Περίληψη:
Objectives: Cardiac rhythm disturbances constitute the most frequent
cardiovascular cause of death in SSc. However, electrocardiographic
findings are not a part of risk stratification in SSc. We aimed to
translate 24 h Holter findings into a tangible risk prediction score
using cardiovascular magnetic resonance.
Methods: The Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS) was
a prospective multicentre study including 150 consecutive SSc patients
from eight European centres, assessed with 24 h Holter and
cardiovascular magnetic resonance, including ventricular function,
oedema (T2 ratio) and late gadolinium enhancement (%LGE).
Laboratory/clinical parameters were included in multivariable
corrections. A combined endpoint of sustained ventricular tachycardia
requiring hospitalization and sudden cardiac death at a median
(interquartile range) follow-up of 1 (1.0-1.4) year was generated.
Results: Only T2 ratio and %LGE were significant predictors of
ventricular rhythm disturbances, but not of supraventricular rhythm
disturbances, after multivariable correction and adjustment for multiple
comparisons. Using decision-tree analysis, we created the SAnCtUS score,
a four-category scoring system based on T2 ratio and %LGE, for
identifying SSc patients at high risk of experiencing ventricular rhythm
disturbance at baseline. Increasing SAnCtUS scores were associated with
a greater disease and arrhythmic burden. All cases of non-sustained
ventricular tachycardia (n = 7) occurred in patients with the highest
SAnCtUS score (=4). Having a score of 4 conveyed a higher risk of
reaching the combined endpoint in multivariable Cox regression compared
with scores 1/2/3 [hazard ratio (95% CI): 3.86 (1.14, 13.04), P =
0.029] independently of left ventricular ejection fraction and baseline
ventricular tachycardia occurrence.
Conclusion: T2 ratio and %LGE had the greatest utility as independent
predictors of rhythm disturbances in SSc patients.
Συγγραφείς:
Mavrogeni, Sophie
Gargani, Luna
Pepe, Alessia
Monti, Lorenzo
and Markousis-Mavrogenis, George
De Santis, Maria
De Marchi,
Daniele
Koutsogeorgopoulou, Loukia
Karabela, Georgia and
Stavropoulos, Efthymios
Katsifis, Gikas
Bratis, Konstantinos and
Bellando-Randone, Silvia
Guiducci, Serena
Bruni, Cosimo and
Moggi-Pignone, Alberto
Dimitroulas, Theodoros
Kolovou, Genovefa
and Bournia, Vasiliki-Kalliopi
Sfikakis, Petros P. and
Matucci-Cerinic, Marco
