Psoriatic arthritis is associated with myocardial repolarization dysregulation as assessed by the QTc interval and the Tp-e/QTc ratio

Abstract

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.

Keywords

• Psoriatic arthritis
• electrocardiography
• Tp-e/QTc ratio
• Myocardial repolarization

Psöriatik artrit, QTc aralığı ve Tp-e/QTc oranı ile değerlendirilen miyokardiyal repolarizasyon düzensizliği ile ilişkilidir

Öz

Amaç: Psoriatik artritli (PsA) hastalarda aritmi riski artışı olduğu gösterilmiştir. Tp-e aralığı ve Tp-e/QT oranı, miyokardiyal repolarizasyon heterojenitesinin değerlendirilmesinde yararlı belirteçler olarak kabul edilmektedir. Bu çalışmada PsA hastalarında QTc aralığı ve Tp-e/QTc oranı temelinde ventriküler repolarizasyonun özelliklerini incelemeyi amaçladık. Yöntemler: Bu kesitsel gözlemsel çalışmaya 18 yaşın üzerinde psoriatik artritli hastalar dahil edildi. Sağlıklı gönüllülerden bir kontrol grubu oluşturuldu. Psoriatik artrit tanısı CASPAR kriterlerine göre yapıldı. PsA hastalarının ve kontrol grubunun 12 kanallı elektrokardiyogramlarından (EKG) QT aralığı, düzeltilmiş QT (QTc), Tp-e aralığı, Tp-e/QT oranı ve Tp-e/QTc oranı ölçüldü. Bulgular: Çalışma popülasyonu 82 PsA hastası ve 82 sağlıklı gönüllüden oluşuyordu. Elektrokardiyografik parametrelere göre kalp hızı her iki grupta da benzerdi, ancak QT, QTc, Tp-e aralıkları; Tp-e/QT ve Tp-e/QTc oranları PsA grubunda anlamlı olarak yüksekti. PsA'lı hastaların medyan Tp-e/QTc oranı, kontrol grubunun medyan Tp-e/QTc oranından (0,21 (0,20-0,25) ve 0,18 (0,17-0,19, P<0,001) anlamlı olarak daha yüksekti. Korelasyon analizi Tp-e/QTc oranı ile CRP değeri arasında zayıf bir korelasyon gösterdi (r=0,197, P=0,012). Sonuçlar: Bu çalışma PsA hastalarında Tp-e/QTc oranının uzadığını gösteren ilk çalışmadır. Bu bulgunun özellikle aritmiler ve ani ölüm açısından klinik önemini gözlemlemeye yönelik ileriye dönük klinik çalışmalar daha değerli olabilir.

Anahtar Kelimeler

• Psoriatik artrit
• Elektrokardiyografi
• Tp-e/QTc oranı
• Miyokardiyal repolarizasyon

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