Electrocardiographic markers for the prediction of ventricular arrhythmias in patients with systemic sclerosis

Abstract

SSc is an autoimmune disease characterized by microvascular damage, endothelial dysfunction and fibrosis of the skin and the internal organs. Cardiac manifestation in patients with SSc is one of the major organ involvements. Approximately 20% of SSc patients suffer from primary cardiovascular disease and another 20% may have secondary cardiac involvement. Although cardiac arrhythmias are mostly linked to myocardial fibrosis, atrioventricular conduction abnormalities are secondary to the fibrosis of the pulse conduction system. Despite the severe consequences of ventricular rhythm disturbances in patients with SSc, the exact role of electrocardiographic markers in the prediction of these arrhythmias has not yet been clearly elucidated. Therefore, the question is whether certain ECG parameters reflecting ventricular repolarization may help to recognize scleroderma patients with increased risk for ventricular arrhythmias and sudden cardiac death.

Sclerodermic Cardiomyopathy—A State-of-the-Art Review

“…Disease-specific autoantibodies offer important prognostic information in patients with SSc. The presence of anti-topoisomerase I (anti-Scl70), anti-Ku, anti-U3 RNP, antihistone, and anti-ribonucleic acid (RNA) polymerase (I, II, III) antibodies are associated with a higher risk of SSc-related cardiac disease [30]. In addition, serum levels of interleukin 6 (IL-6), tissue inhibitor matrix metalloproteinase (TIMP) 1, and TIMP 2 correlate with the degree of LV diastolic dysfunction [23,30].…”

“…Independent predictor of mortality [39]. Anteroseptal myocardial infarction pattern-10% of cases [30]. High frequency of arrhythmias-especially ventricular events [47].…”

“…Myocardial tissue anisotropy is defined by the increased spatial dispersion of ventricular repolarization and plays a role in arrhythmogenesis [30]. The severe fibrotic process characteristic of SSc leads to direct damage of the cardiomyocytes.…”

QT Interval Prolongation in Patients with Systemic Sclerosis—Are the Holter ECG Recordings a Better Option for QT Interval Evaluation?

“…The prevalence of clinical conditions associated with cardiac involvement was estimated between 15–35% and are represented by pericardial effusions, myocardial ischemia, arrhythmias, and other ECG anomalies [ 6 ]. The most frequent ECG anomalies in systemic sclerosis patients are represented by p wave anomalies, non-specific anomalies of ST-segment and T wave, QRS microvoltage, and more subtle changes like the low values of the heart rate variability parameters, QT dispersion (QTd) increase, and prolongation of the corrected QT (QTc) interval [ 7 , 8 ]. Cardiac complications are the second cause of death in systemic sclerosis patients, and some studies are considering that sudden death is responsible for 13% of the deaths recorded in patients with systemic sclerosis [ 9 ].…”

Cardiac arrest during laparoscopic cholecystectomy in a patient with systemic sclerosis

“…Myocardial and ECG abnormalities in SSc can be diagnosed using magnetic resonance imaging and 24 h Holter monitoring and analysis for heart rate variability (HRV), heart rate turbulence (HRT), QT variability index, and arrhythmogenicity index. [ 5 6 ] We were deceived by the absence of suggestive history, normal echocardiography and short surgical procedure proposed. The case highlights the risk of an adverse cardiac event in unsuspecting SSc patients and the need for detailed investigation and prognostication for an adverse cardiac event, in patients presenting for anaesthesia for surgery, irrespective of the extent of surgical intervention, patient's functional and disease status.…”