UOC di Reumatologia, Dipartimento di Specialità Mediche, Azienda Ospedaliero-Universitaria di Sassari, Italy.
Università degli Studi di Sassari, Italy.
Clin Exp Rheumatol. 2020 May-Jun;38(3):516-522. Epub 2019 Aug 27.
To define the prevalence of prolonged QT interval and QT dispersion (QTd) in rheumatoid arthritis (RA) patients and in a control population.
QT interval corrected by Bazett's formula (QTc) was calculated from standard 12-lead ECGs in 963 subjects free of previous cardiovascular events (646 RA patients and 317 controls strictly matched for age, sex and cardiovascular risk factors).
RA patients (59.6±9.6 years, 68.1% females) had a long mean disease duration (10.6 years) and moderate disease activity (DAS28=3.68±1.23). QTc was 5 msec longer in RA patients than in controls (412±9 vs. 407±28 msec, p=0.013). However, the prevalence of QTc prolongation in RA patients and controls was not significantly different (5.3% vs. 6.3%, p=0.50). On the contrary, RA patients had a significantly greater QTd (42±26 vs. 35±18 msec, p<0.001) and a higher prevalence of increased QTd (33.3% vs. 18.3%, p<0.001) than controls. Furthermore, RA was independently associated to increased QTd [OR(95%CI)= 2.21(1.58-3.08), p=0.0001]. In the RA population, male gender and older age were independently associated with a higher prevalence of prolonged QTd.
In this cohort of long-standing and moderately active RA patients, RA showed longer QTc but similar prevalence of prolonged QTc and an increased QTd with a 1.8-fold higher prevalence of increased QTd than the control population. Further studies in larger prospective cohorts are warranted to investigate whether QTd prolongation predicts sudden cardiac death and other adverse cardiovascular outcomes in RA.
确定类风湿关节炎（RA）患者和对照人群中 QT 间期延长和 QT 离散度（QTd）的患病率。
对 963 例无既往心血管事件的患者（646 例 RA 患者和 317 例严格匹配年龄、性别和心血管危险因素的对照者）的标准 12 导联心电图进行校正的 QT 间期（QTc）的计算。
RA 患者（59.6±9.6 岁，68.1%女性）平均患病时间长（10.6 年），疾病活动度中等（DAS28=3.68±1.23）。RA 患者的 QTc 比对照组长 5ms（412±9 与 407±28ms，p=0.013）。然而，RA 患者和对照组中 QTc 延长的患病率无显著差异（5.3%与 6.3%，p=0.50）。相反，RA 患者的 QTd 显著增大（42±26 与 35±18ms，p<0.001），且 QTd 增加的患病率也显著更高（33.3%与 18.3%，p<0.001）。此外，RA 与 QTd 增加独立相关[比值比（95%CI）=2.21（1.58-3.08），p=0.0001]。在 RA 人群中，男性和年龄较大与较长 QTd 的患病率增加独立相关。
在这组患有长期且中度活动的 RA 患者中，RA 患者的 QTc 延长，但 QTc 延长的患病率与对照组相似，而 QTd 增加，其患病率比对照组高 1.8 倍。需要进一步在更大的前瞻性队列中进行研究，以调查 QTd 延长是否预测 RA 患者的心脏性猝死和其他不良心血管结局。
