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OP0092 The Arrhythmic Burden in Systemic Sclerosis: Ventricular Ectopic Beat Rate Correlates with Cardiac Damage and Bad Prognosis
  1. G. De Luca,
  2. S. Bosello,
  3. F. Parisi,
  4. G. Berardi,
  5. M. Rucco,
  6. G. Canestrari,
  7. G. Ferraccioli
  1. Division of Rheumatology, Institute of Rheumatology, Rome, Italy


Background Primary heart involvement is a relevant prognostic determinant in Systemic Sclerosis (SSc) and, together with pulmonary disease, is the leading cause of death in these patients. Arrhytmhias are a frequent event and portend a bad prognosis, accounting alone for the 6% of total deaths.

Objectives The aim of our study was to define the role of EKG-Holter in the characterization of arrhythmic burden in SSc-patients and in the identification of patients with poor prognosis.

Methods Seventy-two consecutive SSc-patients (median age:55.0 years, range 23-81 years; median disease duration: 6.0years, range:0.3-32; diffuse disease: 55.6%; anti-Scl70 positivity: 41.7%), with signs and or symptoms suggestive of cardiac involvement (i.e. dyspnoea, palpitations and/or rise of cardiac enzymes) underwent 24h EKG-Holter from 2008 to 2013. A complete assessment of disease characteristics and organ involvement was also performed. During the same period the occurrence of any cardiac complication and death was recorded.

Results Major EKG-holter modifications (presence of ventricular or supraventricular ectopic beats, ventricular and/or supraventricular tachycardia, rhythm alterations) were present in 55.6% of patients. The majority of patients (94.4%) were on sinus rhythm, while atrial fibrillation or idioventricular rhythm were identifiable only in 2 patients. The mean cardiac frequency was 78.0±11.4 bpm, with a maximum frequency of 131.0±28.7 bpm and a minimum of 54.9±11.3 bpm. Right bundle brunch block was present in 20.8% and ventricular ectopic beats (VEBs) >1000/24h in 19 patients (26.4%); VEBs were classified as polymorphic in 7 patients (9.7%). The mean number of VEBs was strikingly higher (1611.9±4678.3). Supraventricular ectopic beats (SVEBs) >1000/24h were also frequent (16.7%).Twelve patients (16.7%) presented during 24-h evalutation a supraventricular tachycardia and 7 patients (9.7%) a non-sustained ventricular tachycardia (NSVT). The number of VEBs and SVEBs correlated with troponin T levels (R=0.26, R=0.36 respectively, p<0.04 for both correlations). Furthermore, the number of VEBs directly correlated with modified Rodnan skin score (R=0.24, p=0.04) and inversely correlated with ejection fraction (R=-0.39, p=0.001). During the observational period of 5 years, 6 deaths related to the sclerodermic disease progression occurred; five patients (6.9%) died for sudden cardiac death and all of them had VEBs >1000/24h. Dead patients presented higher number of VEBs and SVEBs (p<0.001 for both comparisons), higher levels of troponin T, CPK-MB and NT-proBNP (p<0.001 for all comparisons), and higher disease activity index (p<0.008). On ROC curve, VEBs >1125 showed a sensitivity of 83.3% and a specificity of 92.5% to predict SSc-cardiac related death (AUROC=0.85, CI=0.70-0.98). Patients with VEBS>1125 more frequently presented an increase of cardiac enzymes, right bundle brunch block and episodes of NSVT (p<0.001 for all comparisons) and had higher severity index score.

Conclusions Our data reveal that arrhythmyas are frequent in the course of scleroderma disease and the presence of VEBS>1125/24h correlates with cardiac damage and poor prognosis. The presence of EKG-Holter modifications need to be routinely investigated in SSc patients in order to identify those with a bad prognosis.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4462

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