Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Individuals with rheumatoid arthritis (RA) have two-fold higher risk of sudden death than age- and sex-matched controls without RA. We hypothesized that myocardial abnormalities are associated with corrected QT (QTc) interval in RA. This study aimed to prospectively investigate the association of myocardial abnormalities assessed using cardiac magnetic resonance imaging (CMR) with QTc interval in patients with RA without cardiac symptoms.
Methods: Consecutive patients with RA and control subjects without cardiac symptoms were enrolled. Patients with RA and control subjects with no history and/or clinical findings of systemic hypertension, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia underwent CMR. Patients with RA were administered non-biologic disease-modifying antirheumatic drugs (nbDMARDs) or biologic DMARDs (bDMARDs). Images were assessed for myocardial late gadolinium enhancement (LGE: an indicator of myocardial fibrosis or myocarditis) and T2-weighted imaging (T2WI: indicator of active inflammation). The 440-ms QTc interval was considered prolonged in this study. We investigated the association of MR-assessed myocardial abnormalities with QTc interval.
Results: We enrolled 70 patients (mean age, 55.2±6.7 years; 88% female). nbDMARDs (26, methotrexate [MTX, 9.7±2.1 mg]; 7, other drugs) and bDMARDs (15, infliximab; 15, tocilizumab; 7, abatacept plus MTX [9.8±1.4 mg]) were administered to 33 and 37 patients with RA, respectively. Myocardial and T2WI abnormalities were seen in 27 (38%) and 7 (10%) patients with RA, respectively. A total of 20 (28%) patients with RA were LGE positive, wherein 7 showed T2WI abnormalities. Simplified disease activity index scores in the LGE-positive group were significantly higher than that in the LGE-negative group (p=0.011). All patients with RA showed normal QTc interval (412.0±20.5 ms). However, the QTc interval in the LGE-positive group was significant higher than that in the LGE-negative group (431.1±20.1 vs 408.2±10.5 ms; p=0.001). Myocardial abnormalities were associated with QTc interval (ρ=0.356, p=0.014). The QTc interval in the bDMARDs group was significantly lower than that in the nbDMARDs group (p=0.001). Other RA characteristics such as disease duration, autoantibody status, and cardiovascular risk factors were not associated with myocardial abnormalities and QTc interval. Receiver operating characteristic analysis showed that the QTc interval reliably detected myocardial abnormalities (area under the curve 0.898; 95% confidence interval, 0.830–0.900). Considering patients with RA and normal QTc interval and using 420-ms cut-off value, the sensitivity and specificity for detecting myocardial abnormalities were 91% and 70%, respectively.
Conclusion: Myocardial abnormalities may contribute to the QTc interval. We should consider the possibility of subclinical cardiac involvements in RA cases even in those with normal QTc interval.
To cite this abstract in AMA style:Kobayashi Y, Kobayashi H, Nishiwaki A, Sugiyama K, Nagasawa Y, Nozaki T, Kitamura N, Takei M, Ikumi N, Inomata H. Myocardial Abnormalities Are Associated with Corrected QT Interval in Patients with Rheumatoid Arthritis without Cardiac Symptoms Assessed Using Cardiac Magnetic Resonance Imaging [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/myocardial-abnormalities-are-associated-with-corrected-qt-interval-in-patients-with-rheumatoid-arthritis-without-cardiac-symptoms-assessed-using-cardiac-magnetic-resonance-imaging/. Accessed October 27, 2020.
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