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. 2017 Feb 10;19(1):31.
doi: 10.1186/s13075-017-1240-1.

Prevalence and associated factors of resting electrocardiogram abnormalities among systemic lupus erythematosus patients without cardiovascular disease

Hanan Al Rayes  1 , Paula J Harvey  2 , Dafna D Gladman  1   3 , Jiandong Su  1 , Arthy Sabapathy  1 , Murray B Urowitz  1   3 , Zahi Touma  4
Affiliations

Prevalence and associated factors of resting electrocardiogram abnormalities among systemic lupus erythematosus patients without cardiovascular disease

Hanan Al Rayes et al. Arthritis Res Ther. .

Abstract

Background: Electrocardiogram (ECG) cardiovascular disease (CVD) abnormalities (ECG-CVD) are predictive of subsequent CVD events in the general population. Systemic lupus erythematosus (SLE) patients are vulnerable to CVD. We aimed to determine the prevalence of ECG-CVD in SLE patients and to examine the risk factors associated with ECG-CVD.

Methods: A 12-lead resting supine ECG was performed on consecutive adult patients attending the clinic. One cardiologist interpreted the ECGs. ECG-CVD were defined as the presence of one or more of the following 4 elements (ECG-4): ST-segment and/or T-wave abnormalities, left ventricular hypertrophy (LVH), left axis deviation (LAD), left bundle branch block (LBBB) and right bundle branch block (RBBB). ECG-5 included the same elements as ECG-4 and the Q-wave. Repeated measurement data were created and the associations between ECG-4/ECG-5 and demographics were evaluated with univariate and multivariate Cox regression models.

Results: Of 487 SLE patients, 104 (21.4%) and 118 (24.2%) patients had one or more of the ECG-4 and ECG-5 elements, respectively. A higher prevalence of ECG-CVD was found in patients with a longer SLE disease duration, and the burden of ECG-CVD elements increased with age. Increased age, active SLE disease, and damage were associated with ECG4 and ECG-5, while treatment of hyperlipidemia was protective.

Conclusion: A high prevalence of ECG-4 (21.4%) and ECG-5 (24.2%) was found in this SLE cohort. Controlling SLE disease activity is important since it was associated with ECG-4 and ECG-5. Early identification of ECG-4 and ECG-5 in SLE patients might allow for better stratification and risk management.

Keywords: Cardiovascular disease; Electrocardiogram; Systemic lupus erythematosus.

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Figures

Fig. 1
Fig. 1
Study design and grouping of patients: normal electrocardiogram (ECG), non-ECG-cardiovascular disease (ECG-CVD), ECG-4, and ECG-5. Non-ECG-CVD defined as the presence of any of the following ECG abnormalities: right axis deviation, arrhythmia, sinus tachycardia, sinus bradycardia, atrioventricular blocks, atrial ectopic rhythm, and atrial enlargement
Fig. 2
Fig. 2
Cumulative proportions of individual ECG-5 from systemic lupus erythematosus (SLE) diagnosis up to 20 years of follow-up (e.g., 11 out of 21 (52.4%) patients had LAD/LAFB up to 20 years and the other 10 LAD/LAFB occurred after 20 years of follow-up). ECG-CVD electrocardiogram cardiovascular disease abnormalities, LAD left axis deviation, LAFB left anterior fascicular block, LBBB left bundle branch block, LVH left ventricular hypertrophy, RBBB right bundle branch block
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