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Erschienen in: Herz 5/2022

21.10.2021 | Original articles

Assessment of proarrhythmic ventricular electrophysiological remodeling in patients with rheumatoid arthritis

verfasst von: Nazire Aladag, Ahmet Guner, Cagdas Arslan, Ali Kemal Kalkan, Serkan Kahraman, Hicaz Zencirkiran Agus, Nesrin Sen, Mehmet Engin Tezcan, M.D., Banu Sahin Yildiz, Mustafa Yildiz

Erschienen in: Herz | Ausgabe 5/2022

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Abstract

Introduction

Rheumatoid arthritis (RA) is related to cardiovascular disease and results in increased mortality rates. Ischemia, autonomic nervous system dysfunction, impaired cardiac ionic currents, and genetic predisposition may be the underlying mechanisms. Proarrhythmic ventricular electrophysiological remodeling detected on the basis of Tp‑e interval, Tp-e/QT, and Tp-e/QTc ratios plays a key role in the prognosis. Our aim was to assess proarrhythmic ventricular electrophysiological remodeling in patients with RA, a well-known chronic inflammatory disorder.

Materials and methods

A total of 163 patients with RA and 47 patients as a control group were included in this retrospective study. Proarrhythmic ventricular electrophysiological remodeling markers were evaluated in both groups along with baseline demographic and clinical variables. Patients using medication or with chronic disorders that can affect ventricular repolarization markers were excluded.

Results

The patients with RA had prolonged Tp‑e interval (66 ms [44–80]; 80 ms [78–96], p < 0.001) and increased Tp-e/QT ratio (0.18 [0.12–0.22]; 0.22 [0.20–0.24], p < 0.001) and Tp-e/QTc ratio (0.16 [0.11–0.19]; 0.20 [0.17–0.22], p < 0.001) compared to the control group.

Conclusion

The Tp‑e interval and Tp-e/QT ratio, which may help to clarify the pathophysiological mechanisms of ventricular arrhythmias, were increased in patients with RA.
Literatur
1.
Zurück zum Zitat Lawrence RC, Helmick CG, Arnett FC et al (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41:778–799CrossRef Lawrence RC, Helmick CG, Arnett FC et al (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41:778–799CrossRef
2.
Zurück zum Zitat Gabriel SE (2001) The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 27:269–281CrossRef Gabriel SE (2001) The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 27:269–281CrossRef
3.
Zurück zum Zitat Koopman WJ, Moreland LW (2005) Arthritis and allied conditions. A textbook of rheumatology, 15th edn. Lippincott Williams & Wilkins, Philadelphia Koopman WJ, Moreland LW (2005) Arthritis and allied conditions. A textbook of rheumatology, 15th edn. Lippincott Williams & Wilkins, Philadelphia
4.
Zurück zum Zitat Bacon PA, Townend JN (2001) Nails in the coffin: increasing evidence for the role of rheumatic disease in the cardiovascular mortality of rheumatoid arthritis [editorial. Arthritis Rheum 44:2707–2710CrossRef Bacon PA, Townend JN (2001) Nails in the coffin: increasing evidence for the role of rheumatic disease in the cardiovascular mortality of rheumatoid arthritis [editorial. Arthritis Rheum 44:2707–2710CrossRef
5.
Zurück zum Zitat Vandenbroucke JP, Hazevoet HM, Cats A (1984) Survival and cause of death in rheumatoid arthritis: a 25-year prospective followup. J Rheumatol 11:158–161PubMed Vandenbroucke JP, Hazevoet HM, Cats A (1984) Survival and cause of death in rheumatoid arthritis: a 25-year prospective followup. J Rheumatol 11:158–161PubMed
6.
Zurück zum Zitat Patel KHK, Jones TN, Sattler S, Mason JC, Ng FS (2020) Proarrhythmic electrophysiological and structural remodeling in rheumatoid arthritis. Am J Physiol Heart Circ Physiol 319(5):H1008–H1020CrossRef Patel KHK, Jones TN, Sattler S, Mason JC, Ng FS (2020) Proarrhythmic electrophysiological and structural remodeling in rheumatoid arthritis. Am J Physiol Heart Circ Physiol 319(5):H1008–H1020CrossRef
7.
Zurück zum Zitat Danesh J, Whincup P, Walker M et al (2000) Low grade inflammation and coronary heart disease: prospective study and updated metaanalyses. BMJ 321:199–204CrossRef Danesh J, Whincup P, Walker M et al (2000) Low grade inflammation and coronary heart disease: prospective study and updated metaanalyses. BMJ 321:199–204CrossRef
8.
Zurück zum Zitat Szmitko PE, Wang CH, Weisel RD et al (2003) New markers of inflammation and endothelial cell activation: Part I. Circulation 108:1917–1923CrossRef Szmitko PE, Wang CH, Weisel RD et al (2003) New markers of inflammation and endothelial cell activation: Part I. Circulation 108:1917–1923CrossRef
9.
Zurück zum Zitat Rost NS, Wolf PA, Kase CS et al (2001) Plasma concentration of C‑reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke 32:2575–2579CrossRef Rost NS, Wolf PA, Kase CS et al (2001) Plasma concentration of C‑reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke 32:2575–2579CrossRef
10.
Zurück zum Zitat Evrengül H, Dursunoglu D, Cobankara V, Polat B, Seleci D, Kabukçu S et al (2004) Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int 24:198–202CrossRef Evrengül H, Dursunoglu D, Cobankara V, Polat B, Seleci D, Kabukçu S et al (2004) Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int 24:198–202CrossRef
11.
Zurück zum Zitat Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L (2012) Autonomic impairment in rheumatoid arthritis. Int J Rheum Dis 15:419–426CrossRef Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L (2012) Autonomic impairment in rheumatoid arthritis. Int J Rheum Dis 15:419–426CrossRef
12.
Zurück zum Zitat Mountantonakis S, Deo R (2012) Biomarkers in atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. Cardiovasc Ther 30:74–80CrossRef Mountantonakis S, Deo R (2012) Biomarkers in atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. Cardiovasc Ther 30:74–80CrossRef
13.
Zurück zum Zitat Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W et al (2007) Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 4:1114–1116CrossRef Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W et al (2007) Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 4:1114–1116CrossRef
14.
Zurück zum Zitat Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M, Huber K et al (2011) Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol 44:301–308CrossRef Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M, Huber K et al (2011) Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol 44:301–308CrossRef
15.
Zurück zum Zitat Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT et al (2008) T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 41:567–574CrossRef Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT et al (2008) T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 41:567–574CrossRef
16.
Zurück zum Zitat Arnett FC, Edwothy SM, Bloch DA, Meshane DJ, Fries JF, Cooper NS (1988) The American Rheumatism Association 1987 criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRef Arnett FC, Edwothy SM, Bloch DA, Meshane DJ, Fries JF, Cooper NS (1988) The American Rheumatism Association 1987 criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRef
17.
Zurück zum Zitat Goldenberg I, Moss AJ, Zareba W (2006) QT interval: how to measure it and what is “normal”. J Cardiovasc Electrophysiol 17:333–336CrossRef Goldenberg I, Moss AJ, Zareba W (2006) QT interval: how to measure it and what is “normal”. J Cardiovasc Electrophysiol 17:333–336CrossRef
18.
Zurück zum Zitat Klingenberg R, Lüscher TF (2015) Rheumatoid arthritis and coronary atherosclerosis: two cousins engaging in a dangerous liaison. Eur Heart J 36:3423–3425CrossRef Klingenberg R, Lüscher TF (2015) Rheumatoid arthritis and coronary atherosclerosis: two cousins engaging in a dangerous liaison. Eur Heart J 36:3423–3425CrossRef
19.
Zurück zum Zitat Libby P (2008) Role of inflammation in atherosclerosis associated with rheumatoid arthritis. Am J Med 121:S21–S31CrossRef Libby P (2008) Role of inflammation in atherosclerosis associated with rheumatoid arthritis. Am J Med 121:S21–S31CrossRef
20.
Zurück zum Zitat Meune C, Touze E, Trinquart L, Allanore Y (2009) Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 48(10):1309–1313CrossRef Meune C, Touze E, Trinquart L, Allanore Y (2009) Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 48(10):1309–1313CrossRef
21.
Zurück zum Zitat Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Ballman KV, Roger VL, Jacobsen SJ, Gabriel SE (2005) Increased unrecognized coronary heart disease and sudden death in rheumatoid arthritis. A population-based cohort study. Arthritis Rheum 52:402–411CrossRef Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Ballman KV, Roger VL, Jacobsen SJ, Gabriel SE (2005) Increased unrecognized coronary heart disease and sudden death in rheumatoid arthritis. A population-based cohort study. Arthritis Rheum 52:402–411CrossRef
22.
Zurück zum Zitat Lazzerini PE, Capecchi PL, Acampa M, Galeazzi M, Laghi-Pasini F (2014) Arrhythmic risk in rheumatoid arthritis: the driving role of Systemic inflammation. Autoimmun Rev 13:936–944CrossRef Lazzerini PE, Capecchi PL, Acampa M, Galeazzi M, Laghi-Pasini F (2014) Arrhythmic risk in rheumatoid arthritis: the driving role of Systemic inflammation. Autoimmun Rev 13:936–944CrossRef
23.
Zurück zum Zitat Sgreccia A, Morelli S, Ferrante L, Perrone C, De Marzio P, De Vincentiis G et al (1998) QT interval and QT dispersion in systemic sclerosis(scleroderma). J Inter Med 243:127–132 Sgreccia A, Morelli S, Ferrante L, Perrone C, De Marzio P, De Vincentiis G et al (1998) QT interval and QT dispersion in systemic sclerosis(scleroderma). J Inter Med 243:127–132
24.
Zurück zum Zitat Adlan AM, Panoulas VF, Smith JP, Fisher JP, Kitas GD (2015) Association between correctedQT interval and inflammatory cytokines in rheumatoid arthritis. J Rheumatol 42:421–428CrossRef Adlan AM, Panoulas VF, Smith JP, Fisher JP, Kitas GD (2015) Association between correctedQT interval and inflammatory cytokines in rheumatoid arthritis. J Rheumatol 42:421–428CrossRef
25.
Zurück zum Zitat Acar GR, Akkoyun M, Nacar AB, Dirnak I, Yıldırım Çetin G, Nur Yıldırım M et al (2014) Evaluation of Tp‑e interval and Tp-e/QT ratio in patients with rheumatoid arthritis. Turk Kardiyol Dern Ars 42:29–34CrossRef Acar GR, Akkoyun M, Nacar AB, Dirnak I, Yıldırım Çetin G, Nur Yıldırım M et al (2014) Evaluation of Tp‑e interval and Tp-e/QT ratio in patients with rheumatoid arthritis. Turk Kardiyol Dern Ars 42:29–34CrossRef
26.
Zurück zum Zitat Panoulas VF, Toms TE, Douglas KM, Sandoo A, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD (2014) Prolonged QTc interval predicts all-cause mortality inpatients with rheumatoid arthritis: an association driven by high inflammatory burden. Baillieres Clin Rheumatol 53:131–137 Panoulas VF, Toms TE, Douglas KM, Sandoo A, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD (2014) Prolonged QTc interval predicts all-cause mortality inpatients with rheumatoid arthritis: an association driven by high inflammatory burden. Baillieres Clin Rheumatol 53:131–137
27.
Zurück zum Zitat Zhang Y, Post WS, Blasco-Colmenares E et al (2011) Electrocardiographic QT interval and mortality: ameta-analysis. Epidemiology 22:660–670CrossRef Zhang Y, Post WS, Blasco-Colmenares E et al (2011) Electrocardiographic QT interval and mortality: ameta-analysis. Epidemiology 22:660–670CrossRef
28.
Zurück zum Zitat Kors JA, Ritsema van Eck HJ, van Herpen G (2008) The meaning of theTp-Te interval and its diagnostic value. J Electrocardiol 41:575–580CrossRef Kors JA, Ritsema van Eck HJ, van Herpen G (2008) The meaning of theTp-Te interval and its diagnostic value. J Electrocardiol 41:575–580CrossRef
29.
Zurück zum Zitat Acar GR, Yorgun H, İnci MF, Akkoyun M, Bakan B, Nacar AB et al (2014) Evaluation of Tp‑e interval and Tp-e/QT ratio in patients withankylosing spondylitis. Mod Rheumatol 24(2):327–330CrossRef Acar GR, Yorgun H, İnci MF, Akkoyun M, Bakan B, Nacar AB et al (2014) Evaluation of Tp‑e interval and Tp-e/QT ratio in patients withankylosing spondylitis. Mod Rheumatol 24(2):327–330CrossRef
30.
Zurück zum Zitat Akcay A, Acar G, Sayarlioglu M, Sokmen A, Kaya H, Ispiroglu M et al (2009) QT dispersion and transmural dispersion of repolarization inpatients with familial Mediterranean fever. Mod Rheumatol 19:550–555CrossRef Akcay A, Acar G, Sayarlioglu M, Sokmen A, Kaya H, Ispiroglu M et al (2009) QT dispersion and transmural dispersion of repolarization inpatients with familial Mediterranean fever. Mod Rheumatol 19:550–555CrossRef
31.
Zurück zum Zitat Yayla C, Yayla ME, Yayla KG, Ilgen U, Akboğa MK, Düzgün N (2016) The assessment of Tp‑e interval and Tp-e/QT ratio inpatients with systemic sclerosis. Arch Rheumatol 31(2):139–144CrossRef Yayla C, Yayla ME, Yayla KG, Ilgen U, Akboğa MK, Düzgün N (2016) The assessment of Tp‑e interval and Tp-e/QT ratio inpatients with systemic sclerosis. Arch Rheumatol 31(2):139–144CrossRef
32.
Zurück zum Zitat Erikssen G, Liestol K, Gullestad L, Haugaa KH, Bendz B, Amlie JP (2012) The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol 17:85–94CrossRef Erikssen G, Liestol K, Gullestad L, Haugaa KH, Bendz B, Amlie JP (2012) The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol 17:85–94CrossRef
Metadaten
Titel
Assessment of proarrhythmic ventricular electrophysiological remodeling in patients with rheumatoid arthritis
verfasst von
Nazire Aladag
Ahmet Guner
Cagdas Arslan
Ali Kemal Kalkan
Serkan Kahraman
Hicaz Zencirkiran Agus
Nesrin Sen
Mehmet Engin Tezcan, M.D.
Banu Sahin Yildiz
Mustafa Yildiz
Publikationsdatum
21.10.2021
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 5/2022
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-021-05072-9

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