QTc is Prolonged in Patients with SSc and Associates with Skin Score

Overview

Journal Mediterr J Rheumatol

Specialty Rheumatology

Date 2023 May 24

PMID 37223597

Authors

Alireza Fatemi

Nafiseh Abdolahi

Mehrdad Aghaei

Hamidreza Azimi

Ahmad Mohammadi

Affiliations

Soon will be listed here.

Abstract

Background: Systemic sclerosis is an autoimmune disease characterised by endothelial dysfunction and fibrosis of the skin and internal organs. Cardiac involvement during systemic sclerosis can be primary or secondary to pulmonary arterial hypertension and renal pathology. Among the disorders in systemic sclerosis, prolongation of QTc time is also associated with more anti-RNA polymerase III antibodies, longer duration, and severity of disease.

Methods: This case-control study was performed on 35 patients with systemic scleroderma who filled in the American Society of Rheumatism (ACR / EULAR criteria) and 35 healthy subjects prior to entering the study. Then, the QTc distance was extracted from the electrocardiogram and calculated using the formula. The measured QTc distance in the electrocardiogram, QTc> 440ms in men and QTc> 460ms in women, was defined as QTc long. The patients and the control group then underwent echocardiography, and changes in QTc interval and their relations with echocardiographic findings were evaluated.

Results: The results of this study indicated a significant relationship between QTc distance in patients with scleroderma compared with healthy controls. There was also a significant relationship between QTc and Skin Score of patients. However, there was no significant correlation between QTc distance and age, duration of disease, Anti-Centromere, Anti-Scl70, and pulmonary artery pressure.

Conclusion: This study concludes that patients with scleroderma are at high risk for cardiac conduction impairment. The only factor that significantly correlated with QTc was the Skin Score of the patients.

Citing Articles

Heart involvement in patients with systemic sclerosis-what have we learned about it in the last 5 years.

Nadel A, Nadel M, Taborska N, Stepien B, Gajdecki J, Brzezinska O Rheumatol Int. 2024; 44(10):1823-1836.

PMID: 39192021 PMC: 11393134. DOI: 10.1007/s00296-024-05699-x.

References

Ciftci O, Onat A, Yavuz B, Akdogan A, Aytemir K, Tokgozoglu L . Cardiac repolarization abnormalities and increased sympathetic activity in scleroderma. J Natl Med Assoc. 2007; 99(3):232-7. PMC: 2569635. View

Massie C, Hudson M, Tatibouet S, Steele R, Huynh T, Fritzler M . Absence of an association between anti-Ro antibodies and prolonged QTc interval in systemic sclerosis: a multicenter study of 689 patients. Semin Arthritis Rheum. 2014; 44(3):338-44. DOI: 10.1016/j.semarthrit.2014.07.001. View

Nussinovitch U, Rubin S, Levy Y, Lidar M, Livneh A . QT variability index in patients with systemic sclerosis. Eur J Rheumatol. 2019; 6(4):179-183. PMC: 6812901. DOI: 10.5152/eurjrheum.2019.19074. View

Sebestyen V, Szucs G, Pall D, Ujvarosy D, Otvos T, Csige I . Electrocardiographic markers for the prediction of ventricular arrhythmias in patients with systemic sclerosis. Rheumatology (Oxford). 2020; 59(3):478-486. PMC: 7032033. DOI: 10.1093/rheumatology/kez644. View

Bosello S, Luca G, Berardi G, Canestrari G, de Waure C, Gabrielli F . Cardiac troponin T and NT-proBNP as diagnostic and prognostic biomarkers of primary cardiac involvement and disease severity in systemic sclerosis: A prospective study. Eur J Intern Med. 2018; 60:46-53. DOI: 10.1016/j.ejim.2018.10.013. View

Rosato E, Gigante A, Liberatori M, Gasperini M, Sardo L, Amoroso A . QTc interval prolongation in systemic sclerosis: correlations with clinical variables. Int J Cardiol. 2015; 182:20-2. DOI: 10.1016/j.ijcard.2014.12.069. View

Luca G, Bosello S, Gabrielli F, Berardi G, Parisi F, Rucco M . Prognostic Role of Ventricular Ectopic Beats in Systemic Sclerosis: A Prospective Cohort Study Shows ECG Indexes Predicting the Worse Outcome. PLoS One. 2016; 11(4):e0153012. PMC: 4839708. DOI: 10.1371/journal.pone.0153012. View

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 (Oxford). 2015; 54(9):1616-21. DOI: 10.1093/rheumatology/kev096. View

Gigante A, Rosato E, Liberatori M, Sardo L, Di Paolo M, Marinelli P . In systemic sclerosis prolonged QTc interval is associated with reduced exercise tolerance. Int J Cardiol. 2015; 203:570-2. DOI: 10.1016/j.ijcard.2015.11.004. View

10.

van den Hoogen F, Khanna D, Fransen J, Johnson S, Baron M, Tyndall A . 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2013; 72(11):1747-55. DOI: 10.1136/annrheumdis-2013-204424. View

11.

Karakulak U, Okutucu S, Sahiner L, Maharjan N, Aladag E, Akdogan A . Assessment of cardiac autonomic nervous system involvement in systemic sclerosis via exercise heart rate recovery. Med Princ Pract. 2014; 24(1):17-22. PMC: 5588187. DOI: 10.1159/000368359. View

12.

Sasaoka S, Matsui T, Hane Y, Abe J, Ueda N, Motooka Y . Time-to-Onset Analysis of Drug-Induced Long QT Syndrome Based on a Spontaneous Reporting System for Adverse Drug Events. PLoS One. 2016; 11(10):e0164309. PMC: 5056697. DOI: 10.1371/journal.pone.0164309. View

13.

Lambova S . Cardiac manifestations in systemic sclerosis. World J Cardiol. 2014; 6(9):993-1005. PMC: 4176808. DOI: 10.4330/wjc.v6.i9.993. View

14.

Elhai M, Meune C, Boubaya M, Avouac J, Hachulla E, Balbir-Gurman A . Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis. 2017; 76(11):1897-1905. DOI: 10.1136/annrheumdis-2017-211448. View

15.

Saramet E, Cojocaru D, Ungurianu S, Negru R, Ancuta C . QT Interval Prolongation in Patients with Systemic Sclerosis-Are the Holter ECG Recordings a Better Option for QT Interval Evaluation?. Medicina (Kaunas). 2021; 57(3). PMC: 8004093. DOI: 10.3390/medicina57030295. View