What does this research mean for the field?

Patients with systemic sclerosis have a significantly higher prevalence of abnormal resting electrocardiograms and cardiac conduction abnormalities compared to matched population controls. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 7, 2014Scandinavian Journal of Rheumatology

Electrocardiography in 110 patients with systemic sclerosis: a cross-sectional comparison with population-based controls

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Systemic sclerosis (n=1665). Intervention: Systemic sclerosis vs. Age- and gender-matched population controls without systemic sclerosis. Primary outcome: First-degree atrioventricular block (as a representative conduction abnormality) (p=0.895).

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Key result

Systemic sclerosis is not associated with increased conduction abnormalities or arrhythmias compared to controls.

P=0.895
n=1,665

Why the study?

Patchy myocardial fibrosis in systemic sclerosis is thought to cause conduction abnormalities, but the prevalence and types of rhythm disturbances compared to controls were not well characterized.

Study Design

Type

Cross-Sectional (n=1,665)

Multicenter

Yes

PICO

Population

1,665 participants, consisting of 833 patients with systemic sclerosis from a Canadian multicenter cohort and 832 age- and gender-matched population controls from Italy, analyzed for resting electrocardiographic abnormalities.

Exposure / Comparator

Systemic sclerosis vs Age- and gender-matched population controls without systemic sclerosis

Primary Outcome

First-degree atrioventricular block (as a representative conduction abnormality), p=0.895

Main Result

Absolute Event Rate: 3.8% vs 4%

p-value: p=0.895

Limitations

Patients and controls were drawn from two distinct source populations (a Canadian disease cohort and an Italian population-based cohort).
EKGs for the two groups were read by two different cardiologists, demonstrating only moderate interrater agreement (Cohen kappa 0.53).
Echocardiography was not systematically available in all patients, limiting the ability to correlate right atrial enlargement on EKG with pulmonary hypertension.
The QTc interval, which has been reported as prolonged in previous studies, was not assessed.
The use of a prevalent cohort may have led to survivor bias by excluding patients who died early from severe scleroderma heart disease.

Discussion

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Implication

Does not support routine ECG screening in asymptomatic systemic sclerosis; leaves open value of prospective arrhythmia monitoring.

Cite This Study

Nordin et al. (2014) conducted a cross-sectional in Systemic sclerosis (n=1,665). Systemic sclerosis vs. Age- and gender-matched population controls without systemic sclerosis was evaluated on First-degree atrioventricular block (as a representative conduction abnormality) (p=0.895). Systemic sclerosis was not associated with a higher prevalence of resting conduction abnormalities or arrhythmias compared to controls, suggesting that routine EKG screening for these conditions in asymptomatic patients may not be justified.

synapsesocial.com/papers/6ac6ef609d008ce1080f8a08 https://doi.org/10.3109/03009742.2013.843720

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Electrocardiography in 110 patients with systemic sclerosis: a cross-sectional comparison with population-based controls

Study Design

PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Electrocardiography in 110 patients with systemic sclerosis: a cross-sectional comparison with population-based controls

Study Design

PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider