Prevalence and prognostic relevance of electrocardiographic abnormalities among patients with ANCA-associated vasculitis

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

Abstract

Cardiovascular disease (CVD) is one of the leading causes of death in patients with ANCA-associated vasculitis (AAV). However, in current clinical guidelines, limited evidence is available to support the recommendation of AAV-specific screening for cardiovascular comorbidities. This study reported the prevalence of electrocardiogram (ECG) abnormalities and investigated associations between ECG abnormalities and fatal CVD in a validated cohort of patients with AAV compared to matched controls.Based on a retrospective matched cohort design, patients with granulomatosis with polyangiitis [ICD-10: DM31.3] or microscopic polyangiitis [ICD-10: DM3.17] and accessible ECGs were identified in nationwide Danish health care registers from 2000 to 2021. Patients with AAV were matched 1:3 on age, sex, and calendar year of ECG measurement with controls without AAV. Index date was defined as the date of ECG measurement. ECGs were hierarchically categorized as either no, minor, or major ECG abnormalities according to contemporary literature. The associations between ECG abnormalities and fatal CVD were assessed in multiple Cox regression models adjusted for age, sex, and comorbidities. Counterfactual G-estimation of hazard ratios (HRs) standardized to age and sex was performed to estimate the 5-year absolute risk (AR) of fatal CVD according to ECG-abnormalities.A total of 1431 patients with AAV were matched to 4293 controls. The median age of patients with AAV and matched controls was 69 (IQR 58-77) years, and 52.3% were males. Median study follow-up time was 4.8 (IQR, 2.7-7.8) years. AAV was associated with increased prevalence of left ventricular hypertrophy (17.5% vs. 12.5%, p < 0.001), ST-T deviations (10.1% vs. 7.1%, p < 0.001), atrial fibrillation (9.6% vs. 7.5%, p = 0.017) and corrected QT prolongation (5.9% vs. 3.6%, p < 0.001) compared to controls. When examining associations of fatal CVD across no, minor or major ECG abnormalities, only the patients with AAV and major ECG abnormalities had a higher risk of fatal CVD [HR 1.99 (95% CI, 1.49-2.65)], compared to matched controls. This corresponded to a significantly higher standardized 5-year AR of fatal CVD compared to controls: 19.14% (95% CI, 16-22%) vs. 9.41% (95% CI, 8-11%).AAV was associated with a higher prevalence of major ECG abnormalities such as left ventricular hypertrophy, atrial fibrillation, and ST-T deviations compared to matched controls. Moreover, the patients with AAV demonstrating major ECG abnormalities had a particularly elevated risk of fatal CVD. This indicates that AAV patients with major ECG abnormalities are a distinct high-risk group within AAV patients prone to cardiovascular-related mortality.Figure 1:Age and sex-standardized 5-year absolute risk of fatal CVD and all-cause mortality according to ECG abnormalities in patients with AAV compared to matched controls. Absolute risks are depicted with error bars representing ± Standard Error.Table 1:ECG characteristics comparing AAV patients to matched controls.Control population (n = 4293)AAV (n = 1431)P-valueHeart rate, bpm73 (64-84)76 (66.8-90.0)< 0.001PR interval, ms160 (146-178)156 (142-176)0.005QRS duration, ms90 (82-98)88 (81.5-98.0)0.685QTcF interval, ms417 (403-431)413 (398.0-429.2)0.006No ECG abnormality2433 (56.7)741 (51.8)0.001Minor ECG abnormality309 (7.2)98 (6.8)0.699 First-degree atrioventricular block275 (6.4)88 (6.1)0.778 Incomplete bundle branch block115 (2.7)39 (2.7)1.000 Left fascicular block72 (1.7)29 (2.0)0.451 QTc prolongation154 (3.6)85 (5.9)< 0.001Major ECG abnormality1551 (36.1)592 (41.4)< 0.001 Left ventricular hypertrophy536 (12.5)250 (17.5)< 0.001 Atrial fibrillation324 (7.5)137 (9.6)0.017 Bundle branch block300 (7.0)86 (6.0)0.223 Intraventricular conduction disorder52 (1.2)27 (1.9)0.077 Q waves355 (8.3)106 (7.4)0.326 ST-T deviations303 (7.1)145 (10.1)< 0.001Continuous data are reported as medians (25th-75th percentiles) and categorial data as n (%). Abbreviations: AAV, ANCA-associated vasculitis; ECG, electrocardiogram; bpm, beats per minute; ms, milliseconds; QTcF, Fridericia Corrected QT.
OriginalsprogEngelsk
Artikelnummergfae069.388
TidsskriftNephrology, Dialysis, Transplantation
Vol/bind39
Udgave nummerSuppl. 1
Sider (fra-til)i642-i643
ISSN0931-0509
DOI
StatusUdgivet - maj 2024
Begivenhed61th ERA Congress - Stockholm, Sverige
Varighed: 23 maj 202426 maj 2024
Konferencens nummer: 61
https://www.era-online.org/events/stockholm-2024/

Konference

Konference61th ERA Congress
Nummer61
Land/OmrådeSverige
ByStockholm
Periode23/05/202426/05/2024
Internetadresse

Bibliografisk note

Abstract no. #886

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