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Gamazo-Herrero J, Medina-Luezas JA, Cusacovich I, Martín-Asenjo M, González-Montagut-Gómez C, Sánchez-González MD, Aramburu-Muñoz F, Janta I, García-Morán E, Veras-Burgos CM, Corral-Gudino L, Abad-Molina C, González-Fuentes R. Should Physicians Be Aware of Rhythm Disturbances in Adults with Systemic Autoimmune Diseases and Anti-Ro52 Antibodies? A Cross-Sectional Study. J Clin Med 2024; 13:3510. [PMID: 38930039 PMCID: PMC11204400 DOI: 10.3390/jcm13123510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives: The association between anti-Ro/SSA antibodies and the appearance of cardiac rhythm disorders in adults is discussed. We aim to study this relationship, together with active treatments and comorbidities, and its impact on daily clinical practice in adults with systemic autoimmune diseases (SADs). Methods: This cross-sectional single-center study was conducted in a tertiary hospital between January 2021 and March 2022. A sample of adult patients followed up in the SAD Unit with a diagnosis of a SAD and previously tested for anti-Ro/SSA and anti-La/SSB were recruited. All of them underwent a 12-lead electrocardiogram. Results: 167 patients were included. 90 (53.9%) were positive for anti-Ro60, 101 (60.5%) for anti-Ro52, and 45 (26.9%) for anti-La/SSB; 52 (31.3%) were triple-negative. 84% were women, and the mean age was 59 years (standard deviation 12.8). The most common SAD was primary Sjögren's syndrome (34.8%), followed by systemic lupus erythematosus (24.6%) and rheumatoid arthritis (22.8%). A statistically significant relationship was found between anti-Ro52 positivity and cardiac rhythm disorders (relative risk = 2.007 [1.197-3.366]), specifically QTc prolongation (relative risk = 4.248 [1.553-11.615]). Multivariate regressions showed a significant association, with diabetes mellitus being the most related comorbidity. The association between anti-Ro52 antibodies and atrioventricular conduction disorders was not significant. Conclusions: The presence of anti-Ro52 antibodies in adult patients with SADs is associated with an increased risk of QTc prolongation. Electrocardiographic screening of patients with SAD, anti-Ro52 antibodies, and other risk factors, like diabetes mellitus or QT-prolonging drugs, seems advisable. Those with baseline electrocardiogram abnormalities or additional risk factors should undergo electrocardiographic monitoring.
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Affiliation(s)
- Javier Gamazo-Herrero
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain; (J.G.-H.)
| | - Julio Antonio Medina-Luezas
- Systemic Autoimmune Diseases Unit, Department of Rheumatology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Ivan Cusacovich
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain; (J.G.-H.)
- Department of Medicine, Dermatology and Toxicology, Medicine College, University of Valladolid, Avda. Ramón y Cajal 7, 47003 Valladolid, Spain
| | - Miguel Martín-Asenjo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain; (J.G.-H.)
- Department of Medicine, Dermatology and Toxicology, Medicine College, University of Valladolid, Avda. Ramón y Cajal 7, 47003 Valladolid, Spain
| | - Carmen González-Montagut-Gómez
- Systemic Autoimmune Diseases Unit, Department of Rheumatology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - María Dolores Sánchez-González
- Systemic Autoimmune Diseases Unit, Department of Rheumatology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Francisco Aramburu-Muñoz
- Systemic Autoimmune Diseases Unit, Department of Rheumatology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Iustina Janta
- Systemic Autoimmune Diseases Unit, Department of Rheumatology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Emilio García-Morán
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Carlos Miguel Veras-Burgos
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Luis Corral-Gudino
- Department of Medicine, Dermatology and Toxicology, Medicine College, University of Valladolid, Avda. Ramón y Cajal 7, 47003 Valladolid, Spain
- Department of Internal Medicine, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), C/Dulzaina n°2, 47012 Valladolid, Spain
| | - Cristina Abad-Molina
- Immunology Laboratory, Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain
| | - Roberto González-Fuentes
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Avda. Ramón y Cajal nº3, 47003 Valladolid, Spain; (J.G.-H.)
- Department of Medicine, Dermatology and Toxicology, Medicine College, University of Valladolid, Avda. Ramón y Cajal 7, 47003 Valladolid, Spain
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2
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Farrukh L, Mumtaz A, Wajid S, Waqar HH, Peredo-Wende R. Cardiac Manifestations of Sjogren's Syndrome: A Review of Literature. Cureus 2023; 15:e41002. [PMID: 37503463 PMCID: PMC10371454 DOI: 10.7759/cureus.41002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Sjogren's syndrome (SS) is a chronic inflammatory disorder of the exocrine glands. It is characterized by a lymphocytic infiltrate in the lacrimal and salivary glands causing keratoconjunctivitis sicca and xerostomia. Extra-glandular involvement may be present in about one-third of patients with primary Sjogren's syndrome (pSS). The most commonly affected organs are the thyroid, lungs, gastrointestinal tract, kidneys, skin, and nervous system. Cardiac manifestations of Sjogren's syndrome are rare and not well-described in the current literature. Most of the evidence is present in the form of case reports and small case series. However, recent studies have shown that patients with Sjogren's syndrome (SS) seem to have a greater overall risk of cardiovascular (CV) events. Although not conventionally considered a feature of the disease, cardiac manifestations can lead to increased morbidity and mortality in this patient population. In this review article, we study the association between cardiac diseases and primary Sjogren's syndrome.
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Affiliation(s)
| | - Aqsa Mumtaz
- Internal Medicine, Montefiore St. Luke's Cornwall Hospital, Newburgh, USA
| | - Sumbal Wajid
- Internal Medicine, Albany Medical Center, Albany, USA
| | | | - Ruben Peredo-Wende
- Rheumatology, Albany Stratton VA (Veteran Affairs) Medical Center, Albany, USA
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3
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Melissaropoulos K, Bogdanos D, Dimitroulas T, Sakkas LI, Kitas GD, Daoussis D. Primary Sjögren's Syndrome and Cardiovascular Disease. Curr Vasc Pharmacol 2020; 18:447-454. [PMID: 31995009 DOI: 10.2174/1570161118666200129125320] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/19/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
Sjögren's syndrome is a rheumatic autoimmune disease that primarily affects middle-aged women and runs a slowly progressing course with sicca symptoms being the prevalent manifestation. Premature atherosclerosis and increased cardiovascular (CV) morbidity and mortality are frequently encountered in rheumatic diseases characterized by significant systemic inflammation, such as the inflammatory arthritides, systemic vasculitides and systemic lupus erythematosus. In the same context, chronic inflammation and immune aberrations underlying Sjögren's syndrome are also reported to be associated with augmented risk of atherosclerosis. Increased CV disease (CVD) frequency has been found in recent meta-analyses. The involvement of the CV system is not a common feature of Sjögren's syndrome; however, specific manifestations, such as autoantibody-mediated heart block, pericarditis, pulmonary arterial hypertension and dysautonomia, have been described. This review focuses on studies addressing CV morbidity in Sjögren's syndrome and presents current data regarding distinct CV features of the disease.
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Affiliation(s)
| | - Dimitrios Bogdanos
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41 110, Greece
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41 110, Greece
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, United Kingdom
| | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
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4
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Hidayet Ş, Yağmur J, Karaca Y, Bayramoğlu A, Yolbaş S, Hidayet E, Ulutaş Z, Pekdemir H. Assessment of left atrial volume and function in patients with Sjögren's syndrome using three-dimensional echocardiography. Echocardiography 2020; 37:715-721. [PMID: 32315513 DOI: 10.1111/echo.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjögren's syndrome (SS). METHODS We prospectively included 42 consecutive patients with primary SS and 42 controls who were similar in terms of basal characteristics. 3DTTE was used to assess LA function. RESULTS Maximum LA volume, minimum LA volume, pre-atrial contraction LA volume, LA Active Stroke Volume (ASV), LA Total Stroke Volume (TSV), maximal left atrial volume index (LAVImax), Left atrial pre-contraction volume index, and Left atrial minimum volume index, ASV index, and TSV index were significantly higher in the SS group, and the LA Total Emptying Fraction, LA Expansion Index, and LA Passive Emptying Fraction were significantly lower. Although the active emptying fraction was higher in the SS group, the difference was not statistically significant. LAVImax was positive correlated with disease duration (r = .753). CONCLUSION Left atrial function is impaired in SS patients and serves as an early marker of subclinical cardiac involvement.
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Affiliation(s)
- Şiho Hidayet
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Jülide Yağmur
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yücel Karaca
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Bayramoğlu
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Servet Yolbaş
- Department of Rheuomatology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Emine Hidayet
- Department of Internal Medicine, Malatya Training and Research Hospital, Malatya, Turkey
| | - Zeynep Ulutaş
- Department of Cardiology, Elazığ Fethi Sekin Cıty Hospıtal, Elazığ, Turkey
| | - Hasan Pekdemir
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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5
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Association of Anti-Ro/Sjögren's syndrome type A Antibodies and Complete Atrioventricular Block in an Adult With Sjögren's Syndrome. Arch Rheumatol 2017; 33:225-229. [PMID: 30207577 DOI: 10.5606/archrheumatol.2018.6492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022] Open
Abstract
A 57-year-old female patient with underlying hypertension, dyslipidemia, membranous glomerulonephritis, and Sjögren's syndrome presented to our clinic with near-syncope and dizziness symptoms. We detected non-conducted sinus beat in 12-lead electrocardiography. An echocardiography showed that the left ventricular systolic function was preserved without a regional wall abnormality. The patient did not have symptoms of congestive heart failure or recent myocardial infarction. We observed complete atrioventricular block with longest pause of 6.2 seconds in a 24-hour Holter electrocardiography, and subsequently implanted a permanent pacemaker. Anti-Ro/Sjögren's syndrome type A antibodies are commonly seen in Sjögren's syndrome and associated with a neonatal complete heart block. The pathogenesis of anti-Ro/Sjögren's syndrome type A antibodies in the conduction system of an adult heart is still uncertain. In this article, we report Sjögren's syndrome in an adult patient with complete atrioventricular block and membranous glomerulonephritis, which may be associated with a positive titer of anti-Ro/Sjögren's syndrome type A antibodies.
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6
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Liang M, Bao L, Xiong N, Jin B, Ni H, Zhang J, Zou H, Luo X, Li J. Cardiac arrhythmias as the initial manifestation of adult primary Sjögren's syndrome: a case report and literature review. Int J Rheum Dis 2015; 18:800-6. [PMID: 26171561 DOI: 10.1111/1756-185x.12616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Two middle-aged female patients presenting with heart palpitation and electrocardiogram revealed complex cardiac arrhythmias. A review of systems was positive for dry mouth and transient arthralgia, while laboratory and instrumental tests enabled us to make the diagnosis of primary Sjögren's syndrome (pSS). Cardiac electrophysiology revealed atrioventricular node dysfunction and impaired intraventricular conduction. Prednisone therapy induced a significant improvement in symptoms and electrocardiographic readings. The diagnosis of pSS should be considered in a patient presenting with complex cardiac arrhythmias.
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Affiliation(s)
- Minrui Liang
- Division of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Liwen Bao
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nanqing Xiong
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Jin
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huanchun Ni
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinjin Zhang
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hejian Zou
- Division of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Xinping Luo
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
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7
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Santos-Pardo I, Villuendas R, Salvador-Corres I, Martínez-Morillo M, Olivé A, Bayes-Genis A. Anti-Ro/SSA antibodies and cardiac rhythm disturbances: Present and future perspectives. Int J Cardiol 2014; 184:244-250. [PMID: 25725306 DOI: 10.1016/j.ijcard.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/06/2014] [Accepted: 11/01/2014] [Indexed: 12/17/2022]
Abstract
Several case reports, small case series, and original research papers have recently suggested that the action of certain auto-antibodies related to connective tissue diseases may be responsible for significant cardiac rhythm disturbances in adults. The relationship between anti-Ro/SSA antibodies and congenital complete atrioventricular block is well recognized in the fetal heart. Herein we review the emerging evidences of the link to increased levels of anti-Ro/SSA antibodies with rhythm disorders of unknown origin in the adult. Confirmation of this distinct etiology may eventually be the basis for new therapies.
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Affiliation(s)
- Irene Santos-Pardo
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain
| | - Roger Villuendas
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain
| | - Iñaki Salvador-Corres
- Immunology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), FOCIS-CE, Spain
| | - Melania Martínez-Morillo
- Rheumatology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain
| | - Alejandro Olivé
- Rheumatology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Spain
| | - Antoni Bayes-Genis
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Spain
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8
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Ciçek OF, Bayram NA, Ayhan H, Erten S, Aslan AN, Sarı C, Ozen MB, Bİlen E, Bastuğ S, Durmaz T, Keleş T, Bozkurt E. Assessment of the relationship between aortic stiffness and left ventricular functions with echocardiography in patients with Sjögren's syndrome. Int J Rheum Dis 2013; 17:658-63. [PMID: 24330340 DOI: 10.1111/1756-185x.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Capable of multi-organ involvement in Sjogren's syndrome (SS), cardiac findings of pulmonary effusion, left ventricular diastolic dysfunction and pulmonary hypertension are seen in patients with SS. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta. In this study, our aim is to determine if there is any differences in AS and left ventricular function between patients diagnosed as SS and healthy control groups. METHODS AND RESULTS We enrolled 50 patients with SS and 47 healthy volunteers with similar demographic characteristics. It was found that isovolumetric relaxation time (IVRT) and deceleration time (DT) were significantly longer and early diastolic wave (E) was significantly lower in patients with SS, but there was no difference in the other parameters. When tissue Doppler echocardiography (TDE) findings were compared between the two groups, it was found that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em/Am ratio were significantly lower, and myocardial isovolumetric relaxation time (IVRTm) and myocardial performance index (MPI) values were significantly higher in patients with SS. A significant positive correlations between aortic strain and Sm (r = 0.35, P < 0.001), Em (r = 0.42, P < 0.001) and Em/Am (r = 0.26, P = 0.008) and negative correlations in IVRTm (r = -0.36, P < 0.001) and MPI (r = -0.24, P = 0.01) were detected. A significant positive correlation between aortic distensibility and Sm (r = 0.36, P < 0.001), Em (r = 0.44, P < 0.001), Em/Am (r = 0.26, P = 0.009) and negative correlation of IVRTm (r = -0.22, P = 0.02) were determined. CONCLUSION There is a significant relationship between AS and left ventricular diastolic dysfunction in patients with SS in this study. The parameters of aortic elasticity measured by 2D echocardiographic methods can be beneficial in predicting early cardiovascular risk in SS.
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Affiliation(s)
- Omer F Ciçek
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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9
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Bayram NA, Cicek OF, Erten S, Keles T, Durmaz T, Bilen E, Sarı C, Bozkurt E. Assessment of left ventricular functions in patients with Sjögren's syndrome using tissue doppler echocardiography. Int J Rheum Dis 2013; 16:425-9. [DOI: 10.1111/1756-185x.12049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nihal A. Bayram
- Departments of Cardiology; Ataturk Education and Research Hospital; Yıldırım Beyazıt University; Ankara Turkey
| | - Omer F. Cicek
- Departments of Cardiology; Ataturk Education and Research Hospital; Yıldırım Beyazıt University; Ankara Turkey
| | - Sukran Erten
- Departments of Rheumatology; Ataturk Education and Research Hospital; Yıldırım Beyazıt University; Ankara Turkey
| | - Telat Keles
- Department of Cardiology; Yıldırım Beyazıt University; Ankara Turkey
| | - Tahir Durmaz
- Department of Cardiology; Yıldırım Beyazıt University; Ankara Turkey
| | - Emine Bilen
- Departments of Cardiology; Ataturk Education and Research Hospital; Yıldırım Beyazıt University; Ankara Turkey
| | - Cenk Sarı
- Departments of Cardiology; Ataturk Education and Research Hospital; Yıldırım Beyazıt University; Ankara Turkey
| | - Engin Bozkurt
- Department of Cardiology; Yıldırım Beyazıt University; Ankara Turkey
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10
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Sung MJ, Park SH, Kim SK, Lee YS, Park CY, Choe JY. Complete atrioventricular block in adult Sjögren's syndrome with anti-Ro autoantibody. Korean J Intern Med 2011; 26:213-5. [PMID: 21716914 PMCID: PMC3110856 DOI: 10.3904/kjim.2011.26.2.213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 04/07/2008] [Accepted: 04/22/2008] [Indexed: 11/27/2022] Open
Abstract
Anti-Ro autoantibody is associated with Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), and neonatal lupus syndrome (i.e., congenital complete heart block in newborns). Generally, the adult atrioventricular (AV) node is believed to be relatively resistant to the scarring effects of anti-Ro/anti-La autoantibodies. However, there have been some reports of adult complete AV block in SS and SLE patients. Here, we report a case of complete heart block in primary SS with anti-Ro autoantibodies, with no other risk factor for the development of heart block, and review their etiological association.
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Affiliation(s)
- Myung Jun Sung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Seong-Kyu Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Young-Soo Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Chul-Yeon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
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11
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Lazzerini PE, Capecchi PL, Laghi-Pasini F. Anti-Ro/SSA antibodies and cardiac arrhythmias in the adult: facts and hypotheses. Scand J Immunol 2010; 72:213-22. [PMID: 20696018 DOI: 10.1111/j.1365-3083.2010.02428.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
It is well established that the passive trans-placental passage of anti-Ro/SSA antibodies from mother to foetus is associated with the risk to develop an uncommon syndrome named neonatal lupus (NLE), where the congenital heart block represents the most severe clinical feature. Recent evidence demonstrated that also adult heart, classically considered invulnerable to the anti-Ro/SSA antibodies, may represent a target of the arrhythmogenicity of these autoantibodies. In particular, the prolongation of the QTc interval appears the most frequent abnormality observed in adults with circulating anti-Ro/SSA antibodies, with some data suggesting an association with an increased risk of ventricular arrhythmias, also life threatening. Moreover, even though the association between anti-Ro/SSA antibodies and conduction disturbances is undoubtedly less evident in adults than in infants, from the accurate dissection of the literature data the possibility arises that sometimes also the adult cardiac conduction tissue may be affected by such antibodies. The exact arrhythmogenic mechanisms involved in foetus/newborns and adults, respectively, have not been completely clarified as yet. However, increasing evidence suggests that anti-Ro/SSA antibodies may trigger rhythm disturbances through an inhibiting cross-reaction with several cardiac ionic channels, particularly the calcium channels (L-type and T-type), but also the potassium channel hERG, whose different expression and involvement in the cardiac electrophysiology during lifespan might account for the occurrence of age-related differences.
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Affiliation(s)
- P E Lazzerini
- Department of Clinical Medicine and Immunological Sciences, Division of Clinical Immunology, University of Siena, Italy.
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12
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Eisen A, Arnson Y, Dovrish Z, Hadary R, Amital H. Arrhythmias and conduction defects in rheumatological diseases--a comprehensive review. Semin Arthritis Rheum 2009; 39:145-56. [PMID: 18585758 DOI: 10.1016/j.semarthrit.2008.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 04/07/2008] [Accepted: 05/04/2008] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To review the clinical aspects of cardiac arrhythmias and conduction disturbances in several common and less encountered adult rheumatic diseases and to underline the importance of prompt diagnosis and management in these patients. METHODS The PubMed database was searched for articles published between the years 1960 and 2008 for keywords referring to autoimmune diseases. All relevant English-written articles were reviewed. Most were uncontrolled series and case reports, due to the lack of prospective studies and randomized trials. RESULTS Rheumatologic conditions may affect the cardiovascular system and increase morbidity and mortality. Rhythm and conduction defects are usually mild but may be life-threatening; in certain diseases, such as in systemic lupus erythematosus they may resolve following therapy with corticosteroids. Conduction defects occur frequently in patients with spondyloarthropathies and in those with various forms of vasculitis. Enhanced variation of the QT interval may be a sensitive marker of a higher arrythmogenic tendency in patients with autoimmune conditions. CONCLUSIONS It is important to identify patients at high risk for cardiac arrhythmias. Treating such patients with arrhythmias should not differ fundamentally from other patients. Nevertheless, appropriate clinical attention and judgment should be applied to exclude the possibility that arrhythmias reflect uncontrolled myocardial inflammation.
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Affiliation(s)
- Alon Eisen
- Department of Medicine D, Meir Medical Center, Kefar-Saba, Israel
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Arrhythmogenic effects of anti-Ro/SSA antibodies on the adult heart: More than expected? Autoimmun Rev 2009; 9:40-4. [DOI: 10.1016/j.autrev.2009.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 03/02/2009] [Indexed: 11/18/2022]
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Lodde BM, Sankar V, Kok MR, Leakan RA, Tak PP, Pillemer SR. Adult heart block is associated with disease activity in primary Sjögren's syndrome. Scand J Rheumatol 2009; 34:383-6. [PMID: 16234186 DOI: 10.1080/03009740510026661] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Congenital heart block occurring in the foetus and neonate may be associated with maternal anti-SS-A/anti-SS-B autoantibodies (anti-SSA/anti-SSB). The adult atrioventricular node is generally thought to be resistant to the damaging effects of anti-SSA/anti-SSB. However, case reports suggest that heart block developing in adult Sjögren's syndrome (SS) patients may be associated with these autoantibodies. Therefore, we investigated the relationship between serum antibodies and heart block in adult SS patients. METHODS We abstracted data from clinic patient records. Diagnosis of primary SS was based on American-European classification criteria. Electrocardiograms (EKGs), laboratory immunology parameters, lipid profiles, and focus scores from labial salivary gland biopsies were available for 51 SS patients. Fifteen patients had follow-up EKGs. PR interval200 ms was considered to be first-degree heart block. RESULTS Five patients showed prolonged PR intervals; the presence of heart block was not related to the presence of anti-SSA antibodies. However, significant differences between patients with prolonged and normal PR intervals were seen for mean focus scores (p<0.0001), anti-cardiolipin immunoglobulin IgG (p = 0.0009), age (p = 0.01), IgG (p = 0.02), anti-SSB antibodies (p = 0.02), and high density lipoprotein (HDL) cholesterol levels (p = 0.03). These parameters correlated with prolonged PR intervals. CONCLUSIONS These results suggest an association between disease activity, the presence of anti-SSB antibodies, and the occurrence of first-degree heart block in adults with primary SS.
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Affiliation(s)
- B M Lodde
- Gene Therapy and Therapeutics Branch/National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892-1190, USA.
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Caballero-Güeto J, Rodríguez-Paiz C, J. Caballero-Güeto F, A. Ulecia-Martínez M. Miocardiopatía severa reversible en el síndrome de Sjögren primario. Rev Esp Cardiol 2007. [DOI: 10.1016/s0300-8932(07)75039-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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García-Carrasco M, Fuentes-Alexandro S, Escárcega RO, Salgado G, Riebeling C, Cervera R. Pathophysiology of Sjögren's syndrome. Arch Med Res 2007; 37:921-32. [PMID: 17045106 DOI: 10.1016/j.arcmed.2006.08.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/30/2006] [Indexed: 11/21/2022]
Abstract
The term Sjögren's syndrome refers to keratoconjunctivitis sicca and xerostomia due to lymphocytic infiltrates of lachrymal and salivary glands. The current used criteria for diagnosis of primary Sjögren's syndrome is the American-European consensus. Primary Sjögren's syndrome is an autoimmune disorder characterized by lymphocytic infiltrates and destruction of the salivary and lachrymal glands and systemic production of autoantibodies to the ribonucleoprotein particles SS-A/Ro and SS-B/La. The infiltrating cells (T- and B-cells, dendritic cells) interfere with glandular function at several points: destruction of glandular elements by cell-mediated mechanisms; secretion of cytokines that activate pathways bearing the signature of type 1 and 2 interferons; production of autoantibodies that interfere with muscarinic receptors; and secretion of metalloproteinases (MMPs) that interfere with the interaction of the glandular cell with its extracellular matrix, which is necessary for efficient glandular function. As the process progresses, the mucosal surfaces become sites of chronic inflammation and the start of a vicious circle. Despite extensive study of the underlying cause of Sjögren's syndrome, the pathogenesis remains obscure. In broad terms, pathogenesis is multifactorial; environmental factors are thought to trigger inflammation in individuals with a genetic predisposition to the disorder.
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Affiliation(s)
- Mario García-Carrasco
- Systemic Autoimmune Disease Research Unit, HGZ #36 CMN Manuel Avila Camacho, IMSS, Puebla, Mexico.
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Lazzerini PE, Capecchi PL, Guideri F, Acampa M, Galeazzi M, Laghi Pasini F. Connective tissue diseases and cardiac rhythm disorders: An overview. Autoimmun Rev 2006; 5:306-13. [PMID: 16782554 DOI: 10.1016/j.autrev.2005.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 11/03/2005] [Indexed: 11/23/2022]
Abstract
Cardiovascular involvement is common in connective tissue diseases (CTD), with relevant implications in terms of morbidity and mortality. Rhythm disturbances, i.e. conduction defects and tachyarrhythmias, represent a frequent clinical manifestation of CTD-associated cardiovascular damage and a possible cause of sudden death. The underlying arrhythmogenic mechanisms are probably multiple and intriguing, even though the myocardial fibrosis frequently observed at the pathological examination seems to play a pivotal role. Myocardial fibrosis is produced directly by inflammatory processes, or indirectly as a consequence of coronary artery occlusive disease, and it may affect the conduction system also representing the pathological substrate for reentry circles. An overview of CTD-associated cardiac rhythm disturbances is here provided. Among CTD-associated rhythm disorders, congenital heart block (CHB), which represents the main feature of neonatal lupus, a rare syndrome related to the transplacental passage of autoantibodies from anti-Ro/SSA-positive mother to their newborns, seems to acknowledge a peculiar mechanism of disease possibly dependent on a direct arrhythmogenicity of anti-Ro/SSA antibodies. Moreover, new anti-Ro/SSA-associated EKG abnormalities have been recently described in children (sinus bradycardia and corrected QT (QTc) interval prolongation) as well as in adults (QTc interval prolongation).
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Clinical Medicine and Immunological Sciences, Division of Clinical Immunology, University of Siena, Viale Bracci, 53100 Siena, Italy.
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18
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Costedoat-Chalumeau N, Amoura Z, Le Thi Hong D, Georgin S, Vauthier D, Sebbouh D, Francès C, Villain E, Wechsler B, Piette JC. [Neonatal lupus syndrome: review of the literature]. Rev Med Interne 2003; 24:659-71. [PMID: 14550519 DOI: 10.1016/s0248-8663(03)00211-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Neonatal lupus syndrome include skin lesions, hematological and hepatic disorders, and congenital heart block (CHB) in the absence of severe cardiac malformation. This rare disorder is closely linked to transplacental transport of anti-SSA/Ro and anti-SSB/La maternal antibodies. CURRENT KNOWLEDGE AND KEY POINTS The prevalence of CHB in newborns of anti-Ro/SSA positive women with known connective tissue disease is 2% and the risk of recurrence ranges from 10 to 17%. Skin and systemic lesions are transient, whereas CHB is definitive and is associated with significant morbidity and mortality (estimated at 16-19%). A pacemaker must be implanted in 2/3 of cases. Myocarditis may be associated or may appeared secondarily. Mothers of children with CHB are usually asymptomatic or have Gougerot-Sjögren, or undifferentiated connective tissue disease. Mothers of children with cutaneous manifestations may present with more severe disease and systemic lupus erythematosus. In anti-Ro/SSA positive pregnant women, echocardiograms should be performed at least every 2 weeks from 16 to 24 weeks gestation. Electrocardiogram should be performed for all children. FUTURE PROSPECTS AND PROJECTS The efficiency of prophylactic treatment of CHB is not established. Therapy for CHB detected in utero is not standardized and involves fluorinated steroids (especially betamethasone).
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Affiliation(s)
- N Costedoat-Chalumeau
- Service de médecine interne, centre hospitalier universitaire Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Affiliation(s)
- R I Fox
- Allergy and Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, California 92037, USA
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Brady WJ, Harrigan RA. Evaluation and management of bradyarrhythmias in the emergency department. Emerg Med Clin North Am 1998; 16:361-88. [PMID: 9621848 DOI: 10.1016/s0733-8627(05)70007-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bradyarrhythmias may be due to varied causes, although acute myocardial infarction, hypoxia, sepsis, and hypothermia should be considered. Emergency department therapy consists of treatment of the underlying cause, pharmacologic interventions, and temporary pacing. This article provides a detailed discussion of the causes and treatment of bradyarrhythmias in the emergency department.
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Affiliation(s)
- W J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, USA
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