Associations of ECG-derived markers with clinical and biological characteristics in systemic sclerosis: preliminary findings from the SCAR-SSc study.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Systemic sclerosis (SSc) without overt cardiovascular disease (n=34). Intervention: ECG-derived markers: morphology-voltage-P-wave duration (MVP) score, fragmented QRS (fQRS), and interatrial block (IAB). Primary outcome: Association between MVP score and NT-proBNP levels (exploratory linear regression adjusted for age and sex) (β = 0.557 (B = 0.003), 95% CI 0.001 to 0.005, p=0.003).

Q: What does this research mean for the field?

ECG-derived markers are associated with disease severity, ventricular ectopy, and elevated NT-proBNP levels in patients with systemic sclerosis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

C. Vrancianu; Silvia Gabriela Arbanasu; Dragos Emanuel Popa; Bianca Budu; Isa Ethem Demirkol; Oana Andreea Popa; Adriana Mihaela Ilieșiu; Mihai Bojincă; Ana Ciobanu; Ana Maria Gheorghiu

doi:10.25122/jml-2026-0092

September 1, 2026

Associations of ECG-derived markers with clinical and biological characteristics in systemic sclerosis: preliminary findings from the SCAR-SSc study.

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Key result

Higher ECG MVP score links to elevated NT-proBNP and disease severity in systemic sclerosis.

β = 0.557 (B = 0.003)
95% CI 0.001 to 0.005
P=0.003
n=34

Why the study?

Detecting early cardiac involvement in systemic sclerosis remains challenging in asymptomatic patients, and the application of ECG-derived markers such as the MVP score, fragmented QRS, and interatrial block in this population was exploratory.

Are ECG-derived markers (MVP score, fragmented QRS, and interatrial block) associated with clinical severity, cardiac biomarkers, and ventricular ectopy in patients with systemic sclerosis without overt cardiovascular disease?

Study Design

Type

Cross-Sectional (n=34)

Blinding

Single-blind (cardiologist analyzing ECG recordings was blinded to clinical data and laboratory results)

Multicenter

No

Structured PICO

Are ECG-derived markers (MVP score, fragmented QRS, and interatrial block) associated with clinical severity, cardiac biomarkers, and ventricular ectopy in patients with systemic sclerosis without overt cardiovascular disease?

P

Population

34 adults with systemic sclerosis without overt cardiovascular disease (median age 53.6 years, 85.3% female, median disease duration 7.95 years) evaluated cross-sectionally at a single center.

E

Exposure

Resting 12-lead ECG (digitally magnified to 150 mm/s and 40 mm/mV) and 24-hour Holter ECG monitoring evaluating three a priori ECG-derived markers: morphology-voltage-P-wave duration (MVP) score (0-6), fragmented QRS (fQRS), and interatrial block (IAB).

O

Outcome

Exploratory associations of ECG-derived markers (MVP score, fQRS, and IAB) with clinical disease severity (modified Rodnan skin score [mRSS]), cardiac and inflammatory biomarkers (NT-proBNP, hsTnI, CRP), and 24-hour Holter arrhythmic events (premature ventricular contractions [PVCs], atrial tachycardia).surrogate

Main Result

Effect estimate: β = 0.557 (B = 0.003) (95% CI 0.001 to 0.005)

p-value: p=0.003

In systemic sclerosis patients without overt heart disease, surface ECG markers (MVP score, interatrial block, and fragmented QRS) correlate with skin fibrosis severity, NT-proBNP levels, and premature ventricular contractions, suggesting a potential role for routine ECG parameters in exploring subclinical electrical remodeling.

Limitations

Relatively small sample size (n = 34) and single-center design
Extensive exclusion criteria resulted in a highly selected cohort without overt cardiac disease, limiting generalizability
Predominance of limited cutaneous SSc (lcSSc) resulting in a relatively low median mRSS and restricted range of skin involvement
Exploratory regression analyses with a low number of outcome events for fQRS and IAB and no adjustment for multiple comparisons
Multivariable adjustment limited to age and sex, leaving potential residual confounding
ECG interpretation primarily performed by a single cardiologist without formal assessment of intra- and inter-observer agreement
Lack of cardiac MRI to directly evaluate myocardial fibrosis and structural substrate
Cross-sectional design precludes establishing temporal or predictive relationships
Small sample size (n = 34) and single-center design
Extensive exclusion criteria yielding a highly selected cohort without overt cardiac disease, limiting generalizability
Low number of outcome events for fQRS and IAB and no adjustment for multiple comparisons (exploratory nominal P values)
Adjustment limited to age and sex, leaving potential residual confounding
Single-cardiologist ECG reading without formal intra- or inter-observer agreement assessment
No cardiac MRI performed to directly evaluate myocardial fibrosis
Cross-sectional design precludes causal or temporal conclusions

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Implication

May indicate subclinical cardiac involvement in systemic sclerosis; hypothesis-generating and should not yet change practice.

Abstract

= 0.003). ECG-derived markers were associated with measures of disease severity, ventricular ectopy and NT-proBNP levels. These exploratory findings require confirmation in larger studies.

Discussion

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Cite This Study

Vrancianu et al. (2026) conducted a cross-sectional in Systemic sclerosis (SSc) without overt cardiovascular disease (n=34). ECG-derived markers: morphology-voltage-P-wave duration (MVP) score, fragmented QRS (fQRS), and interatrial block (IAB) was evaluated on Association between MVP score and NT-proBNP levels (exploratory linear regression adjusted for age and sex) (β = 0.557 (B = 0.003), 95% CI 0.001 to 0.005, p=0.003). Higher ECG-derived MVP scores were associated with elevated NT-proBNP levels and modified Rodnan skin scores in systemic sclerosis.

synapsesocial.com/papers/6af46da27bb3da179b850276 https://doi.org/10.25122/jml-2026-0092

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Associations of ECG-derived markers with clinical and biological characteristics in systemic sclerosis: preliminary findings from the SCAR-SSc study.

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Associations of ECG-derived markers with clinical and biological characteristics in systemic sclerosis: preliminary findings from the SCAR-SSc study.

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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