Usefulness of cardiac screening in patients with systemic lupus erythematosus and anti-Ro/SSA antibodies

Abstract

Objectives Recent data suggest that some adult patients with autoimmune rheumatic diseases may develop cardiac conduction and repolarization abnormalities mediated by anti-Ro/SSA antibodies. We aim to investigate the utility of a cardiac screening in patients with systemic lupus erythematous (SLE) and anti-Ro/SSA positivity. Methods SLE patients who consecutively attended a Rheumatology clinic during 1 year where evaluated for the presence and levels of anti-Ro/SSA antibodies, and clinical and biological markers of organ damage and disease activity. All participants underwent a cardiovascular anamnesis and physical examination, ECG, echocardiography, and 24-hour Holter. Results Of the 145 recruited patients, 49 (32%) had anti-Ro/SSA positivity. None had any degree of atrioventricular block in the ECG or Holter monitoring. No significant differences were observed between anti-Ro/SSA–positive vs. negative patients in terms of PR, QRS or QTc intervals. No clinically significant arrhythmias were recorded during Holter monitoring and no differences in average heart rate, heart rate variability, or atrial or ventricular ectopy burden were observed. Finally, no differences were found in echocardiographic measurements. Conclusions In this study of SLE patients, anti-Ro/SSA positivity was not associated with significant alterations in ECG, echocardiography, or 24-hour Holter. These findings do not support ordinary cardiac evaluation in these patients. ( Clinicaltrials.gov registration number: NCT02162992).

Should Physicians Be Aware of Rhythm Disturbances in Adults with Systemic Autoimmune Diseases and Anti-Ro52 Antibodies? A Cross-Sectional Study

“…Since Scott et al [ 39 ] first asked why these autoantibodies affected the fetal heart and not the maternal heart, there have been numerous reports of isolated cases of cardiac rhythm disorders associated with anti-Ro/SSA and also some tiny series (usually with less than 50 cases carrying these autoantibodies), either in the general population or in patients with a specific SAD (SLE, SS, dermatomyositis, scleroderma), where the analysis of the association between rhythm disorders and anti-Ro/SSA has yielded disparate conclusions. In two of the most recently published articles in 2021, Villuendas et al [ 26 ] found no association between positivity against anti-Ro/SSA and alterations in EKG intervals (49 anti-Ro+ cases). Lazzerini et al [ 3 ], in a population-based series of U.S. Veterans where anti-Ro/SSA positivity was screened (612 anti-Ro+ cases), found that the presence of these autoantibodies was associated with the risk of presenting QTc interval prolongation.…”

“…Variables of study; Table S4. Anti-Ro60, anti-Ro52 and anti-La/SSB antibodies: positivity, titer strength, and time since first positivity [ 3 , 15 , 17 , 18 , 19 , 21 , 25 , 26 , 27 , 35 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ].…”

Value of Autostrain LV in the study of left ventricular systolic function and synchronization in patients with systemic lupus erythematosus

“…In summary, as the SLE‐DAI score increases, subclinical manifestations such as reduced left ventricular myocardial deformability and asynchronous myocardial motion become more pronounced, directly affecting the patient's quality of life and long‐term prognosis 29–31 ; Autostrain LV and 3DQA both provide a more accurate quantitative evaluation of left ventricular systolic synchrony in SLE patients. Both Autostrain LV and 3DQA provide a more accurate quantitative assessment of LV systolic synchrony in patients with SLE.…”

“…In summary, as the SLE-DAI score increases, subclinical manifestations such as reduced left ventricular myocardial deformability and asynchronous myocardial motion become more pronounced, directly affecting the patient's quality of life and long-term prognosis [29][30][31] ;…”

Management of Complete Heart Block in a Pregnant Woman with Systemic Lupus Erythematosus-Associated Complications: Treatment Considerations and Pitfalls

“…A recent study by Villuendas et al evaluated a possible link between rheumatologic disease and positive anti-Ro/SSA antibodies, previously discussed as possibly responsible for autoimmune-mediated heart conduction system damage. No association was found, and the results did not support a standard cardiac evaluation in autoimmune disease patients [ 15 ]. A study by Natsheh et al researched case reports of CHB in lupus and found only four anti-Ro/SSA and two anti-La/SSB positive cases out of 32, therefore suggesting other possible pathophysiological mechanisms involved in SLE-induced conduction defects.…”