Prevalence and associated factors of resting electrocardiogram abnormalities among systemic lupus erythematosus patients without cardiovascular disease

Abstract

BackgroundElectrocardiogram (ECG) cardiovascular disease (CVD) abnormalities (ECG-CVD) are predictive of subsequent CVD events in the general population. Systemic lupus erythematosus (SLE) patients are vulnerable to CVD. We aimed to determine the prevalence of ECG-CVD in SLE patients and to examine the risk factors associated with ECG-CVD.MethodsA 12-lead resting supine ECG was performed on consecutive adult patients attending the clinic. One cardiologist interpreted the ECGs. ECG-CVD were defined as the presence of one or more of the following 4 elements (ECG-4): ST-segment and/or T-wave abnormalities, left ventricular hypertrophy (LVH), left axis deviation (LAD), left bundle branch block (LBBB) and right bundle branch block (RBBB). ECG-5 included the same elements as ECG-4 and the Q-wave. Repeated measurement data were created and the associations between ECG-4/ECG-5 and demographics were evaluated with univariate and multivariate Cox regression models.ResultsOf 487 SLE patients, 104 (21.4%) and 118 (24.2%) patients had one or more of the ECG-4 and ECG-5 elements, respectively. A higher prevalence of ECG-CVD was found in patients with a longer SLE disease duration, and the burden of ECG-CVD elements increased with age. Increased age, active SLE disease, and damage were associated with ECG4 and ECG-5, while treatment of hyperlipidemia was protective.ConclusionA high prevalence of ECG-4 (21.4%) and ECG-5 (24.2%) was found in this SLE cohort. Controlling SLE disease activity is important since it was associated with ECG-4 and ECG-5. Early identification of ECG-4 and ECG-5 in SLE patients might allow for better stratification and risk management.

Association of Hydroxychloroquine Use With Decreased Incident Atrial Fibrillation in Systemic Lupus Erythematosus

“…Atrial fibrillation is the most common cardiac arrhythmia in the general population, and patients with SLE are at higher risk (2–4). Hydroxychloroquine is an integral component of care for cutaneous and musculoskeletal manifestations of SLE.…”

“…A recent case–control study demonstrated higher incidence of atrial fibrillation in patients with SLE, a 4.5‐fold higher incidence in men with SLE as compared to women with SLE, and a correlation with disease activity (3). Another recent study showed that the prevalence of resting electrocardiogram (EKG) changes, including atrial fibrillation, that are predictive of future clinical cardiovascular disease was greater among patients with SLE than the general population (prevalence of up to 24% versus 17%) (4).

A few in vitro and animal model studies have explored the antiarrhythmic effect of hydroxychloroquine.

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Cardiovascular magnetic resonance detects silent heart disease missed by echocardiography in systemic lupus erythematosus

“…From the clinical experience of the authors, it is known that the atypical presentation of cardiac involvement in SLE sadly leads some healthcare professionals to mistakenly attributing patient symptoms to psychosomatic manifestations, unrelated to actual organ involvement. However, according to the recent literature, sinus tachycardia is the commonest finding seen in SLE patients; 22 furthermore, ST-segment, T-wave abnormalities, left ventricular hypertrophy, left axis deviation, left bundle branch block and right bundle branch block had a high prevalence in a SLE; 23 finally, a substantial proportion of recent-onset SLE patients exhibited repolarization abnormalities. 24 A careful clinical evaluation of SLE patients from this study cohort documented that similar characteristics, such as those mentioned in the literature, were also common, which was the main motivating factor for re-evaluating these patients with CMR.…”

Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus

“… 3 Research has shown that non-traditional risk factors such as prednisone dose, 9 homocysteine, C reactive protein, proinflammatory high-density lipoprotein (HDL) and certain autoantibodies also play a role in accelerating the atherosclerotic process and are not captured in the current CVD risk tools. 5 10 Several groups have reported the prevalence of coronary heart disease (CHD) in their lupus cohorts and have shown that female patients with lupus are fivefold to sixfold more likely to develop CHD and that female patients with lupus aged 35–44 are 52 times more likely to develop CHD than the general population of a large community-based study of CHD, Framingham Offspring Study. 11 12 Moreover, SLE is recognised as an independent risk factor for CVD.…”