Page 105 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

THE RELATION BETWEEN CARDIAC CONDUCTION TIMES
Conduction*
HR, bpm
QRS, ms
QT, ms
QTc, ms
PQ, ms
T=0
66.4 (11.5)
94.2 (10.1)
405.2 (30.6)
414.5 (17.6)
149.0 (24.3)
T=1
67.0 (10.6)
94.8 (9.8)
401.0 (28.9)
414.5 (19.2)
150.0 (23.4)
p
0.246
0.219
0.005
0.732
0.170
* In patients who did not use β-blockers (n = 227). CRP: C-reactive protein; DAS28: 28-joint Disease Activity Score; ESR: erythrocyte sedimentation rate; HR: heart rate; IQR: interquartile range; QTc: QT corrected for heart rate; SJC: swollen joint count; TJC: tender joint count
Year 1 ECG and heart rhythm.
Paired t tests showed no significant alterations in conduction times after 1 year of treatment (Table 3). There were no significant differences in conduction times between
patients with a good, moderate, or no EULAR response. 5
A prolonged QTc time was seen in 5 patients (2.0%) and in 1 patient with an intraventricular disorder. Of the 5 patients, 2 were currently using a β-blocker. None of these patients had a prolonged QTc time at baseline. Patients with a prolonged QTc time had a higher mean DAS than patients without prolonged QTc [3.4 (0.6) vs 2.8 (1.2), p = 0.30]. Three patients had a moderate EULAR response, 1 had a good and 1 had none.
There was an association between disease improvement and decrease in heart rate. Patients in the quartile with the least DAS improvement or DAS worsening had a mean increase in heart rate over 1 year of 3.8 bpm (p = 0.02). Patients in the quartile with the largest DAS improvement had a decrease in heart rate of -3.5 bpm (p = 0.01). The difference in heart rate change between the 4 groups was statistically significant (p < 0.01; Figure 2A). When patients were divided by EULAR response, patients with a good EULAR response had a mean increase in heart rate of 0.7 bpm, versus a decrease of -1.6 bpm in de moderate responders and an increase of 4.9 bpm in those with no response (Figure 2B). The difference of increase in heart rate of 4.2 bpm between the good and nonresponders was significant (p = 0.02). There was no significant difference between good and moderate EULAR responders.
Year 1 CV risk factors.
The mean BMI increased to 26.8 (5.1) kg/ m2. Mean (SD) systolic and diastolic blood pressure at the 1-year visit were 132 (16) mmHg and 78 (11) mmHg, respectively. In 13.8%, the blood pressure was elevated. BMI and blood pressure were not associated with conduction times. At 1 year, the mean (SD) TChol increased significantly to 5.4 (1.0) mmol/l, and 8.1% of the patients had a TChol > 6.5. Mean HDL levels increased to 1.6 (0.5) mmol/l. The TChol and HDL increases were associated with improvement in DAS28, ESR, and CRP levels, but not with conduction times. The TChol:HDL ratio decreased from 4.1 (1.2) to 3.6 (1.1); p < 0.01 (Supplementary Table 2).
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