Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Fascicular Block: A Predictor of Mortality In Early Systemic Sclerosis.

Draeger1,  Hilda T., Assassi2,  Shervin, Sharif3,  Roozbeh, Gonzalez4,  Emilio B., Harper4,  Brock E., Lange1,  Richard A., Mayes3,  Maureen D.

Univ of TX Health Science Center-San Antonio, San Antonio, TX
Univ of Texas Health Science, Houston, TX
University of Texas Health Science Center at Houston, Houston, TX
University of Texas Medical Branch, Galveston, TX

Background/Purpose:

Previous data from the Genetics versus Environment in Scleroderma Outcome Study (GENISOS) indicated that abnormal electrocardiogram (EKG) findings at an early stage of disease are an independent predictor of mortality in patients with systemic sclerosis (SSc). The objective of this study was to examine the frequency of specific EKG abnormalities in these patients, their serological correlates, and their predictive significance for mortality.

Methods:

SSc patients with disease duration of <= 5 years from their first non-Raynaud's phenomenon symptom were enrolled in the GENISOS cohort. At enrollment, a standard 12-lead EKG was obtained along with demographic, clinical and autoantibody information. All baseline EKGs were reviewed by a cardiologist (RAL). Although not routinely done, echocardiogram data were recorded when available. Social Security death search and the National Death Index database were used to determine vital status. Chi square (c2) was used to examine the correlation between EKG abnormalities and serologic findings. A Cox proportional hazards model was used to investigate the predictive significance of EKG abnormalities for survival after adjusting for age at enrollment. This was extended to include potential confounders for non-SSc related cardiac disease (i.e. gender, hypertension, smoking, diabetes mellitus, and known coronary artery disease).

Results:

Of 265 SSc patients (222 women and 43 men with average age of 48.8 vs. 48.0 years, respectively) with average disease duration of 2.5 years, 50.6% had abnormal ECG findings. A detailed list of observed EKG abnormalities is provided in Table 1. The EKG findings were not associated with SSc disease type (i.e., limited or diffuse) or autoantibody profile. Survival analysis showed that over 9 years average follow-up, patients with fascicular block (i.e., LBBB, RBBB, LAFB or LPFB) were at increased risk of mortality (hazard ratio: 2.3; 95% CI:1.1, 4.6, p=0.02), after adjustment for age at enrollment (Table 1). In the multivariable model, the predictive significance of fascicular blocks for survival was independent of non-SSc related cardiac risk factors (hazard ratio: 2.1; 95% CI: 1.02, 4.28, p=0.04). Moreover, fascicular block was not associated with cardiac disease (i.e., decreased ventricular function or pulmonary arterial hypertension) found on echocardiogram.

Table 1. EKG findings in the GENISOS cohort: Frequency and survival analysis after adjustment for age at enrollment

ECG findingsNumber of cases (Frequency)Hazard Ratio (95% CI)p value*
Sinus bradycardia19 (7.2)0.75 (0.3, 1.89)0.551
Sinus tachycardia7 (2.6)1.7 (0.54, 5.42)0.530
First degree AV block14 (5.3)1.83 (0.8, 4.23)0.217
Premature atrial contractions7 (2.6)0.38 (0.05, 2.74)0.227
Premature ventricular contractions8 (3.0)1.61 (0.39, 6.59)0.696
Left axis deviation18 (6.8)1.37 (0.59, 3.15)0.683
Right axis deviation13 (4.9)0.77 (0.24, 2.46)0.915
Delayed transition8 (3.0)1.15 (0.28, 4.69)0.995
Fascicular block20 (7.6)2.27 (1.12, 4.58)0.022
Widened QRS complex25 (9.4)1.23 (0.57, 2.69)0.559
Left atrial enlargement2 (0.8)2.80 (0.39, 20.22)0.254
Right atrial enlargement3 (1.1)N/A1.000
Left ventricular hypertrophy15 (5.7)2.33 (1.16, 4.68)0.103
Right ventricular hypertrophy3 (1.1)1.74 (0.24, 12.53)0.480
Non-specific ST-T wave changes32 (12.1)1.52 (0.8, 2.89)0.448
Prominent U wave4 (1.5)1.65 (0.41, 6.75)0.568
ST elevation18 (6.8)1.28 (0.56, 2.96)0.470
Prolonged QTc6 (2.3)0.41(0.06, 2.92)0.341
Low voltage20 (7.6)1 (0.36, 2.76)0.993
Previous myocardial infarction11 (4.2)1.54 (0.56, 4.24)0.396
EKG findings consistent with PAH30 (11.3)1.48 (0.76, 2.89)0.223
*p-value adjusted for age; PAH:pulmonary arterial hypertension

Conclusion:

This is the first study reported to date, on correlation of EKG abnormalities with mortality in SSc. EKG abnormalities are common in patient with early SSc. We observed that fascicular block is an independent predictor of mortality. This EKG abnormality may be a surrogate for scleroderma heart disease.

To cite this abstract, please use the following information:
Draeger, Hilda T., Assassi, Shervin, Sharif, Roozbeh, Gonzalez, Emilio B., Harper, Brock E., Lange, Richard A., et al; Fascicular Block: A Predictor of Mortality In Early Systemic Sclerosis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1477
DOI:

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