Right Bundle Branch Block: A Predictor of Mortality in Early Systemic Sclerosis
Open Access
- 31 October 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (10), e78808
- https://doi.org/10.1371/journal.pone.0078808
Abstract
To evaluate the prognostic significance of baseline electrocardiogram (ECG) abnormalities in a multiethnic cohort of patients with early systemic sclerosis (SSc) and to determine the serological, clinical, and echocardiogram correlates of ECG findings. SSc patients with disease duration of≤5 years were enrolled in the GENISOS (Genetics versus Environment in Scleroderma Outcome Study) cohort. At the first visit, a standard 12 lead ECG was obtained along with demographic information, clinical data, and autoantibodies. The results of echocardiograms were also recorded. All ECGs were interpreted by a cardiologist unaware of the patients' clinical data. Of 265 SSc patients with average disease duration at enrollment of 2.5 years, 140 (52.8%) had abnormal ECG findings. These findings were not associated with SSc disease type or autoantibody profile but were associated with more severe heart and lung involvement. A total of 75 patients (28.3%) died over a follow up time of 9.9 years. Complete right bundle branch block (± left anterior hemiblock) on ECG, present in 7 (2.6%) patients, predicted a higher risk of mortality (HR: 5.3; 95% CI: 2.1 to 13.4; p<0.001). The predictive significance of right bundle branch block was independent of age at enrollment, gender, ethnicity and risk factors for coronary artery disease. ECG abnormalities are common in patients with early SSc and are associated with the severity of lung and heart involvement. Right bundle branch block is an independent predictor of mortality, and should be considered a marker of disease severity in SSc.Keywords
This publication has 21 references indexed in Scilit:
- Systemic sclerosis and the heartCurrent Opinion in Rheumatology, 2011
- Intraventricular Conduction Delay in a Standard 12-Lead Electrocardiogram as a Predictor of Mortality in the General PopulationCirculation: Arrhythmia and Electrophysiology, 2011
- Predictors of interstitial lung disease in early systemic sclerosis: a prospective longitudinal study of the GENISOS cohortArthritis Research & Therapy, 2010
- Clinical and genetic factors predictive of mortality in early systemic sclerosisArthritis Care & Research, 2009
- Cardiac magnetic resonance imaging in systemic sclerosis: a cross-sectional observational study of 52 patientsAnnals Of The Rheumatic Diseases, 2008
- Relationships between electrocardiographic and echocardiographic findings in systemic sclerosis (scleroderma)International Journal of Cardiology, 1996
- Preliminary criteria for the classification of systemic sclerosis (scleroderma)Arthritis & Rheumatism, 1980
- Myocardial lesions of progressive systemic sclerosis. A cause of cardiac dysfunction.Circulation, 1976
- A point-score system for the ECG diagnosis of left ventricular hypertrophyAmerican Heart Journal, 1968
- The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leadsAmerican Heart Journal, 1949