Prognostic importance of cardiac arrhythmias in systemic sclerosis

Kostis, John B.; Seibold, James R.; Turkevich, Darya; Masi, Alfonse T.; Grau, Rafael G.; Medsger, Thomas A.; Steen, Virginia D.; Clements, Philip J.; Szydlo, Lillian; D’Angelo, William

doi:10.1016/0002-9343(88)90305-1

Cited by 125 publications

(76 citation statements)

References 34 publications

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“…25 Nevertheless, asymptomatic and subclinic cardiac involvement are common than estimated, prevalence being approximately 15% to 45%. [1][2][3]26 Kostis et al 6 showed a strong correlation between ventricular ectopic beats and total mortality and sudden death in 183 patients with SSc. Ventricular tachycardia was also found in 7% of patients with SSc.…”

Section: Discussionmentioning

confidence: 99%

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The Assessment of Tp-e Interval and Tp-e/QT Ratio in Patients With Systemic Sclerosis

Yayla

et al. 2016

Arch Rheumatol

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Objectives: This study aims to investigate ventricular repolarization using T-peak to T-end (Tp-e) intervals and Tp-e/QT ratios in patients with systemic sclerosis (SSc). Patients and methods: Totally 65 patients (8 males, 57 females; mean age 49.8 years; range 20 to 77 years) with SSc and 63 control subjects (8 males, 55 females; mean age 49.3 years; range 20 to 77 years) were enrolled. Tp-e intervals, Tp-e/QT, and Tp-e/corrected QT (QTc) ratios were measured from the 12-lead electrocardiogram. Results: Tp-e intervals, QT intervals, QTc intervals, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in patients with SSc than control subjects (all p<0.01). There was no difference between patients with diffuse and limited cutaneous SSc in terms of electrocardiogram and echocardiographic findings. Correlation analysis revealed no correlation between Tp-e intervals, Tp-e/QT, and Tp-e/QTc ratios with disease duration and anti-Sjögren's syndrome antigen A antibody levels in patients with SSc (all p>0.05). Conclusion: Our study showed that Tp-e intervals, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with SSc than control subjects. The increased frequency of ventricular arrhythmias can be clarified by increased indexes of ventricular repolarization parameters in patients with SSc.

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Section: Discussionmentioning

confidence: 99%

“…4,5 The major causes of cardiovascular death in patients with SSc are refractory heart failure and dysrhythmias. 6 Ventricular repolarization may be defined using QT interval, QT dispersion, and T wave measurements. Prolonged QT interval and increased QT dispersion have been shown in patients with SSc.…”

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confidence: 99%

The Assessment of Tp-e Interval and Tp-e/QT Ratio in Patients With Systemic Sclerosis

Yayla

et al. 2016

Arch Rheumatol

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“…Risk factors for the development of severe organ involvement have been examined in a variety of studies (17,18). Autoantibodies have been especially helpful in identifying patients at risk for severe organ involvement.…”

Section: Discussionmentioning

confidence: 99%

Severe organ involvement in systemic sclerosis with diffuse scleroderma

Steen

Medsger

2000

Arthritis & Rheumatism

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851

456

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Objective. To determine the natural history and timing of severe involvement of the kidney, heart, lung, gastrointestinal (GI) tract, and skin in patients with systemic sclerosis (SSc) and diffuse cutaneous involvement. Methods. This study used the Pittsburgh Sclero-derma Databank and included patients with diffuse scleroderma who were seen between January 1, 1972 and December 31, 1995. Patients had frequent follow-ups, and a 95% accountability for these patients was maintained. Severe organ involvement was defined as the presence of any of the following: 1) in the kidney, scleroderma "renal crisis"; 2) in the heart, cardiomyop-athy, symptomatic pericarditis, or an arrhythmia requiring treatment; 3) in the lung, pulmonary fibrosis on chest radiograph and a forced vital capacity of <55% of predicted; 4) in the GI tract, malabsorption, repeated episodes of pseudoobstruction, or severe problems requiring hyperalimentation; and 5) in the skin, a modified Rodnan skin score >40. The timing from disease onset to survival for each case of severe organ involvement was determined. Results. Of the 953 patients with diffuse sclero-derma, kidney involvement developed in 177 (19%), heart involvement in 143 (15%), lung involvement in 151 (16%), GI tract involvement in 74 (8%), and skin involvement in 233 (24%). Severe skin and kidney involvement occurred during the first 3 years in 70% of those who ever developed these problems throughout a mean of 10 years of followup. Severe heart, lung, and GI tract involvement developed during the first 3 years in 45-55% of those who were ever affected. The survival of patients with severe organ involvement was poor. The 9-year cumulative survival rate of all patients with severe organ involvement was 38%, compared with 72% in patients without such involvement (P < 0.0001). Conclusion. This study demonstrates that severe organ involvement in SSc patients with diffuse sclero-derma most often occurs early in the course of the disease. Survival for patients with severe organ involvement is markedly reduced. Patients should therefore be monitored very closely during the first 3 years of disease for signs and symptoms that may signal the subsequent development of severe organ damage. Potential disease-modifying therapies must be initiated early to modify the natural history of SSc and to improve survival. Patients who survive the first few years without developing severe organ involvement are less likely to develop such life-threatening involvement later in the disease course.

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“…Pathological studies of the heart in scleroderma revealed diffuse myocardial fibrosis, pericardial lesions, and fibrosis of the conduction system [3, 4]. Cardiac involvement can exist without symptoms, and once it becomes clinically apparent, the prognosis is poor [5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Assessment of Atrial Conduction in Patients with Scleroderma by Tissue Doppler Echocardiography and P Wave Dispersion

Can¹,

Onat

Aytemir³

et al. 2007

Cardiology

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Background: Atrial conduction abnormalities in patients with scleroderma have not been evaluated in terms of P wave duration, P wave dispersion (P_d) and electromechanical coupling measured by tissue Doppler echocardiography. Methods: Twenty-four patients with scleroderma and 24 control subjects underwent resting electrocardiogram (ECG), M mode and tissue Doppler echocardiography. The P wave duration was calculated in all leads of the surface ECG. The difference between the maximum (P_max) and minimum P wave duration was calculated and defined as P_d. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler tissue echocardiography. Results: The left ventricular dimensions, fractional shortening, and left atrial diameter did not differ between the patients and the controls. P_d and P_max were significantly higher in patients with scleroderma compared with controls: 51 ± 17 versus 28 ± 7 ms (p < 0.01) and 109 ± 10 versus 93 ± 6 ms (p < 0.01), respectively. There was a delay between the onset of the P wave on surface ECG and the onset of the late diastolic wave (A wave; PA) obtained by tissue Doppler echocardiography in patients with scleroderma compared with controls measured at lateral septal annulus (lateral PA; 122 ± 8 vs. 105 ± 7 ms, p = 0.001), septal mitral annulus (104 ± 11 vs. 93 ± 10 ms, p = 0.01) and tricuspid annulus (right ventricular PA; 71 ± 9 vs. 64 ± 7 ms, p = 0.05). Interatrial conduction time (lateral PA – right ventricular PA) was delayed in patients with scleroderma compared with controls (88 ± 13 vs. 76 ± 11 ms, p = 0.01). A positive correlation was detected between interatrial electromechanical delay (lateral PA – right ventricular PA) and P_d (r = 0.5, p = 0.03). Conclusion: Atrial conduction abnormalities as estimated with P_d and P_max are significantly higher in patients with scleroderma compared with controls. There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with scleroderma.

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Prognostic importance of cardiac arrhythmias in systemic sclerosis

Cited by 125 publications

References 34 publications

The Assessment of Tp-e Interval and Tp-e/QT Ratio in Patients With Systemic Sclerosis

The Assessment of Tp-e Interval and Tp-e/QT Ratio in Patients With Systemic Sclerosis

Severe organ involvement in systemic sclerosis with diffuse scleroderma

Assessment of Atrial Conduction in Patients with Scleroderma by Tissue Doppler Echocardiography and P Wave Dispersion

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