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Inicio Medicina Clínica Left ventricular dysfunction and arrhythmias in asymptomatic patients with syste...
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Vol. 160. Issue 10.
Pages 434-442 (May 2023)
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Vol. 160. Issue 10.
Pages 434-442 (May 2023)
Original article
Left ventricular dysfunction and arrhythmias in asymptomatic patients with systemic sclerosis
Disfunción ventricular izquierda y arritmias en pacientes asintomáticos con esclerosis sistémica
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Lilian López Núñeza, Irene Carrión-Barberàa,
Corresponding author
, Luis Molinab, Isabel Padróa, Manel Ciriaa, Laura Tíoc, Tarek Carlos Salman-Montea, Ana Prosa
a Rheumatology Department, Hospital del Mar/Parc de Salut Mar, Barcelona, Spain
b Cardiology Department, Hospital del Mar/Parc de Salut Mar, Barcelona, Spain
c Cellular Research Group on Inflammation and Cartilage of the Hospital del Mar Medical Research Institute of Barcelona (IMIM), Barcelona, Spain
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Tables (5)
Table 1. Demographic and clinical characteristics of patients with SS (N=36), classified according to those who had any alteration on the echocardiogram (EKG), those who did in the 24h-Holter and those with clinically significant arrhythmias (CSA) vs those without.
Table 2. Echocardiogram findings.
Table 3. EKG abnormalities (N=18).
Table 5. Types of electrocardiographic abnormalities detected by the 24-h Holter (N=20).
Table 6. Associations between clinically significant arrhythmias by electrocardiogram, by Holter, by either of them or by both simultaneously and different characteristics of the patients.
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Abstract
Introduction and aims

Cardiac involvement in systemic sclerosis (SS) is frequently silent and a major cause of mortality in these patients. This work aims to study the prevalence and associations of left ventricular dysfunction (LVD) and arrhythmias in SS.

Methods and results

Prospective study of SS patients (n=36), excluding those with symptoms of (or) cardiac disease, pulmonary arterial hypertension or cardiovascular risk factors (CVRF). A clinical, analytical, electrocardiogram (EKG), Holter, and echocardiogram with global longitudinal strain (GLS) assessment were performed. Arrhythmias were classified into clinically significant arrhythmias (CSA) and non-significant.

Twenty-eight percent had left ventricular diastolic dysfunction (LVDD), 22% LV systolic dysfunction (LVSD) according to the GLS, 11.1% both, and 16.7% cardiac dysautonomia. Fifty percent presented alterations by EKG (44% CSA), 55.6% by Holter (75% CSA) and 8.3% CSA by both. An association was found between the elevation of troponin T (TnTc) and CSA and between the elevation of both NT-proBNP and TnTc with LVDD.

Conclusions

We found a higher prevalence of LVSD than in the literature, detected by GLS and being 10 times higher than that detected by LVEF, which justifies the need to incorporate this technique in the routine evaluation of these patients. The association of TnTc and NT-proBNP with LVDD suggests that they can be used as minimally invasive biomarkers of this affectation. The absence of correlation between LVD and CSA indicates that the arrhythmias could be due, not only to a supposed structural alteration of the myocardium, but to an independent and early cardiac involvement, which should be actively investigated even in asymptomatic patients without CVRF.

Keywords:
Systemic sclerosis
Scleroderma
Arrhythmias
Left ventricular dysfunction
Dysautonomia
Cardiac involvement
Resumen
Introducción y objetivos

La afectación cardiaca en la esclerosis sistémica (ES) es frecuentemente asintomática y se asocia con una mortalidad importante. Este trabajo tiene como objetivo estudiar la prevalencia y las asociaciones de la disfunción ventricular izquierda (DVI) y las arritmias en la ES.

Métodos y resultados

Estudio prospectivo de pacientes con ES (n = 36), excluyendo aquellos con síntomas o enfermedad cardiaca, hipertensión arterial pulmonar o factores de riesgo cardiovascular (FRCV). Se les realizó una evaluación clínica, analítica, con electrocardiograma (ECG), Holter y ecocardiograma con strain longitudinal global (SLG). Las arritmias se clasificaron en arritmias clínicamente significativas (ACS) y no significativas.

De los pacientes estudiados, 27,8% presentaba disfunción diastólica del ventrículo izquierdo (DDVI), 22% disfunción sistólica del VI (DSVI) según el SLG, 11,1% ambas y 16,7% disautonomía cardiaca; 50% presentó alteraciones por ECG (44% ACS), 55,6% por Holter (75% ACS) y 8,3% ACS por ambos. Se encontró una asociación entre la elevación de troponina T (TnTc) y ACS y entre la elevación NT-proBNP y TnTc con la DDVI.

Conclusiones

Encontramos una prevalencia de DSVI mayor que en la literatura, detectada por SLG y siendo 10 veces superior a la detectada por FEVI, lo que justifica la necesidad de incorporar esta técnica en la evaluación rutinaria de estos pacientes. La asociación de TnTc y NT-proBNP con DDVI sugiere que pueden ser utilizados como biomarcadores mínimamente invasivos de esta afectación. La ausencia de correlación entre DVI y ACS indica que las arritmias podrían deberse, no solo a una supuesta alteración estructural del miocardio, sino a un compromiso cardiaco independiente y temprano, que debe investigarse activamente incluso en pacientes asintomáticos sin FRCV.

Palabras clave:
Esclerosis sistémica
Esclerodermia
Arritmias
Disfunción ventricular izquierda
Disautonomía
Afectación cardiaca

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