Inflammatory Biomarkers and Lipid Parameters May Predict an Increased Risk for Atrial Arrhythmias in Patients with Systemic Sclerosis

Abstract

Background/objectives: Autoimmune inflammation enhances the electrical instability of the atrial myocardium in patients with systemic sclerosis (SSc); thus, atrial arrhythmia risk is increased, which might be predicted by evaluating the P wave interval and dispersion of a 12-lead surface electrocardiogram (ECG).

Methods: We examined 26 SSc patients and 36 healthy controls and measured the P wave interval and P wave dispersion of the 12-lead surface ECG in each patient. Furthermore, echocardiography and 24-h Holter ECG were performed and levels of inflammatory laboratory parameters, including serum progranulin (PGRN), sVCAM-1, sICAM-1, leptin and C-reactive protein (CRP), were determined. Lipid parameters, such as Apo A-I, LDL-cholesterol (LDL-C), oxidized LDL (oxLDL) and the LDL and HDL subfractions were also evaluated.

Results: The P wave interval showed a significant positive correlation with the levels of Apo A-I, LDL-C, CRP, sVCAM-1, sICAM-1 and leptin. The oxLDL level correlated positively with P wave dispersion. Of note, significant positive correlation was also found between the large HDL percentage and the P wave interval.

Conclusions: Our results suggest that PGRN, sVCAM-1, sICAM-1, leptin, CRP, LDL-C and oxLDL, along with LDL and HDL subfractions, might have a role in atrial arrhythmogenesis in patients with SSc.

Keywords: LDL and HDL subfractions; atrial arrhythmias; electrocardiography; inflammation; leptin; oxLDL; systemic sclerosis.

Figure 1

(A–C): Pairwise comparisons of atrial arrhythmia risk markers between the control and SSc groups. (D,E): Echocardiographic parameters describing the size of the left atrium in the control and SSc groups. LA: left atrium, P int: P wave interval, P max: maximal P wave interval, Pd: P wave dispersion. * p < 0.05; ** p < 0.01; **** p < 0.0001; n.s.: not significant.

Figure 2

Correlations of the atrial arrhythmia risk markers with the different examined parameters in SSc patients. (A): Correlation between the CRP and P wave interval. (B,C): Correlations between the levels of adhesion molecules and P wave interval. (D–F): Correlations of different lipid parameters and adipokines with the atrial arrhythmia risk markers. CRP: C-reactive protein, sICAM-1: soluble ICAM-1, sVCAM-1: soluble VCAM-1, Apo A-I: apolipoprotein A-1, LDL-C: low-density lipoprotein cholesterol, oxLDL: oxidized low-density lipoprotein, P int: P wave interval, P max: maximal P wave interval, Pd: P wave dispersion. * p < 0.05; ** p < 0.01; *** p < 0.001.

Figure 3

(A): The P wave interval correlated negatively with the small HDL percentage. (B): The P wave interval showed a positive correlation with the large HDL percentage. (C): The Apo A-I level was found to be positively correlated with the P wave interval. HDL: high-density lipoprotein, P int: P wave interval, Apo A-I: apolipoprotein A-I, * p < 0.05; ** p < 0.01.