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. 2007 Mar;99(3):232–237.

Cardiac repolarization abnormalities and increased sympathetic activity in scleroderma.

Orcun Ciftci 1, Ahmet Mesut Onat 1, Bunyamin Yavuz 1, Ali Akdogan 1, Kudret Aytemir 1, Lale Tokgozoglu 1, Levent Sahiner 1, Ali Deniz 1, Kemal Ureten 1, Guler Kizilca 1, Meral Calguneri 1, Ali Oto 1
PMCID: PMC2569635  PMID: 17393947

Abstract

BACKGROUND: Cardiac involvement in scleroderma is a poor prognostic sign and is usually underdiagnosed, particularly in asymptomatic patient. This paper focuses on QT dynamicity and heart rate variability (HRV) in patients with scleroderma and controls in an attempt to investigate the cardiac autonomic system and ventricular repolarization. METHODS: Sixty patients with scleroderma and 30 age- and sex-matched healthy controls who had no cardiovascular risk factors were included in this study. All patients and the controls underwent a 24-hour holter recording as well as a transthoracic echocardiography. HRV and QT dynamicity parameters were calculated. RESULTS: In HRV analysis, autonomic balance was changed in favor of the sympathetic system in patients with diffuse scleroderma. In QT dynamicity analysis, QT/RR slopes were significantly steeper in patients with diffuse scleroderma compared to patients with limited scleroderma and controls (QTapex/RR: 0.24 +/- 0.16, 0.15 +/- 0.03, 0.14 +/- 0.03 respectively p < 0.001; QTend/RR: 0.26 +/- 0.17, 0.14 +/- 0.04, 0.13 +/- 0.05, respectively p < 0.001). CONCLUSIONS: Patients with diffuse scleroderma may have asymptomatic cardiac repolarization abnormalities and autonomic dysfunction. Our results may indicate that QT dynamicity and HRV can be useful noninvasive methods that may detect impaired state of autonomic balance and cardiac repolarization in patients with diffuse scleroderma.

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Selected References

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  1. Bonnemeier Hendrik, Wiegand Uwe K. H., Bode Frank, Hartmann Franz, Kurowski Volkhard, Katus Hugo A., Richardt Gert. Impact of infarct-related artery flow on QT dynamicity in patients undergoing direct percutaneous coronary intervention for acute myocardial infarction. Circulation. 2003 Dec 8;108(24):2979–2986. doi: 10.1161/01.CIR.0000103682.19844.10. [DOI] [PubMed] [Google Scholar]
  2. Bulkley B. H., Ridolfi R. L., Salyer W. R., Hutchins G. M. Myocardial lesions of progressive systemic sclerosis. A cause of cardiac dysfunction. Circulation. 1976 Mar;53(3):483–490. doi: 10.1161/01.cir.53.3.483. [DOI] [PubMed] [Google Scholar]
  3. Clements P., Lachenbruch P., Siebold J., White B., Weiner S., Martin R., Weinstein A., Weisman M., Mayes M., Collier D. Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. J Rheumatol. 1995 Jul;22(7):1281–1285. [PubMed] [Google Scholar]
  4. D'Angelo W. A., Fries J. F., Masi A. T., Shulman L. E. Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med. 1969 Mar;46(3):428–440. doi: 10.1016/0002-9343(69)90044-8. [DOI] [PubMed] [Google Scholar]
  5. Dessein P. H., Joffe B. I., Metz R. M., Millar D. L., Lawson M., Stanwix A. E. Autonomic dysfunction in systemic sclerosis: sympathetic overactivity and instability. Am J Med. 1992 Aug;93(2):143–150. doi: 10.1016/0002-9343(92)90043-b. [DOI] [PubMed] [Google Scholar]
  6. Ellidokuz E., Kaya D. The effect of metoclopramide on QT dynamicity: double-blind, placebo-controlled, cross-over study in healthy male volunteers. Aliment Pharmacol Ther. 2003 Jul 1;18(1):151–155. doi: 10.1046/j.1365-2036.2003.01641.x. [DOI] [PubMed] [Google Scholar]
  7. Fauchier L., Babuty D., Poret P., Autret M. L., Cosnay P., Fauchier J. P. Effect of verapamil on QT interval dynamicity. Am J Cardiol. 1999 Mar 1;83(5):807-8, A10-1. doi: 10.1016/s0002-9149(98)01001-7. [DOI] [PubMed] [Google Scholar]
  8. Ferri C., Emdin M., Giuggioli D., Carpeggiani C., Maielli M., Varga A., Michelassi C., Pasero G., L'Abbate A. Autonomic dysfunction in systemic sclerosis: time and frequency domain 24 hour heart rate variability analysis. Br J Rheumatol. 1997 Jun;36(6):669–676. doi: 10.1093/rheumatology/36.6.669. [DOI] [PubMed] [Google Scholar]
  9. Follansbee W. P., Miller T. R., Curtiss E. I., Orie J. E., Bernstein R. L., Kiernan J. M., Medsger T. A., Jr A controlled clinicopathologic study of myocardial fibrosis in systemic sclerosis (scleroderma). J Rheumatol. 1990 May;17(5):656–662. [PubMed] [Google Scholar]
  10. Furst D. E. Rational therapy in the treatment of systemic sclerosis. Curr Opin Rheumatol. 2000 Nov;12(6):540–544. doi: 10.1097/00002281-200011000-00011. [DOI] [PubMed] [Google Scholar]
  11. Hermosillo A. G., Ortiz R., Dábague J., Casanova J. M., Martínez-Lavín M. Autonomic dysfunction in diffuse scleroderma vs CREST: an assessment by computerized heart rate variability. J Rheumatol. 1994 Oct;21(10):1849–1854. [PubMed] [Google Scholar]
  12. James T. N. De subitaneis mortibus. VIII. Coronary arteries and conduction system in scleroderma heart disease. Circulation. 1974 Oct;50(4):844–856. doi: 10.1161/01.cir.50.4.844. [DOI] [PubMed] [Google Scholar]
  13. Melzer Christoph, Sowelam Sameh, Sheldon Todd J., Bondke H. J., Baumann Gert, Combs Bill, Theres Heinz. Reduction of right ventricular pacing in patients with sinus node dysfunction using an enhanced search AV algorithm. Pacing Clin Electrophysiol. 2005 Jun;28(6):521–527. doi: 10.1111/j.1540-8159.2005.09470.x. [DOI] [PubMed] [Google Scholar]
  14. Milliez Paul, Leenhardt Antoine, Maisonblanche Pierre, Vicaut Eric, Badilini Fabio, Siliste Calin, Benchetrit Chemia, Coumel Philippe, EMIAT Investigators Usefulness of ventricular repolarization dynamicity in predicting arrhythmic deaths in patients with ischemic cardiomyopathy (from the European Myocardial Infarct Amiodarone Trial). Am J Cardiol. 2005 Apr 1;95(7):821–826. doi: 10.1016/j.amjcard.2004.11.047. [DOI] [PubMed] [Google Scholar]
  15. Mitchell H., Bolster M. B., LeRoy E. C. Scleroderma and related conditions. Med Clin North Am. 1997 Jan;81(1):129–149. doi: 10.1016/s0025-7125(05)70508-3. [DOI] [PubMed] [Google Scholar]
  16. Morelli S., Piccirillo G., Fimognari F., Sgreccia A., Ferrante L., Morabito G., De Marzio P., Valesini G., Marigliano V. Twenty-four hour heart period variability in systemic sclerosis. J Rheumatol. 1996 Apr;23(4):643–645. [PubMed] [Google Scholar]
  17. Pathak Atul, Curnier Daniel, Fourcade Joëlle, Roncalli Jérôme, Stein Phyllis K., Hermant Patricia, Bousquet Marc, Massabuau Pierre, Sénard Jean-Michel, Montastruc Jean-Louis. QT dynamicity: a prognostic factor for sudden cardiac death in chronic heart failure. Eur J Heart Fail. 2005 Mar 2;7(2):269–275. doi: 10.1016/j.ejheart.2004.10.016. [DOI] [PubMed] [Google Scholar]
  18. Pumprla Jiri, Howorka Kinga, Groves David, Chester Michael, Nolan James. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol. 2002 Jul;84(1):1–14. doi: 10.1016/s0167-5273(02)00057-8. [DOI] [PubMed] [Google Scholar]
  19. SACKNER M. A., AKGUN N., KIMBEL P., LEWIS D. H. THE PATHOPHYSIOLOGY OF SCLERODERMA INVOLVING THE HEART AND RESPIRATORY SYSTEM. Ann Intern Med. 1964 Apr;60:611–630. doi: 10.7326/0003-4819-60-4-611. [DOI] [PubMed] [Google Scholar]
  20. Schwartz P. J., Locati E. H., Moss A. J., Crampton R. S., Trazzi R., Ruberti U. Left cardiac sympathetic denervation in the therapy of congenital long QT syndrome. A worldwide report. Circulation. 1991 Aug;84(2):503–511. doi: 10.1161/01.cir.84.2.503. [DOI] [PubMed] [Google Scholar]
  21. Sgreccia A., Morelli S., Ferrante L., Perrone C., De Marzio P., De Vincentiis G., Scopinaro F. QT interval and QT dispersion in systemic sclerosis (scleroderma). J Intern Med. 1998 Feb;243(2):127–132. [PubMed] [Google Scholar]
  22. Suarez-Almazor M. E., Bruera E., Russell A. S. Normal cardiovascular autonomic function in patients with systemic sclerosis (CREST variant). Ann Rheum Dis. 1988 Aug;47(8):672–674. doi: 10.1136/ard.47.8.672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tavernier R., Jordaens L., Haerynck F., Derycke E., Clement D. L. Changes in the QT interval and its adaptation to rate, assessed with continuous electrocardiographic recordings in patients with ventricular fibrillation, as compared to normal individuals without arrhythmias. Eur Heart J. 1997 Jun;18(6):994–999. doi: 10.1093/oxfordjournals.eurheartj.a015389. [DOI] [PubMed] [Google Scholar]
  24. Zareba Wojciech. QT-RR slope: dynamics of repolarization in the risk stratification. J Cardiovasc Electrophysiol. 2003 Mar;14(3):234–235. [PubMed] [Google Scholar]

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