Wojcik Sophie, Galatas Christos, Dekis Alaa, Iacoviello Licia, Di Castelnuovo Augusto, Costanzo Simona, Wang Mianbo, Fritzler Marvin J, Hudson Marie, Huynh Thao, Baron Murray
McGill University, Montreal, Quebec, Canada.
IRCCS Neuromed, Pozzilli, Italy, and LUM University, Casamassima, Italy.
ACR Open Rheumatol. 2025 Sep;7(9):e70030. doi: 10.1002/acr2.70030.
Recommendations have been made to use electrocardiograms (EKGs) to screen for cardiac disease in systemic sclerosis (SSc). The objective of this study was to compare the prevalence of EKG abnormalities in SSc and controls to help determine if the EKG should be used as a screening tool.
EKGs from patients with SSc were compared with those from a random sample of age- and gender-matched controls. Two cardiologists read all EKGs using a standardized approach. The groups were compared using t-tests, chi-squared tests, and Fisher exact tests.
Patients with SSc (n = 833, mean ± SD disease duration 11.3 ± 9.3 years; 39.4% had diffuse cutaneous SSc) and controls (n = 832) were included. The prevalence of conduction and rhythm abnormalities were similar in the SSc and control groups. More patients with SSc than controls had possible right atrial enlargement (5% vs 0.1%, P < 0.001), right axis deviation (3.2% vs 0.4%, P < 0.001), left atrial enlargement (9.2% vs 1.6%, P < 0.001), poor/abnormal R progression (5.6% vs 2.2%, P < 0.001) and nonspecific T wave abnormalities (6.1% vs 3.4%, P = 0.008).
Our findings suggest that conduction abnormalities are not more prevalent in those with SSc than in controls. Evidence of right heart stress on EKG in SSc may be secondary to pulmonary hypertension and left atrial enlargement, and poor R wave progression in precordial leads may indicate myocardial damage. Future studies are required to determine if these EKG abnormalities represent underlying structural heart disease, and, until that is proven, EKGs should not be considered a screening tool for cardiac abnormalities in SSc.
已有人建议使用心电图（EKG）对系统性硬化症（SSc）患者进行心脏疾病筛查。本研究的目的是比较SSc患者与对照组中心电图异常的发生率，以帮助确定EKG是否应作为一种筛查工具。
将SSc患者的EKG与年龄和性别匹配的随机对照组的EKG进行比较。两位心脏病专家采用标准化方法阅读所有EKG。使用t检验、卡方检验和Fisher精确检验对两组进行比较。
纳入了SSc患者（n = 833，平均±标准差病程11.3±9.3年；39.4%为弥漫性皮肤型SSc）和对照组（n = 832）。SSc组和对照组中传导和节律异常的发生率相似。与对照组相比，SSc患者中可能存在右心房扩大（5%对0.1%，P < 0.001）、电轴右偏（3.2%对0.4%，P < 0.001）、左心房扩大（9.2%对1.6%，P < 0.001）、R波进展不良/异常（5.6%对2.2%，P < 0.001）和非特异性T波异常（6.1%对3.4%，P = 0.008）的患者更多。
我们的研究结果表明，SSc患者中传导异常并不比对照组更普遍。SSc患者心电图上右心压力的证据可能继发于肺动脉高压和左心房扩大，胸前导联R波进展不良可能表明心肌损伤。需要进一步的研究来确定这些心电图异常是否代表潜在的结构性心脏病，在得到证实之前，EKG不应被视为SSc患者心脏异常的筛查工具。
