Cardoso C R L, Sales M A O, Papi J A S, Salles G F
Department of Internal Medicine, Clementino Fraga Filho University Hospital, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Lupus. 2005;14(10):846-52. doi: 10.1191/0961203305lu2225oa.
Systemic lupus erythematosus (SLE) patients have increased cardiovascular morbidity and mortality. QT-interval parameters are presumed markers of cardiovascular risk and have not been previously evaluated in SLE. Standard 12-lead ECGs were obtained from 140 female SLE outpatients and 37 age and body mass index-matched controls. QT interval was measured in each lead and heart rate-corrected maximum QT-interval duration (QTcmax) and QT-interval dispersion (QTd) were calculated. Risk factors for cardiovascular disease and lupus clinical features, disease treatment, disease activity and damage index were recorded. SLE patients have increased QT-interval parameters when compared to controls (QTcmax: 427.91 +/- 31.53 ms(1/2) versus 410.05 +/- 15.45 ms(1/2), P < 0.001; QTd: 52.38 +/- 22.21 ms versus 37.12 +/- 12.88 ms, P < 0.001). These differences persisted after excluding those patients with arterial hypertension, diabetes and with ECG abnormalities (QTcmax: 419.90 +/- 28.78 ms(1/2) versus 409.15 +/- 15.85 ms(1/2), P = 0.041; QTd: 54.74 +/- 26.00 ms versus 37.96 +/- 13.05 ms, P = 0.001). Multivariate linear regression for factors associated with QTcmax selected the presence of electrocardiographic left ventricular hypertrophy (ECG-LVH) (P = 0.003), nonspecific ST-T-wave abnormalities (P = 0.022) and left atrial enlargement (P = 0.044). Multivariate associates with QTd were age (P = 0.018), ECG-LVH (P = 0.022) and ST-T abnormalities (P = 0.031). In conclusion, SLE patients have increased QT interval parameters when compared to controls. This prolongation may lead to an increased cardiovascular risk. This finding might be due to subclinical atherosclerotic cardiovascular disease.
系统性红斑狼疮(SLE)患者心血管疾病的发病率和死亡率有所增加。QT间期参数被认为是心血管风险的标志物,此前尚未在SLE患者中进行评估。我们从140名女性SLE门诊患者以及37名年龄和体重指数匹配的对照者中获取了标准12导联心电图。测量每个导联的QT间期,并计算心率校正后的最大QT间期时长(QTcmax)和QT间期离散度(QTd)。记录心血管疾病的危险因素以及狼疮的临床特征、疾病治疗情况、疾病活动度和损伤指数。与对照组相比,SLE患者的QT间期参数增加(QTcmax:427.91±31.53毫秒(1/2)对410.05±15.45毫秒(1/2),P<0.001;QTd:52.38±22.21毫秒对37.12±12.88毫秒,P<0.001)。在排除患有动脉高血压、糖尿病和心电图异常的患者后,这些差异仍然存在(QTcmax:419.90±28.78毫秒(1/2)对409.15±15.85毫秒(1/2),P = 0.041;QTd:54.74±26.00毫秒对37.96±13.05毫秒,P = 0.001)。对与QTcmax相关的因素进行多变量线性回归分析,结果显示心电图左心室肥厚(ECG-LVH)(P = 0.003)、非特异性ST-T波异常(P = 0.022)和左心房扩大(P = 0.044)与之相关。与QTd相关的多变量因素为年龄(P = 0.018)、ECG-LVH(P = 0.022)和ST-T异常(P = 0.031)。总之,与对照组相比,SLE患者的QT间期参数增加。这种延长可能导致心血管风险增加。这一发现可能是由于亚临床动脉粥样硬化性心血管疾病所致。