Limited Utility of Screening Electrocardiograms in Systemic Sclerosis: Data from the Canadian Scleroderma Research
Sophie Wojcik1, Christos Galatas1, Alaa Dekis1
1McGill University, Montreal, Quebec, Canada.
Insights
Electrocardiograms (EKGs) do not show more conduction abnormalities in systemic sclerosis (SSc) patients compared to controls. However, EKGs may reveal right heart stress and potential myocardial damage in SSc, warranting further investigation.
Area of Science:
- Cardiology
- Rheumatology
- Medical Diagnostics
Background:
- Systemic sclerosis (SSc) is associated with cardiac complications.
- Electrocardiograms (EKGs) have been proposed as a screening tool for cardiac disease in SSc.
Purpose of the Study:
- To compare the prevalence of EKG abnormalities in SSc patients versus controls.
- To evaluate the utility of EKGs as a screening tool for cardiac disease in SSc.
Main Methods:
- Retrospective comparison of EKGs from 833 SSc patients and 832 age- and gender-matched controls.
- Standardized EKG interpretation by two cardiologists.
- Statistical analysis using t-tests, chi-squared tests, and Fisher exact tests.
Main Results:
- No significant difference in conduction and rhythm abnormalities between SSc patients and controls.
- Increased prevalence of possible right atrial enlargement, right axis deviation, left atrial enlargement, poor R progression, and non-specific T wave abnormalities in SSc patients.
- These findings suggest potential right heart stress and myocardial damage in SSc.
Conclusions:
- Conduction abnormalities are not more prevalent in SSc patients than controls.
- EKG findings like right heart stress and poor R wave progression may indicate underlying structural heart disease in SSc.
- EKGs are not currently recommended as a screening tool for cardiac abnormalities in SSc pending further research.
Objective:
Recommendations have been made to use electrocardiograms (EKGs) to screen for cardiac disease in systemic sclerosis (SSc). The objective of this study was to compare the prevalence of EKG abnormalities in SSc and controls to help determine if the EKG should be used as a screening tool.
Methods:
EKGs from patients with SSc were compared with those from a random sample of age- and gender-matched controls. Two cardiologists read all EKGs using a standardized approach. The groups were compared using t-tests, chi-squared tests, and Fisher exact tests.
Results:
Patients with SSc (n = 833, mean ± SD disease duration 11.3 ± 9.3 years; 39.4% had diffuse cutaneous SSc) and controls (n = 832) were included. The prevalence of conduction and rhythm abnormalities were similar in the SSc and control groups. More patients with SSc than controls had possible right atrial enlargement (5% vs 0.1%, P < 0.001), right axis deviation (3.2% vs 0.4%, P < 0.001), left atrial enlargement (9.2% vs 1.6%, P < 0.001), poor/abnormal R progression (5.6% vs 2.2%, P < 0.001) and nonspecific T wave abnormalities (6.1% vs 3.4%, P = 0.008).
Conclusion:
Our findings suggest that conduction abnormalities are not more prevalent in those with SSc than in controls. Evidence of right heart stress on EKG in SSc may be secondary to pulmonary hypertension and left atrial enlargement, and poor R wave progression in precordial leads may indicate myocardial damage. Future studies are required to determine if these EKG abnormalities represent underlying structural heart disease, and, until that is proven, EKGs should not be considered a screening tool for cardiac abnormalities in SSc.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy