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Assessment of proarrhythmic ventricular electrophysiological remodeling in patients with rheumatoid arthritis

Untersuchung des proarrhythmischen ventrikulären elektrophysiologischen Remodelings bei Patienten mit rheumatoider Arthritis

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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.

Zusammenfassung

Hintergrund

Die rheumatoide Arthritis (RA) ist mit Herz-Kreislauf-Erkrankungen vergesellschaftet und führt zu einer erhöhten Mortalitätsrate. Ischämie, eine Funktionsstörung des autonomen Nervensystems, beeinträchtigte kardiale Ionenströme und genetische Prädisposition sind möglicherweise die zugrunde liegenden Mechanismen. Proarrhythmisches ventrikuläres elektrophysiologisches Remodeling, das auf der Grundlage des Tp-e-Intervalls, des Tp-e/QT- und des Tp-e/QTc-Verhältnisses diagnostiziert wird, spielt eine wesentliche Rolle für die Prognose. Ziel der vorliegenden Arbeit war es, das proarrhythmische ventrikuläre elektrophysiologische Remodeling bei Patienten mit RA als einer bekannten chronischen entzündlichen Erkrankung zu untersuchen.

Material und Methoden

In diese retrospektive Studie wurden 163 Patienten mit RA und 47 Patienten als Kontrollgruppe einbezogen. Marker für das proarrhythmische ventrikuläre elektrophysiologische Remodeling wurden in beiden Gruppen zusammen mit demografischen und klinischen Ausgangsparametern untersucht. Patienten, die Medikamente nehmen, oder mit chronischen Krankheiten, die ventrikuläre Repolarisationsmarker beeinflussen können, wurden aus der Studie ausgeschlossen.

Ergebnisse

Die RA-Patienten wiesen im Vergleich mit der Kontrollgruppe ein verlängertes Tp-e-Intervall auf (66 ms [44–80]; 80 ms [78–96], p < 0,001) und ein erhöhtes Tp-e/QT-Verhältnis (0,18 [0,12–0,22]; 0,22 [0,20–0,24]; p < 0,001) sowie Tp-e/QTc-Verhältnis (0,16 [0,11–0,19]; 0,20 [0,17–0,22], p < 0,001).

Schlussfolgerung

Das Tp-e-Intervall und das Tp-e/QT-Verhältnis, die dazu beitragen können, die pathophysiologischen Mechanismen ventrikulärer Arrhythmien zu entschlüsseln, waren bei Patienten mit RA erhöht.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Health Sciences, Dr Lutfi Kirdar Kartal City Hospital, Istanbul, Turkey

    Nazire Aladag & Banu Sahin Yildiz

  2. Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Ahmet Guner, Cagdas Arslan, Ali Kemal Kalkan, Serkan Kahraman, Hicaz Zencirkiran Agus & Mustafa Yildiz

  3. Department of Rheumatology, University of Health Sciences, Dr Lutfi Kirdar Kartal City Hospital, Istanbul, Turkey

    Nesrin Sen & Mehmet Engin Tezcan M.D.

  4. Department of Cardiology, Istanbul University-Cerrahpasa Cardiology Institute, Istanbul, Turkey

    Mustafa Yildiz

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  1. Nazire Aladag
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Correspondence to Mehmet Engin Tezcan M.D..

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Conflict of interest

N. Aladag, A. Guner, C. Arslan, A.K. Kalkan, S. Kahraman, H.Z. Agus, N. Sen, M.E. Tezcan, B.S. Yildiz and M. Yildiz declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Aladag, N., Guner, A., Arslan, C. et al. Assessment of proarrhythmic ventricular electrophysiological remodeling in patients with rheumatoid arthritis. Herz 47, 465–470 (2022). https://doi.org/10.1007/s00059-021-05072-9

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  • DOI: https://doi.org/10.1007/s00059-021-05072-9

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