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Rheumatology International

, Volume 27, Issue 9, pp 813–818 | Cite as

P wave dispersion in patients with rheumatoid arthritis: its relation with clinical and echocardiographic parameters

  • Hayal GulerEmail author
  • Ergun Seyfeli
  • Gunsah Sahin
  • Mehmet Duru
  • Ferit Akgul
  • Hayrettin Saglam
  • Fatih Yalcin
Original Article

Abstract

P wave dispersion (PWD) is a sign for the prediction of atrial fibrillation (AF). The aim of this study was to assess P wave dispersion and its relation with clinical and echocardiographic parameters in patients with rheumatoid arthritis (RA). Thirty RA patients (mean age 49 ± 10 years) and 27 healthy controls (mean age 47 ± 8 years) were included in the study. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum and minimum P wave duration were obtained from electrocardiographic measurements. PWD defined as the difference between maximum and minimum P wave duration was also calculated. Maximum P wave duration and PWD was higher in RA patients than controls (P = 0.031 and P = 0.001, respectively). However, there was no significant difference in minimum P wave duration between the two groups (P = 0.152). There was significant correlation between PWD and disease duration (r = 0.375, P = 0.009) and isovolumetric relaxation time (r = 0.390, P = 0.006). P wave duration and PWD was found to be higher in RA patients than healthy control subjects. PWD is closely associated with disease duration and left ventricular (LV) diastolic dysfunction.

Keywords

Rheumatoid arthritis Electrocardiography P wave dispersion Atrial fibrillation Echocardiography 

References

  1. 1.
    Wallberg-Jonsson S, Öhman ML, Dahlqvist SR (1997) Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in northern Sweden. J Rheumatol 24:445–451PubMedGoogle Scholar
  2. 2.
    Wislowska M, Sypula S, Kowalik I (1998) Echocardiographic findings, 24-hour electrocardiographic holter monitoring in patients with rheumatoid arthritis according to Steinbrocker’s criteria, functional index, value of Waaler–Rose titre and duration of disease. Clin Rheumatol 17:369–377CrossRefPubMedGoogle Scholar
  3. 3.
    Koopman WJ, Moreland LW (2005) Arthritis and allied conditions. A textbook of rheumatology, 15th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  4. 4.
    Goldeli O, Dursun E, Komsuoglu B (1998) Dispersion of ventricular repolarisation: a new marker of ventricular arrhythmic in patients with rheumatoid arthritis. J Rheumatol 25:447–450PubMedGoogle Scholar
  5. 5.
    Pırıldar T, Sekuri C, Utuk O, Tezcan UK (2003) QT dispersion in rheumatoid arthritis patients with and without Sjögren’s syndrome. Clin Rheumatol 22:225–228CrossRefPubMedGoogle Scholar
  6. 6.
    Dilaveris PE, Gialafos EJ, Sideris S, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738CrossRefPubMedGoogle Scholar
  7. 7.
    Dilaveris PE, Gialofos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, Gialafos JE (2000) Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 23:352–358CrossRefPubMedGoogle Scholar
  8. 8.
    Dilaveris PE, Gialafos JE (2001) P wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 6:159–165CrossRefPubMedGoogle Scholar
  9. 9.
    Arnett FC, Edwothy SM, Bloch DA, Meshane DJ, Fries JF, Cooper NS (1988) The American Rheumatism Association 1987 criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefPubMedGoogle Scholar
  10. 10.
    Steinbrocker O, Treger H, Cornelius H (1949) Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662Google Scholar
  11. 11.
    Van Gestel AM, Haagsma CJ, van Riel PL (1998) Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 41:1845–1850CrossRefPubMedGoogle Scholar
  12. 12.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458CrossRefPubMedGoogle Scholar
  13. 13.
    Mutru O, Laakso M, İsomaki H, Koota K (1989) Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology 76:71–77PubMedGoogle Scholar
  14. 14.
    Mody GM, Stevens JE, Meyers OL (1987) The heart in rheumatoid arthritis: a clinical and echocardiographic study. Q J Med 65:921–928PubMedGoogle Scholar
  15. 15.
    Cindas A, Gokce-Kutsal Y, Tokgozoklu L, Karanfil A (2002) QT dispersion and cardiac involvement in patients with rheumatoid arthritis. Scand J Rheumatol 31:22–26CrossRefPubMedGoogle Scholar
  16. 16.
    Alkaabi JK, Ho M, Levison R, Pullar T, Belch JJF (2003) Rheumatoid arthritis and macrovascular disease. Rheumatology 42:292–297CrossRefPubMedGoogle Scholar
  17. 17.
    Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Kabakci G, Ovunç K, Nazlı F, Ozmen A, Oto A, Kes S (2000) QT dispersion as a predictor of arrhythmic events in patients with ankylosing spondylitis. Rheumatology 39:875–879CrossRefPubMedGoogle Scholar
  18. 18.
    Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ (1990) Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol 26:497–502CrossRefGoogle Scholar
  19. 19.
    Leier CV, Meacham JA, Schall SF (1978) Prolonged atrial conduction: a major predisposing factor to atrial flutter. Circulation 57:213–216PubMedGoogle Scholar
  20. 20.
    Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunç K, Oto A, Ozmen F, Kes S (2000) P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation . Pacing Clin Electrophysiol 23:1109–1112CrossRefPubMedGoogle Scholar
  21. 21.
    Yilmaz R, Demirbag R (2005) P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 38(3):279–284CrossRefPubMedGoogle Scholar
  22. 22.
    Gunduz H, Binak E, Arinc H, Akdemir R, Ozhan H, Tamer A, Uyan C (2005) The relationship between P wave dispersion and diastolic dysfunction. Tex Heart Inst J 32:163–167PubMedGoogle Scholar
  23. 23.
    Yilmaz R, Kasap H, Baykan M, Durmus I, Kaplan S, Celik S, Erdol C (2005) Assessment of left ventricular function by Doppler tissue imaging in patients with atrial fibrillation following acute myocardial infarction. Int J Cardiol 102:79–85CrossRefPubMedGoogle Scholar
  24. 24.
    Bonfiglio T, Atwater EC (1969) Heart disease in patients with seropositive rheumatoid arthritis. Arch Intern Med 124:714–719CrossRefPubMedGoogle Scholar
  25. 25.
    Reimer KA, Rodgers RF, Oyasu R (1976) Rheumatoid arthritis with rheumatoid heart disease and granulomatous aortitis. JAMA 235:2510–2512CrossRefPubMedGoogle Scholar
  26. 26.
    Morris PB (1986) Rheumatoid arthritis and coronary arteritis. Am J Cardiol 57:689–690CrossRefPubMedGoogle Scholar
  27. 27.
    Iglesias Cubero G, Rodriguez Reguero JJ, Rojo Ortega JM (1993) Restrictive cardiomyopathy caused by chloroquine. Br Heart J 69:451–452PubMedGoogle Scholar
  28. 28.
    Ratliff NB, Estes ML, Myles JL, Shirey EK, McMahon JT (1987) Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. N Engl J Med 316:191–193PubMedCrossRefGoogle Scholar
  29. 29.
    Qasim FJ, Thiru S, Gillespie K (1997) Gold and D-penicillamine induce vasculitis and up-regulate m RBA for IL-4 in the Brown Norway rat: support for a role of Th2 cell activity. Clin Exp Immunol 108:438–445CrossRefPubMedGoogle Scholar
  30. 30.
    Page J, Henry D (2000) Consumption of NSAIDs and the development of congestive heart failure in elderly patients. Arch Intern Med 160:777–784CrossRefPubMedGoogle Scholar
  31. 31.
    Nashel D (1986) Is atherosclerosis a complication of long-term corticosteroid treatment? Am J Med 80:925–929CrossRefPubMedGoogle Scholar
  32. 32.
    Landewe R, van den Borne B, Breedveld F, et al. (2000) Methotrexate effects in patients with rheumatoid arthritis with cardiovascular comorbidity. Lancet 355:1616–1617CrossRefPubMedGoogle Scholar
  33. 33.
    Haagsma C, Blom H, van Riel PL, et al. (1999) Influence of sulfasalazine, methotrexate and combination of both on plasma homocysteine concentrations in patients with rheumatoid arthritis. Ann Rheum Dis 58:79–84PubMedCrossRefGoogle Scholar
  34. 34.
    Schiff MH, Strand V, Oed C, Loew-Frriedrich I (2000) Leflunomide: efficacy and safety in clinical trials for the treatment of rheumatoid arthritis. Drugs Today Barc 36:383–394PubMedGoogle Scholar
  35. 35.
    Tukek T, Akkaya V, Demirel S, Sozen AB, Kudat H, Atılgan D, Ozcan M, Guven O, Korkut F (2000) Effect of valsalva maneuver on surface electrocardiographic P wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 85:896–899CrossRefPubMedGoogle Scholar
  36. 36.
    Evrengul H, Dursunoglu D, Cobankara N, Polat B, Seleci D, Kabukcu S, Kaftan A (2004) Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int 24:198–202CrossRefPubMedGoogle Scholar
  37. 37.
    Dekkers JC, Geenen R, Godaert GL, Bijlsma JW, van Doornen LJ (2004) Elevated sympathetic nervous system activity in patients with recently diagnosed rheumatoid arthritis with active disease. Clin Exp Rheumatol 22:63–70PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Hayal Guler
    • 1
    Email author
  • Ergun Seyfeli
    • 2
  • Gunsah Sahin
    • 3
  • Mehmet Duru
    • 4
  • Ferit Akgul
    • 2
  • Hayrettin Saglam
    • 5
  • Fatih Yalcin
    • 2
  1. 1.Department of Physical Medicine and Rehabilitation, Faculty of MedicineMustafa Kemal UniversityAntakya/HatayTurkey
  2. 2.Department of Cardiology, Faculty of MedicineMustafa Kemal UniversityHatayTurkey
  3. 3.Department of Physical Medicine and Rehabilitation, Faculty of MedicineMersin UniversityMersinTurkey
  4. 4.Department of Emergency Medicine, Faculty of MedicineMustafa Kemal UniversityHatayTurkey
  5. 5.Department of Cardiology, Faculty of MedicineAfyon Kocatepe UniversityAfyonkarahisarTurkey

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