Lazzerini Pietro Enea, Capecchi Pier Leopoldo, Guideri Francesca, Bellisai Francesca, Selvi Enrico, Acampa Maurizio, Costa Agnese, Maggio Roberta, Garcia-Gonzalez Estrella, Bisogno Stefania, Morozzi Gabriella, Galeazzi Mauro, Laghi-Pasini Franco
Department of Clinical Medicine and Immunological Sciences, Division of Clinical Immunology, University of Siena, Italy.
Am J Cardiol. 2007 Sep 15;100(6):1029-34. doi: 10.1016/j.amjcard.2007.04.048. Epub 2007 Jul 6.
A previous study of electrocardiography at rest showed that anti-Ro/SSA-positive patients with connective tissue disease (CTD) frequently had corrected QT (QTc) interval prolongation. Because QTc interval prolongation is a definite risk factor for arrhythmic sudden death in the general population, a 24-hour electrocardiographic monitoring study was performed to investigate the possible relation between QTc interval prolongation and incidence of ventricular arrhythmias as a possible expression of immunomediated electric instability of the myocardium in anti-Ro/SSA-positive patients with CTD. The study population consisted of 46 patients with CTD; 26 anti-Ro/SSA-positive and 20 anti-Ro/SSA-negative (control group) patients (Sjögren's syndrome, 9 and 3 patients; systemic lupus erythematosus, 4 and 9 patients; systemic sclerosis, 2 and 4 patients; undifferentiated CTD, 8 and 1 patients; mixed CTD, 2 and 2 patients, and polymyositis/dermatomyositis, 1 and 1 patient, respectively). All patients underwent ambulatory Holter electrocardiography to obtain 24-hour monitoring of the QTc interval and ventricular arrhythmias. With respect to the control group, anti-Ro/SSA-positive patients with CTD (1) commonly showed QTc interval prolongation (46% vs 5%), and this abnormality, when present, persisted for the 24 hours (global mean 24-hour QTc interval 440.5+/-23.4 vs 418.2+/-13.2 ms); (2) had a higher incidence of complex ventricular arrhythmias (i.e., Lown classes 2 to 5, 50% vs 10%) also in the absence of detectable cardiac abnormalities; and (3) in patients with CTD, there is a direct relation between global mean 24-hour QTc interval and ventricular arrhythmic load independently of age and disease duration. In conclusion, anti-Ro/SSA-positive patients with CTD seemed to have a particularly high risk of developing ventricular arrhythmias. The risk appeared related mainly to abnormalities in ventricular electrophysiologic characteristics emerging in the clinical setting as QTc interval prolongation.
先前一项关于静息心电图的研究表明，抗Ro/SSA阳性的结缔组织病（CTD）患者经常出现校正QT（QTc）间期延长。由于QTc间期延长是普通人群发生心律失常性猝死的一个明确危险因素，因此进行了一项24小时心电图监测研究，以调查QTc间期延长与室性心律失常发生率之间的可能关系，这可能是抗Ro/SSA阳性CTD患者心肌免疫介导的电不稳定的一种表现。研究人群包括46例CTD患者；26例抗Ro/SSA阳性和20例抗Ro/SSA阴性（对照组）患者（干燥综合征，分别为9例和3例；系统性红斑狼疮，分别为4例和9例；系统性硬化症，分别为2例和4例；未分化CTD，分别为8例和1例；混合性CTD，分别为2例和2例，以及多发性肌炎/皮肌炎，分别为1例和1例）。所有患者均接受动态心电图监测，以获取24小时QTc间期和室性心律失常监测结果。与对照组相比，抗Ro/SSA阳性的CTD患者：（1）普遍出现QTc间期延长（46%对5%），并且这种异常一旦出现，会持续24小时（24小时平均QTc间期为440.5±23.4对418.2±13.2毫秒）；（2）即使在未检测到心脏异常的情况下，复杂室性心律失常（即Lown分级2至5级）的发生率也更高（50%对10%）；（3）在CTD患者中，24小时平均QTc间期与室性心律失常负荷之间存在直接关系，且与年龄和病程无关。总之，抗Ro/SSA阳性的CTD患者似乎发生室性心律失常的风险特别高。该风险似乎主要与临床环境中出现的QTc间期延长所导致的心室电生理特征异常有关。
