński

Kisiel

et al. 2020

Lupus

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Background There are no data on the influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in 24-hour Holter monitoring in systemic lupus erythematosus (SLE). Methods Consecutive 92 SLE and 51 healthy subjects were studied. The standard 12-lead electrocardiography (ECG), Holter monitoring with heart rate turbulence (HRT) and QT, Tp-e and Tp-e/QT ratio assessment (including corrected values) were performed. Subjects with conditions causing repolarization abnormalities or insufficient number of beats suitable for QT evaluation were excluded (17 SLE and 8 controls). Results Finally, 75 SLE and 43 sex- and age-matched controls were included to the study. In SLE patients, the median disease severity score (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI)) was 3.0. The mean values of QTc, cTp-e and cTp-e/QTc were significantly higher in SLE patients than in controls. QTc ≥ 460 ms was observed in 18.7% of patients using standard ECG and in 58.7% using Holter monitoring. With Holter monitoring, patients with SLICC/ACR-DI >3.0 presented longer QTc than those with SLICC/ACR-DI ≤3.0 (418±15 vs. 409 ± 16, p = 0.04), while cTp-e and cTp-e/QTc values were similar. Patients with abnormal HRT presented longer cTp-e and higher cTp-e/QTc than those with normal HRT (92 ± 52 vs. 71 ± 16 ms, p = 0.04; 0.244 ± 0.126 vs. 0.187 ± 0.035, p = 0.03), while QTc values were similar. No differences in QT and Tp-e parameters were observed according to disease duration. Conclusion In SLE patients, Holter monitoring revealed QTc prolongation more frequently than standard ECG. Longer QTc values were observed in patients with more advanced disease, while increased cTp-e and cTp-e/QTc were related to cardiac autonomic dysfunction expressed by abnormal HRT.

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Section: Resultssupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in electrocardiographic assessment of patients with systemic lupus erythematosus

Bienias

Ciurzyński

Kisiel

et al. 2020

Lupus

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“…5 Other ECG abnormalities have been described in SLE patients, including: tachyarrhythmias (such as atrial fibrillation, flutter, atrioventricular reentrant tachycardia, paroxysmal ventricular tachycardia); QT prolongation; atrioventricular block and sinus bradycardia. 5 , 12 , 13 Severe bradyarrhythmias requiring permanent pacemakers have been described in isolated adult SLE cases. 8 , 12…”

Section: Discussionmentioning

confidence: 99%

Sinus node disfunction in an adolescent with systemic lupus erythematosus

Mata

Rebelo

Sousa

et al. 2020

Lupus

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Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, myocardium and endocardium, as well as the coronary arteries, the valves and the conduction system can all be affected. While pericarditis is common, arrythmias are less frequently described. We present a 13-year-old male, who had fatigue, anorexia, weight loss, myalgias and arthralgias for four months. On physical examination, we identified bradycardia (heart rate 31–50 bpm), oral and nasal ulcers and polyarthritis. The laboratory results showed hemolytic anemia, hypocomplementemia, antinuclear and anti-dsDNA antibodies, hematuria and non-nephrotic proteinuria. Renal function was normal. Lupus nephritis class II was diagnosed by kidney biopsy. On the transthoracic echocardiogram we identified a minimal pericardial effusion, suggesting pericarditis, and, on the electrocardiogram, we detected sinus arrest with junctional rhythm, denoting sinus node dysfunction. The patient was diagnosed with juvenile SLE with cardiac, renal, musculoskeletal and hematologic involvement. Disease remission and cardiac rhythm control were obtained with steroids and mycophenolate mofetil. Currently, the patient is asymptomatic, with normal sinus rhythm. We described an adolescent with SLE who had sinus node dysfunction upon diagnosis. Other cases have been reported in adults but none in juvenile SLE. All SLE patients should have a thorough cardiac examination to promptly diagnose and treat the innumerous cardiac manifestations of this disease.

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Prognostic Value of Cardiac Axis Deviation in Systemic Sclerosis–Related Pulmonary Hypertension

Lui

Sangani

Chen

et al. 2022

Arthritis Care & Research

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Objective Systemic sclerosis–related pulmonary hypertension (SSc‐PH) is a common complication of SSc associated with accelerated mortality. The present study was undertaken to investigate whether cardiac axis deviation indicates abnormalities in cardiac function allowing for prognostication of disease severity and mortality. Methods This was a retrospective study in which electrocardiograms (ECGs) were reviewed for cardiac axis deviation and their association with echocardiography and cardiopulmonary hemodynamics on right‐sided heart catheterization. The primary outcome observed was all‐cause mortality from the time of PH diagnosis. Results ECG results were reviewed from 169 patients with SSc‐PH. Right axis deviation (RAD) and left axis deviation (LAD) occurred in 28.4% and 30.8% of patients with SSc‐PH, respectively. Compared to those without RAD, patients with RAD exhibited predominantly right‐sided cardiac disease on echocardiography and increased PH severity by cardiopulmonary hemodynamics including a greater mean ± SD pulmonary artery pressure (42.0 ± 12.5 mm Hg versus 29.8 ± 7.0 mm Hg) and mean ± SD pulmonary vascular resistance (645.6 ± 443.2 dynes · seconds/cm5 versus 286.3 ± 167.7 dynes · seconds/cm5). LAD was associated with predominantly left‐sided cardiac disease on echocardiography but was not associated with PH severity on cardiopulmonary hemodynamics. Both RAD (hazard ratio 10.36 [95% confidence interval 4.90–21.93], P < 0.001) and LAD (hazard ratio 2.94 [95% confidence interval 1.53–5.68], P = 0.001) were associated with an increased hazard for all‐cause mortality. Conclusion RAD and LAD reflect structural cardiac abnormalities and are associated with poor prognosis in patients with SSc‐PH. These findings support the importance of electrocardiography, an inexpensive, widely available noninvasive test, in risk stratification.

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Comparison of non-invasive assessment of arrhythmias, conduction disturbances and cardiac autonomic tone in systemic sclerosis and systemic lupus erythematosus

Cited by 14 publications

References 36 publications

Influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in electrocardiographic assessment of patients with systemic lupus erythematosus

Influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in electrocardiographic assessment of patients with systemic lupus erythematosus

Sinus node disfunction in an adolescent with systemic lupus erythematosus

Prognostic Value of Cardiac Axis Deviation in Systemic Sclerosis–Related Pulmonary Hypertension

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