Increased QT dispersion in patients with psoriasis

Abstract

Objectives: Psoriasis is a chronic infl ammatory skin disorder characterized by erythematous plaques, generally at the elbows, knees, scalp, umbilicus and lumber area. Many systemic diseases including cardiovascular disturbances have been described in psoriatic patients. In the present study, we aimed to investigate QT dispersion (QTD) and corrected QT dispersion (QTcD) as a possible indicator of increased risk for ventricular arrhythmias and sudden cardiac death in patients with psoriasis. Materials and methods: Twenty-three patients with psoriasis and age and gender matched 20 control subjects were enrolled in the study. The severity of the disease was evaluated by the “Psoriasis Area and Severity Index (PASI)”. Standard 12-lead electrocardiographs at 25 mm/s paper speed and 24-hour holter examination were performed in all subjects. QTD and QTcD were measured. QTD was defi ned as the difference between the maximum and minimum QT interval measurements and QTc was calculated according to Bazett\'s formula. Correlation analysis was performed between QTD and QTcD and PASI and duration of the disease. Results: QTD and QTcD were signifi cantly greater in psoriatic patients than controls (QTD, 67.5}17.4 vs 44.0}11.9 ms, p

Keywords

• psoriasis; QT dispersion

Psöriazis hastalarında artmıs QT dispersiyonu

Abstract

Amaç: Psöriazis, genellikle diz, dirsek, saçlı deri, umblikus ve lomber alanda ortaya çıkan gümüşi beyaz renkli kepeklenmelerle kaplı eritemli plaklarla karakterize, kronik infl amatuar bir deri hastalığıdır. Psöriaziste kardiyovasküler bozukluklar dahil çok sayıda sistemik hastalık tanımlanmıştır. Biz bu çalışmada psöriazis hastalarında, ventriküler aritmilerin artışı ve ani kardiyak ölüm riskinin muhtemel bir göstergesi olan QT dispersiyonunu (QTD) ve düzeltilmiş QT dispersiyonunu (QTcD) değerlendirmeyi planladık.Gereç ve Yöntemler: Çalışmaya psöriazisli 23 hasta ve yaş ve cinsiyet açısından hasta grubu ile benzerlik gösteren sağlıklı 20 kontrol bireyi alındı. Hastalığın ciddiyetinin değerlendirilmesinde, “Psoriazis Alan Şiddet İndeksi” (PASİ) kullanıldı. Tüm bireylere 25 mm/sn hızında 12 derivasyonlu elektrokardiyograŞ çekildi ve 24 saatlik holter monitorizasyonu yapıldı. QTD ve QTcD ölçümleri yapıldı. QTD, en büyük ve en küçük QT değerleri arası fark olarak tanımlandı ve düzeltilmiş QT (QTc) Bazett formülüne göre hesaplandı. QTD ve QTcD ile PASİ ve hastalık süresi arasında korelasyon analizi yapıldı.Bulgular: QTD ve QTcD hasta grubunda kontrol grubundan istatistiksel olarak anlamlı düzeyde yüksek tespit edildi (QTD; sırasıyla, 67.5±17.4ve 44.0±11.9 ms, p

Keywords

• Psöriazis, QT dispersiyonu

References

1. Güneş AT, Altıner D. History and epidemiology of psoriasis. Turkiye Klinikleri J Int Med Sci 2005; 1:1-4.
2. Kalayciyan A, Tüzün Y. Clinical characteristics of psoriasis. Turkiye Klinikleri J Dermatol 2003; 13.
3. Güven A, Şaşmaz S, Aksu E, Çağlayan E. Echocardiographic evaluation in patients with psoriasis. Turkiye Klinikleri J Cardiol 2003; 16; 77-81.
4. Torok L, Toth E, Bruncsak A. Correlation between psoriasis and cardiovascular diseases. Z Hautkr 1982; 57:734-9.
5. Ena P, Madeddu P, Glorioso N, Cerimele D, Rappelli A. High prevalence of cardiovascular diseases and enhanced activ- ity of the renin-angiotensin system in psoriatic patients. Acta Cardiol 1985;40:199-205.
6. Salonen JT, Yla-Herttuala S, Yamamoto R, et al. Autoanti- body against oxidised LDL and progression of carotid ath- erosclerosis. Lancet 1992; 339:883-7.
7. Moya JL, Sanchez M, Morales MD, Brito E. Mitral valve prolapse (MVP) in psoriatic arthritis (PA). Arch Intern Med 1987; 147:992.
8. Muna WF, Roller DH, Craft J, Shaw RK, Ross AM. Psoriatic arthritis and aortic regurgitation. JAMA 1980;244:363–5.

9. Zabel M, Protnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 1995;25:746-52
10. Day CP, McComb JM, Campbell RWF. QT dispersion: an indication of arrhytmia risk in patients with long QT inter- vals. Br Heart J 1990;63:342-4
11. Aksöyek S, Batur M, Atalar MK. Akut miyokard infarktüsü sonrası gelişen taşiaritmilerde QT dispersiyonu. Türk Kar- diyol Der Arş 1996;24:88-92
12. Zareba W, Moss AJ, Le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary ar- tery disease. Am J Cardiol 1994; 74:550-553.
13. De Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bem- mel JH, Grobbee DE. QTc dispersion predicts cardiac mor- tality in the elderly: the Rotterdam Study. Circulation 1998; 97:467-72.
14. Feldman SR. A quantitative deŞ nition of severe psoriasis for use in clinical trials. J Dermatol Treat 2004;15.27–9.
15. Hanci V, Ayoğlu H, Yurtlu S, et al. An evaluation of P wave dispersion, QT, corrected QT and corrected QT dispersion intervals on the electrocardiograms of malnourished adults. Anaesth Intensive Care. 2010; 38:122-7.
16. Das RP, Jain AK, Ramesh V. Current concepts in the patho- genesis of psoriasis. Indian J Dermatol 2009; 54:7-12.
17. Wakkee M, Thio HB, Prens EP, Sijbrands EJ, Neumann HA. Unfavorable cardiovascular risk proŞ les in untreated and treated psoriasis patients. Atherosclerosis. 2007; 190:1-9.
18. Markuszeski L, Bissinger A, Janusz I, Narbutt J, Jedrzejows- ka AS, Zalewska A. Heart rate and arrhythmia in patients with psoriasis vulgaris. Arch Med Res 2007; 38:64-9.
19. Kettunen R, Huikuri HV, Oikarinen A, Takkunen JT. Metho- trexate-linked ventricular arrhythmias. Acta Derm Venereol 1995;75:391-2
20. Carvalho M, Soares R, Ribeiro F, et al. Rhythm pro- Ş le in patients with psoriatic arthritis. Rev Port Cardiol. 1990;9:311-7
21. Novikova DS, Korotaeva TV, Loginova EIu, et al. Clini- cal implication of assessment of heart rate variability in pa- tients with psoriatic arthritis. Ter Arkh 2009; 81:47-52.
22. Tamer A, Gündüz H, Karabay O, et al. The Effect Of coro- nary risk factors on Qt intervals and Qt dispersion. Kardi- yoloji Derg 2004; 17:1.
23. Perkiomaki JS, Koistinen J, Yli-Mayry S, Huikuri HV. Dis- persion of QT interval in patients with and without suscep- tibility to ventricular taschyarrhytmias after previous myo- cardial infarction. J Am Coll Cardiol 1995;26:174-9
24. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: structure, function and time dependent of risk. Cir- culation 1992; 85:I2-10.
25. Loo AV, Arendts W, Hohnloser SH: Variability of QT dis- persion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994; 74:1113-18
26. Zabel M, Klingenheben T, Franz MR, Hohnloser SH. As- sesment of QT dispersion for prediction of mortality or arrhythmic events after miyocardial infarction: Result of prospective long term follow up study. Circulation 1998; 97:2543-2550.
27. Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994;343:327-9.
28. Cardoso C, Salles G, Bloch K, Deccache W, Siqueira-Filho AG. Clinical determinants of increased QT dispersion in patients with diabetes mellitus. Int J Cardiol 2001;79:253- 62
29. Yildirir A, Aksoyek S, Calguneri M, et al. QT dispersion as a predictor of arrhythmic events in patients with ankylosing spondylitis. Rheumatology 2000; 39:875-9.
30. Göldeli O, Dursun E, Komsuoglu B. Dispersion of ventricu- lar repolarization: a new marker of ventricular arrhythmias in patients with rheumatoid arthritis. J Rheumatol 1998; 25:447-50.