ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid arthritis

Abstract

ObjectivesCardiovascular disease (CVD) is a leading cause of death in systemic lupus erythematosus (SLE) and in rheumatoid arthritis (RA). Although only explored in one study, ECG non-specific ST-T abnormalities, in addition to corrected QT-interval (QTc) prolongation, were recently reported in an SLE inception cohort. Importantly, these ECG abnormalities are known predictors of CVD mortality in the general population, yet their prevalence in patients with established SLE has not been evaluated.MethodsWe cross-sectionally investigated the presence of non-specific ST-T and QTc abnormalities in 50 patients with SLE, predominantly Hispanic and black, without CVD or SLE-related cardiac involvement and compared them with 139 patients with RA without CVD. Demographics, disease-specific characteristics and CVD risk factors were ascertained and adjusted for.ResultsPatients with SLE (mean age 36±13 years, 92% women, 6 years median disease duration, 96% Hispanics and blacks) had a 3.3-fold higher adjusted prevalence of non-specific ST-T abnormalities (56% vs 17%; p <0.0001) compared with RA, despite the older age and higher percentage of men in the RA group. The QTc was 26 ms longer in SLE compared with RA (p=0.002) in the setting of a higher percentage of women, blacks, Hispanics and higher C reactive protein levels in the SLE group.ConclusionsThis study demonstrates a high prevalence of ECG abnormalities in predominantly Hispanic and black patients with SLE. Longitudinal evaluation of the progression to potentially life-threatening arrhythmias and/or cardiovascular events is warranted.

Assessing QT interval in patients with autoimmune chronic inflammatory diseases: perils and pitfalls

“…However, the two groups of patients studied by Geraldino-Parrilla et al 21 are very different, maybe too much, in terms of sex and ethnicity, and this could have significantly biased the results. In particular, in the general population it is well-established that female sex is associated with longer QTc duration (accordingly QTc prolongation cut-offs are different in males vs females) and higher TdP risk, via complex effects of sexual hormones on cardiac ion currents 3…”

“…In a recent publication in Lupus Science and Medicine , Geraldino-Parrilla et al 21 analysed ECG repolarisation parameters in a cross-sectional study involving 189 patients with autoimmune chronic inflammatory diseases, 50 affected with SLE and 139 with RA. The authors reported that non-specific ST-T abnormalities were significantly more common (∼fivefold), and mean QTc significantly longer (∼25 ms) in SLE when compared with patients with RA.…”

“…In fact, while an increased prevalence of non-specific ST-T abnormalities was found in patients with SLE despite the presence of a ‘favourable’ matching (patients with SLE were younger, predominantly females and with shorter disease duration than patients with RA) thus supporting the validity of these findings, this consideration is not true for the QTc, whose assessment may have been also biased by some additional procedural issues. In this view, the paper of Geraldino-Parrilla et al 21 gives us the opportunity to alert about perils potentially sneaking in this kind of investigation. In particular, we here discuss a number of crucial methodological aspects that require careful attention in order to avoid pitfalls when a study assessing the QT interval in patients with autoimmune chronic inflammatory diseases is performed.…”

Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy

“…We excluded patients with alcohol-related or inflammatory liver diseases in order to avoid association of these conditions to the ECG patterns discovered. C-reactive protein levels have been shown to predict prolonged QT intervals in patients with systemic lupus erythematosus [34], rheumatoid arthritis [35] and patients with other connective tissue diseases [36]. A possible explanation for the better correlation between QT interval and biologic parameters in our study could be the very restrictive selection of patients, excluding, at our best, many possible reasons for altered ECG traces.…”

Clinical Study of Cardiovascular Involvement in Patients with Connective Tissue Diseases

“…The high frequency of sinus bradycardia, sinus tachycardia, right bundle branch block, ST interval and T waves changes were seen in RA and SLE patients. Steroid therapy was probably responsible for producing the slowly ascending modify ST-T changes and previously reported increase of ST-T changes in RA and SLE [18] [19] [20]. In a recent study, we found 12 patients with abnormal chest X-ray with cardiomegaly and pulmonary artery hypertension.…”