Predictors of sudden cardiac death in patients with rheumatoid arthritis


DOI: https://dx.doi.org/10.18565/therapy.2021.2.94-99

Feyskhanova L.I., Abdulganieva D.I.

Kazan State Medical University of the Ministry of Healthcare of Russia
Abstract. Objective: to study the prevalence of risk factors for sudden cardiac death (SCD) in patients with rheumatoid arthritis (RA).
Material and methods. 282 patients with verified RA were examined. Standard laboratory and instrumental diagnostic tests, electrocardiography with calculation of QT interval variance and determination of T wave alternation, two-dimensional transthoracic echocardiography with myocardial tissue Dopplerography, and determination of serum ST2 levels were performed.
Results. In 146 patients (51,8%), structural and geometric heart remodeling was detected, most often in the form of eccentric hypertrophy (n=82). The average age in the group with heart remodeling was higher than in the group with normal heart geometry: 57,9±8,55 vs 47,2±11,92 years. Regardless of the type of myocardial hypertrophy, these patients are significantly more likely to suffer from systemic manifestations of RA than those with normal geometry and concentric remodeling: 67,5 vs 53,9%. In the subgroup with diastolic dysfunction (DD) with normal heart geometry, the mean age and the level of the ST2 marker were higher than in the subgroup without DD. Individuals with DD with altered structural geometry were significantly more likely to have a high QT interval variance than those without myocardial dysfunction. In patients with high QT interval variance, regardless of structural geometry and myocardial dysfunction, T-wave alternation is significantly more frequently recorded than in patients with normal QT interval variance: 55,6 vs 29,3%.
Conclusion. Given the fact that myocardial hypertrophy, along with an increase in the QT interval variance and the appearance of T-wave alternation, is an important predictor of the development of SCD, special attention should be paid to patients with extra-articular manifestations of RA and with diastolic heart dysfunction, especially if there is a violation of the structural geometry.
Keywords: rheumatoid arthritis, sudden cardiac death, QT interval dispersion, T wave alternation, myocardial hypertrophy, diastolic dysfunction
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Literature


  1. Patel K.H.K., Jones T.N., Sattler S. et al. Proarrhythmic electrophysiological and structural remodeling in rheumatoid arthritis. Am J Physiol Heart Circ Physiol. 2020; 319(5): H1008–H1020. doi: 10.1152/ajpheart.00401.2020.

  2. Maradit-Kremers H., Crowson C.S., Nicola P.J. et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: A population-based cohort study. Arthritis Rheum. 2005; 52(2): 402–11. doi: 10.1002/art.20853.

  3. Masoud S., Lim P.B., Kitas G.D., Panoulas V. Sudden cardiac death in patients with rheumatoid arthritis. World J Cardiol. 2017; 9(7): 562–73. doi: 10.4330/wjc.v9.i7.562.

  4. Lazzerini P.E., Capecchi P.L., Laghi-Pasini F. Systemic inflammation and arrhythmic risk: Lessons from rheumatoid arthritis. Eur Heart J. 2017; 38(22): 1717–27. doi: 10.1093/eurheartj/ehw208.

  5. Национальные рекомендации по определению риска и профилактике внезапной сердечной смерти (2-е изд.). М.: Медпрактика-М. 2018; 247 с. [National guidelines for risk determination and prevention of sudden cardiac death (2nd edition). Moscow: Medpraktika-M. 2018; 247 pp. (In Russ.)]. ISBN: 978-5-98803-397-4.

  6. Merchant F.M., Sayadi O., Moazzami K. et al. T-wave alternans as an arrhythmic risk stratifier: State of the art. Curr Cardiol Rep. 2013; 15(9): 398. doi: 10.1007/s11886-013-0398-7.

  7. Gao C., Yang D. Electrical inhomogeneity in left ventricular hypertrophy. Cell Biochem Biophys. 2014; 69(3): 399–404. doi: 10.1007/s12013-014-9850-6.

  8. Przewlocka-Kosmala M.K.W. Zaleznosc dyspersji odstepu QT od geometrii lewej komory serca u chorych na pierwotne nadcisnienie tetnicze [QT dispersion and left ventricular geometry in hypertensive patients]. Pol Arch Med Wewn. 2003;109(3): 251–55. Polish.

  9. Клинические рекомендации. Хроническая сердечная недостаточность. Ассоциация сердечно-сосудистых хирургов России. Ассоциация флебологов России. Ассоциация нейрохирургов России. 2020. Доступ: http://cr.rosminzdrav.ru/schema/156_1 (дата обращения – 01.02.2021). [Clinical guidelines. Chronic heart failure. Association of Cardiovascular Surgeons of Russia. Association of Phlebologists of Russia. Association of Neurosurgeons of Russia. 2020. Available at: http://cr.rosminzdrav.ru/schema/156_1 (date of access – 01.02.2021) (In Russ.)].

  10. Gabriel S.E. Heart disease and rheumatoid arthritis: Understanding the risks. Ann Rheum Dis. 2010; 69 Suppl 1(0 1): i61–64. doi: 10.1136/ard.2009.119404.

  11. Клинические рекомендации. Ревматоидный артрит. Ассоциация ревматологов России. 2018. Доступ: http://cr.rosminzdrav.ru/schema/250_1 (дата обращения – 01.02.2021). [Clinical guidelines. Rheumatoid arthritis. Association of Rheumatologists of Russia. Available at: http://cr.rosminzdrav.ru/schema/250_1 (date of access – 01.02.2021) (In Russ.)].

  12. Рекомендации по количественной оценке структуры и функции камер сердца. Российский кардиологический журнал. 2012; 4s4: 1–27. [Recommendations for quantifying the structure and function of the heart chambers. Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology. 2012; 4s4: 1–27 (In Russ.)].

  13. Nagueh S.F., Smiseth O.A., Appleton C.P. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016; 17(12): 1321–60. doi: 10.1093/ehjci/jew082.

  14. Pascual-Figal D.A., Ordonez-Llanos J., Tornel P.L. et al. Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic dysfunction. J Am Coll Cardiol. 2009; 54(23): 2174–79. doi: 10.1016/j.jacc.2009.07.041.


About the Autors

Lyutsia I. Feyskhanova, PhD, associate professor of the Department of hospital therapy, Kazan State Medical University of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 49 Butlerov Str. Tel.: +7 (917) 275-21-66. E-mail: ljuts@rambler.ru. ORCID: 0000-0001-7830-5283
Diana I. Abdulganieva, MD, professor, head of the Department of hospital therapy, Kazan State Medical University of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 49 Butlerov Str. Tel.: +7 (987) 296-27-68. E-mail: diana_s@mail.ru. ORCID: 0000-0001-7069-2725

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