Psoriatic arthritis is associated with myocardial repolarization dysregulation as assessed by the QTc interval and the Tp-e/QTc ratio
Keywords:
Psoriatic arthritis, electrocardiography, Tp-e/QTc ratio, Myocardial repolarizationAbstract
Aim: An increased risk of arrhythmia has been shown in patients with psoriatic arthritis (PsA). Tp-e interval and Tp-e/QT ratio are considered useful markers for the assessment of myocardial repolarization heterogeneity. In present study we aim to investigate the characteristics of ventricular repolarization on the basis of QTc interval and Tp-e/QTc ratio in patients PsA. Methods: This cross-sectional observational study included patients with psoriatic arthritis who were over 18 years of age. A control group was created with healthy volunteers. The diagnosis of psoriatic arthritis were done according to the CASPAR criteria. QT interval, corrected QT (QTc), Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were measured from the 12-lead electrocardiograms(ECG) of the PsA patients and control group. Results: The study population consisted of 82 patients with PsA and 82 healthy volunteers. According to electrocardiographic parameters the heart rate was similar in both groups, but QT, QTc, Tp-e intervals; Tp-e /QT and Tp-e/ QTc ratios were significantly higher in the PsA group. The median Tp-e/QTc ratio of the patients with PsA was significantly higher than the median Tp-e/QTc ratio of the control group (0.21 (0.20-0.25) vs. 0.18 (0.17-0.19, P<0.001). The correlation analysis showed a weak correlation between Tp-e/QTc ratio and CRP value (r=0.197, P=0.012). Conclusions: This is the first study to demonstrate the prolongation of the Tp-e/QTc ratio in patients with PsA. Prospective clinical studies to observe clinical importance of this finding particularly with regard to the arrhythmias and sudden death may be more valuable.
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Feld J, Weiss G, Rosner I, Rozenbaum M, Laor A, Rimar D, et al. Electrocardiographic findings in psoriatic arthritis: a case-controlled study. J Rheumatol. 2008;35(12):2379-82. Epub 2008/10/10. doi: 10.3899/jrheum.080314. PubMed PMID: 18843776.
Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol. 2000;27(5):1247-50. Epub 2000/05/17. PubMed PMID: 10813295.
Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61(2):233-9. Epub 2009/01/30. doi: 10.1002/art.24172. PubMed PMID: 19177544; PubMed Central PMCID: PMCPMC3061343.
Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Current rheumatology reports. 2010;12(4):281-7. doi: 10.1007/s11926-010-0112-3. PubMed PMID: 20589485.
Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. Journal of the European Academy of Dermatology and Venereology : JEADV. 2013;27 Suppl 3:12-29. doi: 10.1111/jdv.12163. PubMed PMID: 23845149.
Jamnitski A, Symmons D, Peters MJ, Sattar N, McInnes I, Nurmohamed MT. Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Annals of the rheumatic diseases. 2013;72(2):211-6. doi: 10.1136/annrheumdis-2011-201194. PubMed PMID: 22532629.
Markuszeski L, Bissinger A, Janusz I, Narbutt J, Jedrzejowska AS, Zalewska A. Heart rate and arrhythmia in patients with psoriasis vulgaris. Arch Med Res. 2007;38(1):64-9. Epub 2006/12/19. doi: 10.1016/j.arcmed.2006.08.004. PubMed PMID: 17174725.
Gaydukova I, Rebrov A, Nikitina N, Poddubnyy D. Decreased heart rate variability in patients with psoriatic arthritis. Clinical rheumatology. 2012;31(9):1377-81. doi: 10.1007/s10067-012-2015-3. PubMed PMID: 22673792.
Arisoy A, Karaman K, Karayakali M, Demirelli S, Seckin HY, Celik A, et al. Evaluation of ventricular repolarization features with novel electrocardiographic parameters (Tp-e, Tp-e/QT) in patients with psoriasis. Anatol J Cardiol. 2017;18(6):397-401. Epub 2017/12/20. doi: 10.14744/AnatolJCardiol.2017.7901. PubMed PMID: 29256874; PubMed Central PMCID: PMCPMC6282903.
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665-73. Epub 2006/07/28. doi: 10.1002/art.21972. PubMed PMID: 16871531.
Kibari A, Cohen AD, Gazitt T, Bitterman H, Lavi I, Feldhamer I, et al. Cardiac and cardiovascular morbidities in patients with psoriatic arthritis: a population-based case control study. Clinical rheumatology. 2019;38(8):2069-75. Epub 2019/04/03. doi: 10.1007/s10067-019-04528-y. PubMed PMID: 30937638.
Tam LS, Tomlinson B, Chu TT, Li M, Leung YY, Kwok LW, et al. Cardiovascular risk profile of patients with psoriatic arthritis compared to controls--the role of inflammation. Rheumatology (Oxford). 2008;47(5):718-23. Epub 2008/04/11. doi: 10.1093/rheumatology/ken090. PubMed PMID: 18400833.
Han C, Robinson DW, Jr., Hackett MV, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167-72. Epub 2006/09/19. PubMed PMID: 16981296.
Chiu HY, Chang WL, Huang WF, Wen YW, Tsai YW, Tsai TF. Increased risk of arrhythmia in patients with psoriatic disease: A nationwide population-based matched cohort study. J Am Acad Dermatol. 2015;73(3):429-38. Epub 2015/07/21. doi: 10.1016/j.jaad.2015.06.023. PubMed PMID: 26188627.
Rautaharju PM. A farewell to QT dispersion. Are the alternatives any better? J Electrocardiol. 2005;38(1):7-9. Epub 2005/01/22. doi: 10.1016/j.jelectrocard.2004.09.017. PubMed PMID: 15660341.
Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41(6):567-74. Epub 2008/09/16. doi: 10.1016/j.jelectrocard.2008.07.016. PubMed PMID: 18790499.
Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41(6):575-80. Epub 2008/10/29. doi: 10.1016/j.jelectrocard.2008.07.030. PubMed PMID: 18954608.
Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M, Huber K, et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol. 2011;44(3):301-8. Epub 2011/04/23. doi: 10.1016/j.jelectrocard.2011.03.004. PubMed PMID: 21511064.
Rosenthal TM, Masvidal D, Abi Samra FM, Bernard ML, Khatib S, Polin GM, et al. Optimal method of measuring the T-peak to T-end interval for risk stratification in primary prevention. Europace. 2018;20(4):698-705. Epub 2017/03/25. doi: 10.1093/europace/euw430. PubMed PMID: 28339886.
Erikssen G, Liestol K, Gullestad L, Haugaa KH, Bendz B, Amlie JP. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17(2):85-94. Epub 2012/04/28. doi: 10.1111/j.1542-474X.2012.00493.x. PubMed PMID: 22537325; PubMed Central PMCID: PMCPMC6932507.
Xia Y, Liang Y, Kongstad O, Liao Q, Holm M, Olsson B, et al. In vivo validation of the coincidence of the peak and end of the T wave with full repolarization of the epicardium and endocardium in swine. Heart Rhythm. 2005;2(2):162-9. Epub 2005/04/27. doi: 10.1016/j.hrthm.2004.11.011. PubMed PMID: 15851290.
Hidayet S, Demir V, Turan Y, Gurel G, Tasolar MH. Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with Behcet's disease. Anatol J Cardiol. 2019;22(2):85-90. Epub 2019/08/04. doi: 10.14744/AnatolJCardiol.2019.70019. PubMed PMID: 31375650; PubMed Central PMCID: PMCPMC6735444.
Lazzerini PE, Capecchi PL, Acampa M, Galeazzi M, Laghi-Pasini F. Arrhythmic risk in rheumatoid arthritis: the driving role of systemic inflammation. Autoimmun Rev. 2014;13(9):936-44. Epub 2014/05/31. doi: 10.1016/j.autrev.2014.05.007. PubMed PMID: 24874445.
Sgreccia A, Morelli S, Ferrante L, Perrone C, De Marzio P, De Vincentiis G, et al. QT interval and QT dispersion in systemic sclerosis (scleroderma). J Intern Med. 1998;243(2):127-32. Epub 1998/05/05. PubMed PMID: 9566641.
Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012;60(22):2263-70. Epub 2012/12/01. doi: 10.1016/j.jacc.2012.04.063. PubMed PMID: 23194937.
Kazumi T, Kawaguchi A, Hirano T, Yoshino G. C-reactive protein in young, apparently healthy men: associations with serum leptin, QTc interval, and high-density lipoprotein-cholesterol. Metabolism. 2003;52(9):1113-6. Epub 2003/09/25. doi: 10.1016/s0026-0495(03)00184-7. PubMed PMID: 14506615.
Kim E, Joo S, Kim J, Ahn J, Kim J, Kimm K, et al. Association between C-reactive protein and QTc interval in middle-aged men and women. Eur J Epidemiol. 2006;21(9):653-9. Epub 2006/10/31. doi: 10.1007/s10654-006-9034-9. PubMed PMID: 17072542.
Lazzerini PE, Acampa M, Capecchi PL, Hammoud M, Maffei S, Bisogno S, et al. Association between high sensitivity C-reactive protein, heart rate variability and corrected QT interval in patients with chronic inflammatory arthritis. Eur J Intern Med. 2013;24(4):368-74. Epub 2013/03/23. doi: 10.1016/j.ejim.2013.02.009. PubMed PMID: 23517852.
Yayla C, Yayla ME, Yayla KG, Ilgen U, Akboga MK, Duzgun N. The Assessment of Tp-e Interval and Tp-e/QT Ratio in Patients With Systemic Sclerosis. Arch Rheumatol. 2016;31(2):139-44. Epub 2016/01/28. doi: 10.5606/ArchRheumatol.2016.5753. PubMed PMID: 29900933; PubMed Central PMCID: PMCPMC5827829.
Demirtas K, Yayla C, Yuksel M, Acar B, Unal S, Ertem AG, et al. Tp-e interval and Tp-e/QT ratio in patients with celiac disease. Rev Clin Esp. 2017;217(8):439-45. Epub 2017/10/11. doi: 10.1016/j.rce.2017.09.001. PubMed PMID: 28992960.
Si̇vri̇ S, Çeli̇k M . Effect of anti-TNFα treatment on Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis: A case-control study. J Surg Med. 2020;4(3):182-5.
Osto E, Piaserico S, Maddalozzo A, Forchetti G, Montisci R, Famoso G, et al. Impaired coronary flow reserve in young patients affected by severe psoriasis. Atherosclerosis. 2012;221(1):113-7. Epub 2012/01/13. doi: 10.1016/j.atherosclerosis.2011.12.015. PubMed PMID: 22236480.
Balci DD, Balci A, Karazincir S, Ucar E, Iyigun U, Yalcin F, et al. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. Journal of the European Academy of Dermatology and Venereology : JEADV. 2009;23(1):1-6. Epub 2008/08/16. doi: 10.1111/j.1468-3083.2008.02936.x. PubMed PMID: 18702627.
Yiu KH, Yeung CK, Zhao CT, Chan JC, Siu CW, Tam S, et al. Prevalence and extent of subclinical atherosclerosis in patients with psoriasis. J Intern Med. 2013;273(3):273-82. Epub 2012/09/26. doi: 10.1111/joim.12002. PubMed PMID: 23003220.
Gonzalez-Juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007;57(6):1074-80. Epub 2007/08/01. doi: 10.1002/art.22884. PubMed PMID: 17665475.
Gladman DD, Ang M, Su L, Tom BD, Schentag CT, Farewell VT. Cardiovascular morbidity in psoriatic arthritis. Annals of the rheumatic diseases. 2009;68(7):1131-5. Epub 2008/08/14. doi: 10.1136/ard.2008.094839. PubMed PMID: 18697777.
Ahlehoff O, Gislason GH, Charlot M, Jorgensen CH, Lindhardsen J, Olesen JB, et al. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med. 2011;270(2):147-57. Epub 2010/12/01. doi: 10.1111/j.1365-2796.2010.02310.x. PubMed PMID: 21114692.
Saba S, Janczewski AM, Baker LC, Shusterman V, Gursoy EC, Feldman AM, et al. Atrial contractile dysfunction, fibrosis, and arrhythmias in a mouse model of cardiomyopathy secondary to cardiac-specific overexpression of tumor necrosis factor-{alpha}. Am J Physiol Heart Circ Physiol. 2005;289(4):H1456-67. Epub 2005/06/01. doi: 10.1152/ajpheart.00733.2004. PubMed PMID: 15923312.
Dave J, Ahlman MA, Lockshin BN, Bluemke DA, Mehta NN. Vascular inflammation in psoriasis localizes to the arterial wall using a novel imaging technique. J Am Acad Dermatol. 2014;70(6):1137-8. Epub 2014/03/20. doi: 10.1016/j.jaad.2013.12.043. PubMed PMID: 24641984; PubMed Central PMCID: PMCPMC4024331.
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