Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud's - Clinical Aspects and Therapeutics II
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose:
Heart involvement is common during Systemic Sclerosis (SSc), even if often clinically silent, and represents the leading cause of death in about one third of patients. Arrhythmias, in particular, are a frequent event and portend a bad prognosis, accounting alone for 6% of SSc total deaths. We performed a prospective cohort study to define the role of 24h-ECG-Holter in the identification of patients at high risk of life-threatening arrhythmias and sudden cardiac death(SCD) in Systemic Sclerosis.
Methods:
100 SSc-patients with symptoms and/or signs suggestive of cardiac involvement underwent 24h-ECG-Holter. The primary end-point was a composite of SCD or the need for implantable cardioverter defibrillator(ICD). A mean follow-up of 23.1±16.0 months was reached.
Results:
Fifty-six patients(56%) had 24h-ECG-Holter alterations and 24(24%) presented frequent ventricular ectopic beats(VEBs), classified as polymorphic in 11 (26.2%). The mean number of VEBs was strikingly high (2046.1 ± 6027.8//24h), with a maximum of 33615/24h. Supraventricular ectopic beats (SVEBs)>1000/24h were also frequent (19%), with a mean number of 798.9±1835.6 per day; seventeen patients (17%) presented runs of SVEBs. Fourteen patients (14%) presented episodes of supraventricular paroxysmal tachycardia (SVPT), with a maximum of 36 beats, while 11 patients (11%) exhibited runs of NS-VT, the longest of 34 beats. The number of VEBs correlated with cardiac troponin T(cTnT) levels (R=0.4,p<0.001) and inversely correlated with left ventricular ejection fraction(LV-EF) on echocardiography (R=-0.4,p<0.001). Furthermore, the number of VEBs directly correlated with severity index and with the extension of skin involvement evaluated by the mRSS (p=0.3 for both correlations).
During the follow-up, 5 patients died of SCD and two required ICD-implantation for life-threatening arrhythmias. The 7 patients who met the composite end-point had a higher number of VEBs, higher levels of cTnT and NT-proBNP and lower LV-EF(p=0.001 for all correlations), while in all of them a pulmonary arterial hypertension was ruled out by right heart catheterization. All 7 patients had frequent ventricular ectopy at baseline ECG-Holter, while LV-EF range in patients who met the primary end-point was wide and LV-EF was not reduced in all. At ROC curve, VEBs>1190/24h showed 100% of sensitivity and 83% of specificity to predict the primary end-point (AUROC=0.92,p<0.0001). Patients with VEBS>1190/24h had lower LV-EF and higher cTnT levels compared to patients with VEBs<1190/24h.
Conclusion:
VEBs are frequent in SSc and correlate with cardiac damage; VEBS>1190/24h identify patients at high risk of major arrhythmic complications. 24h-ECG-Holter need to be considered as a part of routine evaluation in SSc-patients with suspicious cardiac involvement and it could be an additional risk-stratification technique for selection of SSc-patients at high-risk of SCD, in whom an ICD-implantation could represent a potential life-saving intervention.
To cite this abstract in AMA style:
De Luca G, Bosello SL, Gabrielli F, Berardi G, parisi F, Rucco M, Canestrari G, Galiuto L, Crea F, Loperfido F, Ferraccioli G. Prognostic Role of Ventricular Ectopic Beats in Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/prognostic-role-of-ventricular-ectopic-beats-in-systemic-sclerosis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prognostic-role-of-ventricular-ectopic-beats-in-systemic-sclerosis/