AB0603 Fragmented qrs in patients with systemic lupus erythematosus: relation to the disease activity: a cross-sectional study
Authors: M. Hosonuma, N. Yajima
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Cardiovascular disease is an important contributor to mortality in Systemic Lupus Erythematosus (SLE)<sup>1</sup>. Fragmented QRS (fQRS) is an easily evaluated non-invasive electrocardiographic parameter defined as additional spikes within the QRS complex<sup>2</sup>. fQRS can represent conduction disturbance and a predictor of cardiac events<sup>3</sup>. Even in a patient with SLE, it has reported that the prevalence of fQRS appears to be higher than in controls<sup>4</sup>. However, no clinical studies have investigated the prevalence at the time of diagnosis. In addition, there is no report that examined the association of disease activity of SLE and fQRS. <h3>Objectives</h3> This study aimed to assess the relationship between disease activity of SLE and fQRS in Japanese SLE patients at the time of diagnosis. We hypothesised that the frequency of fQRS on ECGs would be greater in SLE patients with high disease activity. <h3>Methods</h3> The study design was a cross-sectional study. The participants were SLE patients who diagnosed at Showa University Hospital and Showa University Koto Toyosu Hospital from January 2010 to December 2017. The participants who satisfied American College of Rheumatology (ACR) criteria were included. The patients with already treatment at the time of an ECG measurement, cardiovascular disease, history of arrhythmia, cardiomyopathy, rheumatoid arthritis, systemic sclerosis were excluded. The exposure was the appearance of fQRS. The primary outcome was Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). The secondary outcomes were the complement level, the ds-DNA antibody level and the organ involvement. In the main analysis, a multiple regression analysis was conducted to assess the association between fQRS and SLE activity adjusted for age, sex and period from the estimated date of onset to the date of diagnosis. In the secondary analysis, a multiple regression analysis was conducted to analysis the association between fQRS and the serological activity of SLE (the complement level, the ds-DNA antibody level) and the organ involvement under the same conditions as above. <h3>Results</h3> In total, 45 participants were enrolled. The mean age was 42.3 years, and 37 (82%) were female. The median SLEDAI-2K was 14 [IQR, 10 to 20]. The median period from the estimated date of onset to the date of diagnosis was 3 months [IQR, 2 to 14.5]. 25 patients (56%) had fQRS. In the main analysis, the regression coefficients [95% CI] of fQRS for SLEDAI were 2.99 [ 1.15 to 4.84, p=0.002 ] with reference to non-fQRS. In the secondary analysis, there were no significant associations between fQRS and the blood test or the organ involvement. <h3>Conclusions</h3> Our results demonstrated that the frequency of fQRS on ECGs would be greater in SLE patients with high disease activity. <h3>References</h3> [1] Knight JS. et al. Cardiovascular disease in lupus: insights and updates. Curr Opin Rheumatol.2013;25:597–605. [2] Das MK. et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113:2495–501. [3] Take Y. et al. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Indian Pacing and Electrophysiology Journal.2012;12:213–225. [4] Demir K. et al. Fragmented QRS in patients with systemic lupus erythematosus. Scandinavian Cardiovascular Journal.2014;48:197–201 <h3>Disclosure of Interest</h3> None declared