ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid
Laura Geraldino-Pardilla1, Yevgeniya Gartshteyn1, Paloma Piña2
1Columbia University, College of Physicians & Surgeons , New York, New York , USA.
Insights
Systemic lupus erythematosus (SLE) patients show significantly higher rates of electrocardiogram (ECG) abnormalities, including ST-T changes and prolonged QTc intervals, compared to rheumatoid arthritis patients. These findings highlight increased cardiovascular risk in SLE.
Area of Science:
- Cardiology
- Rheumatology
- Public Health
Background:
- Cardiovascular disease (CVD) is a major cause of mortality in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
- Electrocardiogram (ECG) abnormalities like non-specific ST-T changes and corrected QT-interval (QTc) prolongation are known CVD mortality predictors in the general population.
- Previous research indicated these ECG abnormalities in an SLE inception cohort, but their prevalence in established SLE remains unevaluated.
Purpose of the Study:
- To investigate the prevalence of non-specific ST-T abnormalities and QTc prolongation in patients with established SLE.
- To compare the prevalence of these ECG abnormalities between patients with SLE and patients with RA.
- To identify potential associations between ECG abnormalities and patient demographics or disease characteristics.
Main Methods:
- A cross-sectional study comparing 50 patients with SLE and 139 patients with RA, all without pre-existing CVD.
- Patients were assessed for non-specific ST-T abnormalities and QTc interval duration.
- Demographics, disease characteristics, and CVD risk factors were collected and adjusted for in the analysis.
Main Results:
- Patients with SLE exhibited a 3.3-fold higher adjusted prevalence of non-specific ST-T abnormalities (56% vs 17%; p <0.0001) compared to RA patients.
- The QTc interval was significantly longer in SLE patients (26 ms longer; p=0.002) compared to RA patients.
- The SLE cohort was predominantly Hispanic and black (96%), with a mean age of 36 years and 92% women, while the RA group was older with more men.
Conclusions:
- This study reveals a high prevalence of ECG abnormalities in a predominantly Hispanic and black SLE patient population.
- The findings suggest an elevated cardiovascular risk associated with SLE, indicated by frequent ST-T abnormalities and QTc prolongation.
- Further longitudinal studies are warranted to assess the progression of these ECG changes and their link to potentially life-threatening arrhythmias and cardiovascular events in SLE patients.
Objectives:
Cardiovascular 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.
Methods:
We 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.
Results:
Patients 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.
Conclusions:
This 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.
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