Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Department of Internal Diseases and Rheumatology, Military Institute of Medicine, Warsaw, Poland.
Lupus. 2020 Jul;29(8):913-923. doi: 10.1177/0961203320928402. Epub 2020 Jun 2.
There are no data on the influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in 24-hour Holter monitoring in systemic lupus erythematosus (SLE).
Consecutive 92 SLE and 51 healthy subjects were studied. The standard 12-lead electrocardiography (ECG), Holter monitoring with heart rate turbulence (HRT) and QT, Tp-e and Tp-e/QT ratio assessment (including corrected values) were performed. Subjects with conditions causing repolarization abnormalities or insufficient number of beats suitable for QT evaluation were excluded (17 SLE and 8 controls).
Finally, 75 SLE and 43 sex- and age-matched controls were included to the study. In SLE patients, the median disease severity score (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI)) was 3.0. The mean values of QTc, cTp-e and cTp-e/QTc were significantly higher in SLE patients than in controls. QTc ≥ 460 ms was observed in 18.7% of patients using standard ECG and in 58.7% using Holter monitoring. With Holter monitoring, patients with SLICC/ACR-DI >3.0 presented longer QTc than those with SLICC/ACR-DI ≤3.0 (418±15 vs. 409 ± 16, = 0.04), while cTp-e and cTp-e/QTc values were similar. Patients with abnormal HRT presented longer cTp-e and higher cTp-e/QTc than those with normal HRT (92 ± 52 vs. 71 ± 16 ms, = 0.04; 0.244 ± 0.126 vs. 0.187 ± 0.035, = 0.03), while QTc values were similar. No differences in QT and Tp-e parameters were observed according to disease duration.
In SLE patients, Holter monitoring revealed QTc prolongation more frequently than standard ECG. Longer QTc values were observed in patients with more advanced disease, while increased cTp-e and cTp-e/QTc were related to cardiac autonomic dysfunction expressed by abnormal HRT.
系统性红斑狼疮（SLE）患者 24 小时动态心电图监测中心律变异性与心室复极和离散度的关系尚未见报道。
连续入选 92 例 SLE 患者和 51 例健康对照者。常规行 12 导联心电图（ECG）、心率震荡（HRT）和 QT、Tp-e 及 Tp-e/QT 比值（包括校正值）检测。剔除存在心电图复极异常或不能满足 QT 测量的研究对象（SLE 患者 17 例，对照组 8 例）。
最终 SLE 患者 75 例，对照组 43 例（性别、年龄匹配）纳入研究。SLE 患者的平均疾病严重程度评分（SLE 国际合作临床组/美国风湿病学会损害指数，SLICC/ACR-DI）为 3.0。SLE 患者的 QT 离散度、校正的 Tp-e 间期（cTp-e）和 cTp-e/QT 比值均显著高于对照组。标准 12 导联心电图和 24 小时动态心电图分别检测到 QTc 间期延长（460 ms）的患者分别占 18.7%和 58.7%。与 SLICC/ACR-DI≤3.0 的患者相比，SLICC/ACR-DI＞3.0 的患者的 QTc 间期更长（418±15 比 409±16， = 0.04），但 cTp-e 间期和 cTp-e/QT 比值无显著差异。HRT 异常的患者的 cTp-e 间期和 cTp-e/QT 比值显著高于 HRT 正常的患者（92±52 比 71±16 ms， = 0.04；0.244±0.126 比 0.187±0.035， = 0.03），但 QTc 间期无显著差异。QT 和 Tp-e 间期的参数与疾病持续时间无显著相关性。
与标准 12 导联心电图相比，24 小时动态心电图监测更易发现 SLE 患者的 QT 间期延长。疾病严重程度较高的患者 QTc 间期更长，而 cTp-e 间期和 cTp-e/QT 比值的增加与 HRT 异常提示的心脏自主神经功能障碍有关。
