Page 103 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

THE RELATION BETWEEN CARDIAC CONDUCTION TIMES
Baseline ECG and heart rhythm.
At baseline, 12.5% of all patients with early arthritis had a conduction disorder according to the cardiologist, of which LAFB (27.8%), incomplete RBBB (22.2%), and first degree AV block (22.2%) were most often diagnosed (Figure 1). A prolonged QTc time was present in 2 patients (0.4%) and in 1 patient with an LBBB. There was no association between ESR, CRP, or DAS28 and the presence of conduction disorders. Patients with a disorder were, however, generally older than those without (56 vs 52 yrs; p=0.03). Mean (SD) heart rate was 67 (12) bpm; 451 patients had sinus rhythm and 4 had atrial fibrillation. Heart rate was significantly associated with indices of disease activity (Table 2). QT time was significantly associated with DAS28, ESR and CRP levels; however QTc time was not significantly associated (Table 2).
Table 2. Association of heart rate and conduction times with disease activity at baseline in patients who did not use β-blockers (n = 455). All data are corrected for sex, age, symptom duration, RF or ACPA positivity, pain visual analog scale, and body mass index
5
DAS28 levels ESR levels CRP levels
HR, bpm
QRS, ms
QT, ms
QTc, ms
PR, ms
B (CI) P-value
2.268 < 0.001 (1.222-3.331)
-1.078 0.063 (-2.217-0.060)
-4.207 0.003 (-6.994- -1.420)
0.657 0.428 (-0.973-2.288)
-1.403 0.224 (-3.669-0.863)
B (CI) P-value
0.210 < 0.001 (0.151-0.268)
-0.038 0.259 (-0.105-0.028)
-0.372 < 0.001 (-0.531- -0.213)
0.033 0.493 (-0.062-0.128)
-0.135 0.043 (-0.266-0.004)
B (CI)
0.207 (0.152-0.261)
-0.028 (-0.091-0.036)
-0.380
(-0.530- -0.231)
-0.007 (-0.097-0.084)
-0.117 (-0.242-0.009)
P-value
< 0.001
0.392
< 0.001
0.886
0.069
B: beta; CI: confidence interval; CRP: C-reactive protein; DAS28: 28-joint Disease Activity Score; ESR: erythrocyte sedimentation rate; HR: heart rate; QTc: QT corrected for heart rate; RF: rheumatoid factor; ACPA: anticitrullinated protein antibodies
CV risk profile.
The mean BMI was 26.4 (4.9) kg/m2, and 32.1% were current smokers. Being overweight (defined as BMI > 25 kg/m2) or current smoking were not significantly associated with conduction disorders. Mean (SD) systolic blood pressure in patients who did not use antihypertensives was 134 (20) mmHg and diastolic blood pressure was 80 (12) mmHg. A high systolic (> 140 mmHg) or diastolic (> 90 mmHg) blood pressure was found 118 patients (30.1%). Of these, 14.6% had a conduction disorder versus 11.6% in the patients with a normal blood pressure (p = 0.34). Prolongation of the QRS time tended to be related to abnormal blood pressure [B: 2.28 (-0.25-4.80), p = 0.08]. However, after correction for baseline demographics [DAS28, sex, age, symptom duration, rheumatoid
101