Cerşit Sinan, Cerşit Hülya Peynirci
Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey.
Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, İstanbul, Turkey.
J Electrocardiol. 2018 Sep-Oct;51(5):787-791. doi: 10.1016/j.jelectrocard.2018.06.010. Epub 2018 Jun 19.
Abnormalities in ventricular repolarization (VR) parameters have been associated with sudden cardiac death (SCD) in patients with rheumatoid arthritis (RA). The benefits of cardiac rehabilitation (CR) in patients with RA are well recognized. We aimed to assess its impact on VR indexes in patients with RA.
This study included 45 patients with RA (36 female, age 58 ± 5.5 years) and 50 age- and sex-matched otherwise healthy controls. Baseline electrocardiogram (ECG) recordings were used to compare VR parameters such as maximum and minimum QT intervals, and corrected, and dispersion (QTmax, QTmin, cQTmax, cQTmin, QTd, cQTd, respectively), JT and cJT intervals, Tp-e and cTp-e intervals, and Tp-e/QT and Tp-e/cQT ratios in patients with RA and healthy individuals. The effects of 6-week CR in patients with RA were also evaluated by comparing pre- and post-CR ECGs, exercise tolerance test (MET and VO2max) and RA characteristics (C-reactive protein (CRP), Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire(HAQ)).
In comparison with the healthy individuals, the patients with RA had significantly higher cQTmax and QTmin intervals, QTd, cQTd, Tp-e and cTp-e intervals, and Tp-e/QT and Tp-e/cQT ratios. At the end of CR, all VR indexes (p < 005), except QTd, were significantly decreased as did the results for CRP, DAS28, and HAQ (all p < 0.05), and MET and VO2max (p < 0.05 for both) were significantly increased in patients with RA.
CR may provide an improvement in the majority of VR indexes which are related with ventricular arrhythmia and SCD in patients with RA. Changes in ETT parameters and RA characteristics may contribute to improvement of several VR indexes such as cQTd, cJT and Tp-e intervals at the end of CR.
类风湿关节炎（RA）患者的心室复极（VR）参数异常与心源性猝死（SCD）相关。心脏康复（CR）对RA患者的益处已得到充分认可。我们旨在评估其对RA患者VR指标的影响。
本研究纳入45例RA患者（36例女性，年龄58±5.5岁）和50例年龄及性别匹配的健康对照。采用基线心电图（ECG）记录比较RA患者和健康个体的VR参数，如最大和最小QT间期、校正QT间期及离散度（分别为QTmax、QTmin、cQTmax、cQTmin、QTd、cQTd）、JT和cJT间期、Tp-e和cTp-e间期，以及Tp-e/QT和Tp-e/cQT比值。通过比较CR前后的ECG、运动耐量试验（MET和VO2max）以及RA特征（C反应蛋白（CRP）、疾病活动评分28（DAS28）和健康评估问卷（HAQ）），评估6周CR对RA患者的影响。
与健康个体相比，RA患者的cQTmax和QTmin间期、QTd、cQTd、Tp-e和cTp-e间期，以及Tp-e/QT和Tp-e/cQT比值显著更高。CR结束时，除QTd外，所有VR指标（p<0.05）均显著降低，CRP、DAS28和HAQ的结果也显著降低（均p<0.05），RA患者的MET和VO2max显著升高（两者均p<0.05）。
CR可能会改善RA患者中与室性心律失常和SCD相关的大多数VR指标。运动耐量试验参数和RA特征的变化可能有助于在CR结束时改善一些VR指标，如cQTd、cJT和Tp-e间期。
