Leveraging ECG Markers to Predict Ventricular Arrhythmia in Systemic Sclerosis

The use of novel laboratory biomarkers and the measurement of specific parameters on electrocardiograms may improve the early recognition of cardiac involvement in patients with systemic sclerosis (SSc), according to a review published in Rheumatology. 

Cardiac disease or dysfunction from autoimmune activity in SSc is highly prevalent, with approximately 20% of patients with comorbid primary cardiovascular disease, and approximately 20% of patients exhibiting cardiac involvement secondary to interstitial lung disease and/or pulmonary arterial hypertension. Subclinical cardiac involvement has been detected on cardiac magnetic resonance imaging in up to 75% of patients with SSc.

Factors underlying cardiac symptoms in SSc are generally secondary to conductive and impulse-generating disorders, which are the consequence of cellular and structural alterations of the myocardium. Patients with SSc who develop cardiac arrhythmias or conduction abnormalities have a higher relative risk for mortality, but the utility of electrocardiographic markers in predicting arrhythmias in this population is still unclear. The investigators sought to determine whether certain electrocardiogram parameters that reflect ventricular repolarization could be used more effectively to identify patients with SSc at increased risk for ventricular arrhythmia and sudden cardiac death.

Recent studies have reported contradictory data on the applicability of QT interval and dispersion in patients with SSc; however, there is agreement that the occurrence of ventricular arrhythmias and sudden cardiac death can be predicted by the prolongation of these electrocardiographic parameters. In addition to measures of N-terminal pro-brain natriuretic peptide and serum high-sensitive troponin, there may be additional novel laboratory biomarkers that can be used to optimize diagnosis and assessment of inflammatory activity. By using echocardiography and laboratory biomarkers as cornerstones of diagnosis, clinicians may be able to better evaluate the extent of cardiac damage and more accurately predict long-term outcomes.

“[I]nvestigating the [electrocardiogram] alterations together with echocardiographic findings and laboratory parameters may result in the building of a more effective risk stratification and management strategy of patients with SSc,” the researchers concluded.

Reference

Sebestyén V, Szűcs G, Páll D, et al. Electrocardiographic markers for the prediction of ventricular arrhythmias in patients with systemic sclerosis [published online January 14, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez644