Intervalo QTC do eletrocardiograma e sua associação com atividade inflamatória. Um estudo em pacientes com artrite reumatoide
Carregando...
Tipo
TCC
Data de publicação
2025-05-29
Periódico
Citações (Scopus)
Autores
Lazzaretti, Ana Luisa Buttini
Souza, Gabriel Leite Ramos de
Souza, Gabriel Leite Ramos de
Orientador
Skare, Thelma Larocca
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
Programa
Resumo
Introdução: A Artrite Reumatoide (AR) é uma doença inflamatória crônica autoimune que compromete principalmente as articulações, mas também pode provocar manifestações sistêmicas graves, reduzindo a qualidade e a expectativa de vida. Com prevalência global de aproximadamente 1%, afeta principalmente mulheres entre 35 e 50 anos. Sua etiologia é multifatorial, envolvendo predisposição genética e fatores ambientais como infecções, tabagismo e alterações hormonais. O diagnóstico é complexo e exige avaliação clínica, exames sorológicos, radiológicos e análise do líquido sinovial. Dentre as manifestações sistêmicas, destacam-se complicações cardiovasculares, como arritmias e prolongamento do intervalo QT, atribuídas à ação de citocinas inflamatórias sobre o sistema nervoso autônomo e os cardiomiócitos. Essas alterações aumentam o risco de morte súbita em pacientes com AR, ressaltando a importância de estudos que investiguem a relação entre a atividade inflamatória da doença e alterações eletrocardiográficas como o prolongamento do intervalo QT. Objetivos: Avaliar a prevalência de prolongamento do intervalo QT corrigido pela frequência cardíaca (QTc) e sua possível associação com a atividade inflamatória em pacientes com artrite reumatoide (AR). Métodos: Estudo observacional transversal com 97 adultos portadores de AR atendidos em ambulatório de Reumatologia de um hospital universitário em Curitiba (PR). Foram coletados dados demográficos, clínicos, terapêuticos e índices de atividade da doença (DAS-28 VHS/PCR, CDAI, SDAI). O QTc foi calculado a partir de eletrocardiogramas de 12 derivações utilizando a fórmula de Bazett. Resultados: A amostra foi composta predominantemente por mulheres de meia-idade (mediana 63 anos), com tempo de doença de 11 anos. A mediana do QTc foi 410 ms (IIQ = 387,5–437,0), e 11/97 pacientes (11,3%) apresentaram QTc prolongado. Não se observaram correlações significativas entre QTc ou frequência cardíaca e VHS, PCR, DAS-28, CDAI ou SDAI (p > 0,05 para todas as comparações). Conclusão: Embora o prolongamento do QTc seja relativamente frequente em pacientes com AR, neste estudo não houve evidência de associação com a atividade inflamatória medida pelos principais índices clínico-laboratoriais. O achado reforça a necessidade de monitorização eletrocardiográfica rotineira e avaliação individualizada de risco arrítmico nesses pacientes, independentemente do grau de atividade da doença.
Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disease that primarily affects the joints but can also cause severe systemic manifestations, reducing both quality of life and life expectancy. With a global prevalence of approximately 1%, it mainly affects women between the ages of 35 and 50. Its etiology is multifactorial, involving genetic predisposition and environmental factors such as infections, smoking, and hormonal changes. Diagnosis is complex and requires clinical evaluation, serological and radiological tests, and synovial fluid analysis. Among the systemic manifestations, cardiovascular complications—such as arrhythmias and prolonged QT interval—stand out, attributed to the action of inflammatory cytokines on the autonomic nervous system and cardiomyocytes. These alterations increase the risk of sudden death in RA patients, highlighting the importance of studies investigating the relationship between disease inflammatory activity and electrocardiographic changes such as QT interval prolongation. Objectives: To assess the prevalence of heart rate-corrected QT interval (QTc) prolongation and its possible association with inflammatory activity in patients with Rheumatoid Arthritis (RA). Methods: Cross-sectional observational study with 97 adult RA patients followed at the Rheumatology outpatient clinic of a university hospital in Curitiba (PR), Brazil. Demographic, clinical, therapeutic data, and disease activity scores (DAS-28 ESR/CRP, CDAI, SDAI) were collected. QTc was calculated from 12-lead electrocardiograms using Bazett's formula. Results: The sample consisted predominantly of middle-aged women (median age 63 years) with a disease duration of 11 years. The median QTc was 410 ms (IQR = 387.5–437.0), and 11 out of 97 patients (11.3%) presented prolonged QTc. No significant correlations were found between QTc or heart rate and ESR, CRP, DAS-28, CDAI, or SDAI (p > 0.05 for all comparisons). Conclusion: Although QTc prolongation is relatively frequent in patients with RA, this study found no evidence of an association with inflammatory activity as measured by major clinical-laboratory indices. The finding reinforces the need for routine electrocardiographic monitoring and individualized arrhythmic risk assessment in these patients, regardless of disease activity level.
Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disease that primarily affects the joints but can also cause severe systemic manifestations, reducing both quality of life and life expectancy. With a global prevalence of approximately 1%, it mainly affects women between the ages of 35 and 50. Its etiology is multifactorial, involving genetic predisposition and environmental factors such as infections, smoking, and hormonal changes. Diagnosis is complex and requires clinical evaluation, serological and radiological tests, and synovial fluid analysis. Among the systemic manifestations, cardiovascular complications—such as arrhythmias and prolonged QT interval—stand out, attributed to the action of inflammatory cytokines on the autonomic nervous system and cardiomyocytes. These alterations increase the risk of sudden death in RA patients, highlighting the importance of studies investigating the relationship between disease inflammatory activity and electrocardiographic changes such as QT interval prolongation. Objectives: To assess the prevalence of heart rate-corrected QT interval (QTc) prolongation and its possible association with inflammatory activity in patients with Rheumatoid Arthritis (RA). Methods: Cross-sectional observational study with 97 adult RA patients followed at the Rheumatology outpatient clinic of a university hospital in Curitiba (PR), Brazil. Demographic, clinical, therapeutic data, and disease activity scores (DAS-28 ESR/CRP, CDAI, SDAI) were collected. QTc was calculated from 12-lead electrocardiograms using Bazett's formula. Results: The sample consisted predominantly of middle-aged women (median age 63 years) with a disease duration of 11 years. The median QTc was 410 ms (IQR = 387.5–437.0), and 11 out of 97 patients (11.3%) presented prolonged QTc. No significant correlations were found between QTc or heart rate and ESR, CRP, DAS-28, CDAI, or SDAI (p > 0.05 for all comparisons). Conclusion: Although QTc prolongation is relatively frequent in patients with RA, this study found no evidence of an association with inflammatory activity as measured by major clinical-laboratory indices. The finding reinforces the need for routine electrocardiographic monitoring and individualized arrhythmic risk assessment in these patients, regardless of disease activity level.
Descrição
Palavras-chave
artrite reumatoide , eletrocardiograma , arritmias cardíacas , rheumatoid arthritis , electrocardiogram , cardiac arrhythmias