Fragmented QRS complex in patients with systemic lupus erythematosus at the time of diagnosis and its relationship with disease activity
Autoři:
Masahiro Hosonuma aff001; Nobuyuki Yajima aff001; Ryo Takahashi aff001; Ryo Yanai aff001; Taka-aki Matsuyama aff004; Eiji Toyosaki aff005; Jumpei Saito aff006; Kengo Kusano aff007; Hiroshi Morita aff008
Působiště autorů:
Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
aff001; Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
aff002; Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
aff003; Department of Legal Medicine, Showa University, School of Medicine, Tokyo, Japan
aff004; Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
aff005; Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
aff006; Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
aff007; Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
aff008
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0227022
Souhrn
Objective
Cardiovascular disease is an important contributor to the mortality rate of patients with systemic lupus erythematosus (SLE), which is related to SLE disease activity. Fragmented QRS (fQRS) complexes, defined by additional spikes in the QRS complex, are useful for identifying myocardial scars on electrocardiography and can be an independent predictor of cardiac events. We aimed to assess the relationship between disease activity in patients with SLE and fQRS at the time of diagnosis.
Methods
Forty-four patients with SLE were included. Patients with cardiac diseases, other rheumatic diseases, and prior treatment at the time of electrocardiography measurement were excluded. The appearance of fQRS represented exposure. The primary outcome was SLE Disease Activity Index 2000 (SLEDAI-2K). Multiple regression analysis was conducted to assess the association between fQRS and SLEDAI-2K adjusted for age, sex, and time from the estimated onset date to the date of diagnosis.
Results
Among patients with SLE at diagnosis, 26 (59.1%) had fQRS. The median SLEDAI-2K was 18 (interquartile range [IQR], 12–22) and 9 (IQR, 8–15) in the fQRS(+) and fQRS(-) groups, respectively. SLEDAI-2K was significantly higher in the fQRS(+) group than in the fQRS(-) group (regression coefficient, 2.69; 95% confidence interval, 0.76–4.61; p = 0.008).
Conclusion
Our results suggested that fQRS(+) patients with SLE had high disease activity. fQRS could likely detect subclinical myocardial involvement in patients with SLE and predict long-term occurrence of cardiac events.
Klíčová slova:
Antibodies – Electrocardiography – Complement system – Inflammatory diseases – Cardiovascular diseases – Regression analysis – Myocardial infarction
Zdroje
1. Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. 2009;62: 584–592. doi: 10.1136/jcp.2009.064311 19561227
2. Björnådal L, Yin L, Granath F, Klareskog L, Ekbom A. Cardiovascular disease a hazard despite improved prognosis in patients with systemic lupus erythematosus: results from a Swedish population based study 1964–95. J Rheumatol. 2004;31: 713–719. 15088296
3. Kim CH, Al-Kindi SG, Jandali B, Askari AD, Zacharias M, Oliveira GH. Incidence and risk of heart failure in systemic lupus erythematosus. Heart. 2017;103: 227–233. doi: 10.1136/heartjnl-2016-309561 27613169
4. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001;44: 2331–7. doi: 10.1002/1529-0131(200110)44:10<2331::aid-art395>3.0.co;2-i 11665973
5. Apte M, McGwin G, Vilá LM, Kaslow RA, Alarcón GS, Reveille JD, et al. Associated factors and impact of myocarditis in patients with SLE from LUMINA, a multiethnic US cohort (LV). Rheumatology (Oxford). 2008;47: 362–367.
6. Nikpour M, Urowitz MB, Ibanez D, Harvey PJ, Gladman DD. Importance of cumulative exposure to elevated cholesterol and blood pressure in development of atherosclerotic coronary artery disease in systemic lupus erythematosus: a prospective proof-of-concept cohort study. Arthritis Res Ther. 2011;13: R156. doi: 10.1186/ar3473 21955652
7. Zhang Y, Corona-Villalobos CP, Kiani AN, Eng J, Kamel IR, Zimmerman SL, et al. Myocardial T2 mapping by cardiovascular magnetic resonance reveals subclinical myocardial inflammation in patients with systemic lupus erythematosus. Int J Cardiovasc Imaging. 2015;31: 389–397. doi: 10.1007/s10554-014-0560-3 25352245
8. Abdel-Aty H, Siegle N, Natusch A, Gromnica-Ihle E, Wassmuth R, Dietz R, et al. Myocardial tissue characterization in systemic lupus erythematosus: value of a comprehensive cardiovascular magnetic resonance approach. Lupus. 2008;17: 561–567. doi: 10.1177/0961203308089401 18539710
9. Singh JA, Woodard PK, Dávila-Román VG, Waggoner AD, Gutierrez FR, Zheng J, et al. Cardiac magnetic resonance imaging abnormalities in systemic lupus erythematosus: a preliminary report. Lupus. 2005;14: 137–144. doi: 10.1191/0961203305lu2050oa 15751818
10. Mavrogeni S, Koutsogeorgopoulou L, Markousis-Mavrogenis G, Bounas A, Tektonidou M, Lliossis SC, et al. Cardiovascular magnetic resonance detects silent heart disease missed by echocardiography in systemic lupus erythematosus. Lupus. 2018;27: 564–571. doi: 10.1177/0961203317731533 28927316
11. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113: 2495–2501. doi: 10.1161/CIRCULATIONAHA.105.595892 16717150
12. de Bakker JM, van Capelle FJ, Janse MJ, Tasseron S, Vermeulen JT, de Jonge N, et al. Slow conduction in the infarcted human heart. ‘Zigzag’ course of activation. Circulation. 1993;88: 915–926. doi: 10.1161/01.cir.88.3.915 8353918
13. Sadeghi R, Dabbagh VR, Tayyebi M, Zakavi SR, Ayati N. Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature. Kardiol Pol. 2016;74: 331–337. doi: 10.5603/KP.a2015.0193 26412470
14. Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium cardiac magnetic resonance imaging. Ann Noninvasive Electrocardiol. 2009;14: 319–326. doi: 10.1111/j.1542-474X.2009.00320.x 19804507
15. Güngör B, Özcan KS, Karataş MB, Şahin İ, Öztürk R, Bolca O. Prognostic value of QRS fragmentation in patients with acute myocardial infarction: a meta-analysis. Ann Noninvasive Electrocardiol. 2016;21: 604–612. doi: 10.1111/anec.12357 27018003
16. Morita H, Kusano KF, Miura D, Nagase S, Nakamura K, Morita ST, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation. 2008;118: 1697–1704. doi: 10.1161/CIRCULATIONAHA.108.770917 18838563
17. Vogels RJ, Teuwen CP, Ramdjan TT, Evertz R, Knops P, Witsenburg M, et al. Usefulness of fragmented QRS complexes in patients with congenital heart disease to predict ventricular tachyarrhythmias. Am J Cardiol. 2017;119: 126–131. doi: 10.1016/j.amjcard.2016.09.021 27780553
18. Kadi H, Inanir A, Habiboglu A, Ceyhan K, Koc F, Çelik A, et al. Frequency of fragmented QRS on ECG is increased in patients with rheumatoid arthritis without cardiovascular disease: a pilot study. Mod Rheumatol. 2012;22: 238–242. doi: 10.1007/s10165-011-0493-9 21728076
19. Bayar N, Çay HF, Erkal Z, Sezer İ, Arslan Ş, Çağırcı G, et al. The importance of fragmented QRS in the early detection of cardiac involvement in patients with systemic sclerosis. Anatol J Cardiol. 2015;15: 209–212. doi: 10.5152/akd.2014.5191 25333976
20. Inanir A, Ceyhan K, Okan S, Kadi H. Frequency of fragmented QRS in ankylosing spondylitis: a prospective controlled study. Z Rheumatol. 2013;72: 468–473. doi: 10.1007/s00393-012-1102-9 23262561
21. Sayin MR, Akpinar I, Gursoy YC, Kiran S, Gudul NE, Karabag T, et al. Assessment of QRS duration and presence of fragmented QRS in patients with Behçet’s disease. Coron Artery Dis. 2013;24: 398–403. doi: 10.1097/MCA.0b013e328361a978 23612364
22. Demır K, Avcı A, Yılmaz S, Demır T, Ersecgın A, Altunkeser BB. Fragmented QRS in patients with systemic lupus erythematosus. Scand Cardiovasc J. 2014;48: 197–201. doi: 10.3109/14017431.2014.935801 24978862
23. Wilson PF, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97: 1837–1847. doi: 10.1161/01.cir.97.18.1837 9603539
24. Mavrogeni S, Markousis-Mavrogenis G, Koutsogeorgopoulou L, Dimitroulas T, Bratis K, Kitas GD, et al. Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases. Int J Cardiol. 2017;236: 151–156. doi: 10.1016/j.ijcard.2017.01.104 28185705
25. Bulut M, Deniz Acar R, Ergün S, Geçmen Ç, Akçakoyun M. Cardiac rehabilitation improves the QRS fragmentation in patients with ST elevation myocardial infarction. J Cardiovasc Thorac Res. 2015;7: 96–100. doi: 10.15171/jcvtr.2015.21 26430496
26. Lorgis L, Jourda F, Hachet O, Zeller M, Gudjoncik A, Dentan G, et al. Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction. Heart Lung. 2013;42: 326–331. doi: 10.1016/j.hrtlng.2013.05.005 23850293
27. Bidani AK, Roberts JL, Schwartz MM, Lewis EJ. Immunopathology of cardiac lesions in fatal systemic lupus erythematosus. Am J Med. 1980;69: 849–858. doi: 10.1016/s0002-9343(80)80010-6 7004181
28. Mostoslavsky G, Fischel R, Yachimovich N, Yarkoni Y, Rosenmann E, Monestier M, et al. Lupus anti-DNA autoantibodies cross-react with a glomerular structural protein: a case for tissue injury by molecular mimicry. Eur J Immunol. 2001;31: 1221–1227. doi: 10.1002/1521-4141(200104)31:4<1221::aid-immu1221>3.0.co;2-p 11298348
29. Deocharan B, Qing X, Lichauco J, Putterman C. Alpha-actinin is a cross-reactive renal target for pathogenic anti-DNA antibodies. J Immunol. 2002;168: 3072–3078. doi: 10.4049/jimmunol.168.6.3072 11884481
30. Beggs AH, Byers TJ, Knoll JH, Boyce FM, Bruns GA, Kunkel LM. Cloning and characterization of two human skeletal muscle alpha-actinin genes located on chromosomes 1 and 11. J Biol Chem. 1992;267: 9281–9288. 1339456
31. Lim KL, Abdul-Wahab R, Lowe J, Powell RJ. Muscle biopsy abnormalities in systemic lupus erythematosus: correlation with clinical and laboratory parameters. Ann Rheum Dis. 1994;53: 178–182. doi: 10.1136/ard.53.3.178 8154935
32. Hermansen ML, Lindhardsen J, Torp-Pedersen C, Faurschou M, Jacobsen S. The risk of cardiovascular morbidity and cardiovascular mortality in systemic lupus erythematosus and lupus nephritis: a Danish nationwide population-based cohort study. Rheumatology (Oxford). 2017;56: 709–715.
33. Gustafsson JT, Herlitz Lindberg M, Gunnarsson I, Pettersson S, Elvin K, Öhrvik J, et al. Excess atherosclerosis in systemic lupus erythematosus,-A matter of renal involvement: Case control study of 281 SLE patients and 281 individually matched population controls. PLoS One. 2017;12: e0174572. doi: 10.1371/journal.pone.0174572 28414714
34. Konno T, Hayashi K, Fujino N, Oka R, Nomura A, Nagata Y, et al. Electrocardiographic QRS fragmentation as a marker for myocardial fibrosis in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol. 2015;26: 1081–1087. doi: 10.1111/jce.12742 26102305
35. Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography. 2011;28: 62–68. doi: 10.1111/j.1540-8175.2010.01242.x 20618390
36. Goovaerts G, Padhy S, Vandenberk B, Varon C, Willems R, Huffel SV. A machine learning approach for detection and quantification of QRS fragmentation. IEEE J Biomed Health Inform. Epub ahead of print 2018 Oct 29. doi: 10.1109/JBHI.2018.2878492 30371397
37. Take Y, Morita H. Fragmented QRS: what is the meaning? Indian Pacing Electrophysiol J. 2012;12: 213–225. doi: 10.1016/s0972-6292(16)30544-7 23071383
38. Kanitsoraphan C, Rattanawong P, Mekraksakit P, Chongsathidkiet P, Riangwiwat T, Kanjanahattakij N, et al. Baseline fragmented QRS is associated with increased all-cause mortality in heart failure with reduced ejection fraction: a systematic review and meta-analysis. Ann Noninvasive Electrocardiol. 2019;24: e12597. doi: 10.1111/anec.12597 30329201
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