E. Gialafos, P. Konstantopoulou, C. Voulgari, I. Giavri, S. Panopoulos, G. Vaiopoulos, M. Mavrikakis, I. Moyssakis, P. Sfikakis
First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Athens, Greece. email@example.com
Cardiac involvement may be under-diagnosed in asymptomatic patients with systemic sclerosis (SSc). Standard electrocardiography-derived spatial QRS-T angle (spQRS-Ta) is an established marker of ventricular repolarisation heterogeneity, and a strong independent predictor of cardiac morbidity and mortality, including sudden death, in the general population. We examined whether spQRS-Ta is abnormal in asymptomatic SSc patients and assessed its predictive value for possibly concurrent, serious ventricular arrhythmia.
SpQRS-Ta and 24-hour Holter recordings were obtained from 69 SSc patients (aged 51±13 years, 63 women) without clinically evident cardiac involvement and having left ventricular ejection fraction at least 50% by echocardiography. `Healthy` subjects matched 1:1 with patients for age, gender and body mass index served as controls.
SpQRS-Ta was wider in SSc (median value 15.6°, interquartile range 10.6–24.3°) than controls (10.5°, 7.3–13.5°, p=0.0001) and not associated with skin fibrosis extent or specific clinical manifestations and autoantibodies. Twenty-four-hour Holter recordings revealed couplets of ventricular beats in six (Lown class IVa) and non-sustained ventricular tachycardia in five patients (Lown class IVb); spQRS-Ta was wider in those eleven patients with serious ventricular arrhythmia than the remaining patients (24.9°, 14.9–31.3° vs. 14.4°, 9.6–22.3°; p=0.02). A spQRS-Ta>19.3° demonstrated 80% sensitivity and 68% specificity (area under the curve 0.81, p=0.02) to predict the presence of non-sustained ventricular tachycardia in Holter monitoring.
Ventricular repolarisation heterogeneity, as reflected by wider spQRS-Ta, is common in SSc. Increased spQRS-Ta could serve as a simple screening test for further investigation to identify patients at risk or prone to develop life-threatening ventricular arrhythmia.
PMID: 22510222 [PubMed]
Received: 09/06/2011 - Accepted : 26/10/2011 - In Press: 25/06/2012 - Published: 25/06/2012