QTc interval prolongation in systemic sclerosi

Gigante, Antonietta

Rosato, Edoardo

Tubani, Luigi

English

E. Rosato

L. Tubani

A. Gigante

Crossref

International Journal of Cardiology

QTc interval prolongation in systemic sclerosis

ROSATO, Edoardo

TUBANI, Luigi

GIGANTE, ANTONIETTA

Archivio della ricerca- Università di Roma La Sapienza

International Journal of Cardiology 239 (2017) 34Contents lists available at ScienceDirectInternational Journal of Cardiologyj ourna l homepage: www.e lsev ie r .com/ locate / i j ca rdLetter to the EditorQTc interval prolongation in systemic sclerosisE. Rosato, L. Tubani, A. Gigante ⁎Department of Clinical Medicine, Clinical Immunology Unit, Scleroderma Center, Sapienza University of Rome, Italy⁎ Corresponding author at: Department of Clinical MRome, Viale dell'Università 37, 00185 Rome, Italy.E-mail address: antonietta_gigante@yahoo.it (A. Giganhttp://dx.doi.org/10.1016/j.ijcard.2017.03.1600167-5273/© 2017 Elsevier B.V. All rights reserved.a r t i c l e i n f oArticle history:Received 21 March 2017Accepted 30 March 2017Keywords:Systemic sclerosisQTc interval was longer in patients with SSc than in control subjects.In addition they conclude that QT dispersion and QTc dispersion weresignificantly increased in SSc patients withmyocardial resting perfusiondefects [1–2].De Luca et al. reported aQTc prolongation only in 11% of SSc-patientswith new onset of suggestive symptoms of cardiac involvement, such asQTc prolongationArrhythmiaCardiac involvementDear Dr De Luca,In systemic sclerosis (SSc) QTc interval prolongation was report-ed from 14 to 25% of patients [1–3]. Massie et al. in a cohort of 689SSc patients reported a prolonged QTc interval (N440 ms) in 25% ofpatients. However, in both univariate and multivariate analyses,QTc prolongationwas associated with longer disease duration, great-er disease severity and the presence of anti-RNA polymerase III anti-bodies. The authors did not find an association between prolongedQTc and anti- Ro antibodies. In the study, the authors reported amean value of QTc of 422± 47ms [1]. Themedian value of QTc inter-val in our group is 447 ms (414–566). Our data of QTc interval aresimilar to data reported by Massie et al., although in a higherpercentage of SSc patients. Massie et al. concluded that QTc prolon-gation, which is common in SSc may be due, at least in part, to myo-cardial fibrosis, which may prolong the ventricular recovery time bydisturbing the coronary microcirculation [1]. Foocharoen et al. re-ported a prolonged QTc in 14.6% of 103 asymptomatic cardiac SSc pa-tients. The QTc prolongation correlated with skin involvement andRaynaud's phenomenon [4].edicine, Sapienza University ofte).Sgreccia et al. demonstrated in asymptomatic cardiac patients thatdyspnea, palpitations, chest pain, and/or signs of heart failure. We aresurprised because it is the lowest percentage reported of QTc prolonga-tion in patients with cardiac involvement [5].Io our paper we demonstrated only that QTc was longer in SSc pa-tients than healthy controls. We suppose that microvascular damageis present early in myocardium of SSc patients and it may be the patho-genic mechanism of autonomic dysfunction and arrhythmias. We havejust formulated a hypothesis about correlation between QTc prolonga-tion and digital microvascular damage. Future largest studies are need-ed to evaluate this correlation.References[1] C. Massie, M. Hudson, S. Tatibouet, R. Steele, T. Huynh, M.J. Fritzler, M. Baron, C.A.Pineau, Canadian Scleroderma Research Group (CSRG). Absence of an association be-tween anti-Ro antibodies and prolonged QTc interval in systemic sclerosis: a multi-center study of 689 patients, Semin. Arthritis Rheum. 44 (3) (2014) 338–344.[2] A. Sgreccia, S. Morelli, L. Ferrante, C. Perrone, P. De Marzio, G. De Vincentiis, F.Scopinaro, QT interval and QT dispersion in systemic sclerosis (scleroderma), J. In-tern. Med. 243 (2) (1998) 127–132.[3] S. Morelli, A. Sgreccia, L. Ferrante, C. Barbieri, M.L. Bernardo, C. Perrone, P. De Marzio,Relationships between electrocardiographic and echocardiographic findings in sys-temic sclerosis (scleroderma), Int. J. Cardiol. 57 (2) (1996) 151–160.[4] C. Foocharoen, B. Pussadhamma, A. Mahakkanukrauh, S. Suwannaroj, R. Nanagara,Asymptomatic cardiac involvement in Thai systemic sclerosis: prevalence and clinicalcorrelations with non-cardiac manifestations (preliminary report), Rheumatology(Oxford) 54 (9) (2015) 1616–1621.[5] G. De Luca, S.L. Bosello, F.A. Gabrielli, G. Berardi, F. Parisi, M. Rucco, G. Canestrari, F.Loperfido, L. Galiuto, F. Crea, G. Ferraccioli, Prognostic role of ventricular ectopicbeats in systemic sclerosis: a prospective cohort study shows ECG indexes predictingthe worse outcome, PLoS One 11 (4) (2016), e0153012.

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QTc interval prolongation in systemic sclerosis

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