Ventricular late potentials in systemic sclerosis: relationship with skin involvement.
OBJECTIVE
To detect the myocardial involvement in patients with systemic sclerosis (SSc) by signal averaged electrocardiography method (SA-ECG) in relationship to the skin changes.


METHODS
We selected 24 SSc outpatients according to American Rheumatism Association criteria, without clinical and instrumental evidence of cardiac disease, and compared them with 24 control subjects. All patients and controls underwent SA-ECG to detect ventricular late potentials (LP). The extent and severity of skin involvement in SSc patients was detected by modified Rodnan (m-Rodnan) skin score.


RESULTS
SSc patients had higher prevalence of LP compared to controls (46 versus 8%, p < 0.003). Median skin score value in the overall SSc population was 7 [mean, SD (range): 7.8, 3.2, (4-18)]. Patients with LP had a higher median skin score value compared to SSc patients without LP [median (range): 10 (6-18) versus 6 (4-9); Mann-Whitney U test 22.5, p < 0.005]. A subset analysis was also performed to verify the correlation of antibodies positivity (anti-centromere and Scl 70) pattern and the presence of LP. Our findings showed that higher values of skin score correlated with the presence of LP independent of antibody subsets.


CONCLUSIONS
Our data suggest that diffuse abnormalities of the cardiac tissue detected by SA-ECG may be present, even in patients without cardiac symptoms. The relationship between LP and skin involvement in patients without clinical evidence of cardiac involvement may help detect of a subset of patients who may develop scleroderma heart disease.
Department of Medical Therapy, University La Sapienza, Rome, Italy. michele.paradiso@uniroma1.it
Michele
M
Paradiso
Manuela
M
Di Franco
Antonino
A
Musca
Stefania
S
Basili
Valeria
V
Riccieri
Vincenzo
V
Paoletti
Antonio
A
De Matteis
Antonio
A
Mammarella
D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology; D016022:Case-Control Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012494:Sampling Studies; D012594:Scleroderma, Localized / Q000150:complications / Q000175:diagnosis; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D018709:Statistics, Nonparametric; D016276:Ventricular Function