A RELATIONSHIP BETWEEN QT INTERVAL AND CARDIOVASCULAR RISK FACTORS IN WOMEN WITH RHEUMATOID ARTHRITIS
https://doi.org/10.17650/1818-8338-2013-1-30-35
Abstract
Objective: to study a relationship of QT interval to cardiovascular risk factors in women with rheumatoid arthritis (RA).
Subjects and methods. 291 female patients aged less than 60 years with a valid diagnosis of RA were examined. A control group consisted of
125 women without rheumatic diseases. In addition to the clinical manifestations, acidity, and severity of RA, the authors assessed traditional risk factors (TRF) of cardiovascular diseases (CVD), performed Holter ECG monitoring, common carotid artery duplex scanning, transthoracic echocardiographic study, and determined the levels of serum inflammatory markers.
Results. The patients with RA differ from the control group in a longer adjusted QT interval, corrected for TRF of CVD. The major factors
associated with a daily prolonged QTc interval in the women with RA are arterial hypertension, systolic, diastolic, pulse blood pressure level s, body mass index, subclinical target organ damage (carotid artery atherosclerosis, left ventricular (LV) diastolic dysfunction, LV hypertrophy
and remodeling), and the duration of RA. Leflunomide therapy is an additional factor associated with a prolonged nocturnal QT interval.
Conclusion. The RA patients with a prolonged QTc interval and no clinical signs of cardiac lesion need meticulous examination aimed to identify CVD.
About the Authors
D. S. Novikova
Research Institute of Rheumatology, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
T. V. Popkova
Research Institute of Rheumatology, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
A. N. Gerasimov
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
A. V. Volkov
Research Institute of Rheumatology, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
Ye. L. Nasonov
Research Institute of Rheumatology, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
References
1. Ревматология. Клинические рекомендации. Под ред. акад. РАМН Е.Л. Насонова. М.: ГЭОТАР-Медиа, 2010.
2. Meune C., Touze E., Trinqurte L., Allanore Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 2009;48(10):1309–13.
3. Peters M.J., Symmons D.P., McCarey D. et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other types of inflammatory arthritis. Ann Rheum Dis 2010;69(2):325–31.
4. van Halm V.P., Peters M.J., Voskuyl A.E. et al. Rheumatoid arthritis versus type 2 diabetes as a risk factor for cardiovascular disease: a cross-sectional study. Ann Rheum Dis 2009;68(9):1395–400.
5. Никитин Ю.П., Кузнецов А.А., Малютин а С.К. и др. Прогностическое значение длительности и дисперсии интерва-лов Q–T и R–R в общей популяции Новосибирска. Кардиология 2002;42(2):76–83.
6. Higham P.D., Furniss S.S., Campbell R.W. et al. QT dispersion and components of the QT interval in ischemia and infarction. Br Heart J 1995;73(1):32–6.
7. Dobson C.P., Larovere M.T., Olsen C. et al. 24-Hour QT variability in heart failure. J Electrocardiol 2009;42(6):500–4.
8. Watanabe E., Arakawa T., Uchiyama T. et al. Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure. Heart Rhythm 2007;4(8):999–1005.
9. Padmanabhan S., Silvet H., Amin J., Pai R.G. Prognostic value of QT interval and QT dispersion in patients with left ventricular systolic dysfunction: results from a cohort of 2265 patients with an ejection fraction of 40 %. Am Heart J 2003;145(1):132–8.
10. Ziegler D., Zentai C.P., Perz S. et al. Prediction of mortality using measures of cardiac autonomic dysfunction in the diabetic and nondiabetic population: the MONICA/KORA Augsburg Cohort Study.
11. Diabetes Care 2008;31(3):556–61.
12. Elming H., Holm E., Jun L. et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J 1998;19(9):1391–400.
13. De Bruyne M.C., Hoes A.W., Kors J.A. et al. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. Eur Heart J 1999;20(4):278–84.
14. Макаров Л.М. Оценка интервала QT при холтеровском мониторировании (лекция).
15. www.medass.ru/news/con_2003/p345_356.doc.
16. Göldeli O., Dursun E., Komsuoglu B. Dispersion of ventricular repolarization: a new marker of ventricular arrhythmias in patients with rheumatoid arthritis. J Rheumatol 1998;25(3):447–50.
17. López de Guzmán A., de D García Díaz J., Díez-Pérez de la Vacas M.I. et al. Coronary calcification and subclinical myocardial dysfuncion in rheumatoid arthritis. Rev Clin Esp 2009;209(9):428–32.
18. Arnett F.C., Edworthy S.M., Bloch D.A. The American Rheumatism Association 1987 revised criteria for classification of rheumatoid arthritis. Arthritis Rheum 1988;31(3):315–24.
19. De Backer G., Ambrosioni E., Borch-Johnsen K. et al. European guidelines on cardiovascular disease and prevention in clinical practice. Atherosclerosis 2003;171(1):145–55.
20. Haward G., Sharrett A.R., Heiss G. et al. Carotid artery intima-media thickness distribution
21. in general populations as evaluated by B-mode ultrasound. Stroke 1993;24(9):1297–304.
22. Российские рекомендации по диагностике и лечению артериальной гипертензии. В кн.:
23. Национальные клинические рекомендации: Сборник. Под ред. Р.Г. Оганова. 2-е изд. М.: Силицея-Полиграф, 2009. С. 292–332.
24. Российские рекомендации по диагностике и лечению хронической сердечной недостаточности (третий пересмотр). Сердечн недостат 2010;11(1):69–160.
25. Герасимов А.Н. Медицинская статистика. М.: Медицинское информационное агентство, 2007.
26. Крамeр Г. Математические методы статистики. Пер. с англ. 2-е изд. М.: Мир, 1975.
27. Рябыкина Г.В., Шишова Т.А., Лапте в Д.Н. и др. Динамика артериального давления, вариабельности ритма сердца и QTс у больных с метаболическим синдромом при лечении селективным β-блокатором и бигуанидами. Системные гипертензии 2009;(3):38–56.
28. Soydinc S., Davutoglu V., Akcay M. Uncomplicated metabolic syndrome is associated with prolonged electrocardiographic QTc interval and QTc dispertion. Ann Noninvasive Electrocardiol 2006;11(4):313–7.
29. Пшеничников И., Шипилова Т., Кара й Д. и др. Связь интервала QT и дисперсии интервала QT с факторами, определяющими прогноз сердечно-сосудистой заболеваемости и смертности в популяции женщин 56–65 лет города Таллин. Кардиология 2009;49(4):46–51.
30. Laurent S., Cockcroft J., Van Bortel L. et al. Expert consensus document on arterial stiffness:
31. methodological issues and clinical applications. Eur Heart J 2006;27(21):2588–605.
32. Новикова Д.С., Попкова Т.В., Насоно в Е.Л. Современные представления о патогенезе и особенности лечения артериальной гипертензии при ревматоидном артрите. Тер архив 2011;83(5):24–33.
33. Новикова Д.С., Попкова Т.В., Мач Э.С., Насонов Е.Л. Ригидность артерий – интегральный показатель сердечно-сосудистого риска у больных ревматоидным артритом. Науч-практ ревматол 2009;(5):38–48.
34. Solomon D.H., Avorn J., Katz J.N. et al. Immunosuppressive medications and hospitalization for cardiovascular events in patients with rheumatoid arthritis. Arthritis Rheum 2006;54(12):3790–8.
35. Serelis J., Panagiotakos D.B., Mavrommati M., Skopouli F.N. Cardiovascular disease is related to
36. hypertension in patients with RA: a greek cohort study. J Rheumatol 2011;38(2):236–41.
37. Rozman B., Praprotnik S., Logar D. et al. Leflunomide and hypertension. Ann Rheum Dis 2002;61(6):567–69.
38. Alcorn N., Saunders S., Madhok R. Benefit-risk assessment of leflunomide: an appraisal of leflunomide in rheumatoid arthritis 10 years after licensing. Drug Saf 2009;32(12):1123–34.
Review
For citations:
Novikova D.S., Popkova T.V., Gerasimov A.N., Volkov A.V., Nasonov Ye.L. A RELATIONSHIP BETWEEN QT INTERVAL AND CARDIOVASCULAR RISK FACTORS IN WOMEN WITH RHEUMATOID ARTHRITIS. The Clinician. 2013;7(1):30-35. (In Russ.) https://doi.org/10.17650/1818-8338-2013-1-30-35
Views:
905
Email this article 