Electrocardiographic markers of arrhythmic risk in psoriatic arthritis: a retrospective comparative cohort analysis
D Bismpos, P Sewerin, N Horstmann, H Sprave, P S Lange, X Baraliakos, C UkenaAbstract
Background
Psoriatic arthritis (PsA) is a systemic inflammatory disease increasingly recognized for its cardiovascular burden, particularly its arrhythmic complications.
Purpose
Our goal was to provide a comprehensive stratification of arrhythmic risk in PsA, integrating electrocardiographic (ECG) findings with clinical variables.
Methods
We retrospectively analyzed patients with established PsA who received treatment between 2014 and 2022. A cohort of age- and sex-matched cardiovascular patients without systemic inflammatory disease served as the control group. Standard ECG parameters reflecting atrioventricular conduction as well as atrial and ventricular depolarization and repolarization were assessed, including interatrial block (IAB), P-wave peak time (PWPT), P-wave terminal force (PWTF), P-wave dispersion (PWd), atrioventricular block (AVB), corrected QT interval (QTc), corrected T-peak to T-end interval (cTpTe), and QT dispersion (QTd). The control group served the validation of the predictive value of the recorded ECG parameters. In addition, clinical variables such as the duration of PsA, the HLA-B27 status, the presence of cardiovascular comorbidities and the type of autoimmune therapy were recorded.
Results
A total of 725 PsA patients and 725 matched controls were included (mean age 52.5 ± 13.4 years; 61.8% female). The median PsA duration was 2 years (IQR 0–8). Rates of first-degree AVB were comparable between PsA and controls (9.5% vs. 10.2%; p = 0.725). Excluding individuals with known atrial arrhythmias, PsA patients exhibited a higher prevalence of abnormal PWTF (30.2% vs. 14.1%; p < 0.001). Furthermore, PsA patients had a longer cTpTe (0.26 ± 0.04 vs. 0.23 ± 0.05; p<0.001). Within the PsA cohort, male sex (16.4% vs. 7.1%; p = 0.006) and a longer disease duration (disease duration ≥ 10 years: 18.0% vs. 6.9%; p < 0.001) were independently associated with AVB I°, even after age adjustment. Similarly, male sex (30.1% vs. 14.9%; p < 0.001) and the use of conventional synthetic disease-modifying antirheumatic drugs (25.4% vs. 16.6%; p = 0.069) were linked to a prolonged cTpTe.
Conclusions
Patients with PsA are at an increased risk for arrhythmias, demonstrated by disorders of both atrial and ventricular repolarization as well as atrioventricular conduction. These findings highlight the potential role of routine, non-invasive ECG-based assessment for early identification and risk stratification of arrhythmic complications in PsA.