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

Louis Nygaard; Caroline Hundborg Liboriussen; Nicholas Carlson; Karl Emil Nelveg-Kristensen; Salome Kristensen; Mikkel Porsborg Andersen; Helle Collatz Christensen; Kristian Kragholm; Claus Graff; Christian Torp-Pedersen; Per Ivarsen; My Svensson; Jon Waarst Gregersen; DANVAS Investigators; Christoffer Polcwiartek

doi:10.1093/rheumatology/keae434

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

Rheumatology (Oxford). 2024 Aug 12:keae434. doi: 10.1093/rheumatology/keae434. Online ahead of print.

Authors

Louis Nygaard^{1

2

3}, Caroline Hundborg Liboriussen^{1

3}, Nicholas Carlson⁴, Karl Emil Nelveg-Kristensen⁴, Salome Kristensen^{2

5}, Mikkel Porsborg Andersen^{6

7}, Helle Collatz Christensen^{7

8}, Kristian Kragholm⁹, Claus Graff¹⁰, Christian Torp-Pedersen^{6

11}, Per Ivarsen^{12

13}, My Svensson^{1

3}, Jon Waarst Gregersen^{1

2

3}; DANVAS Investigators; Christoffer Polcwiartek⁹

Affiliations

¹ Renal Research Group, Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
² Center for SLE and Vasculitis, Aalborg University Hospital, Aalborg, Denmark.
³ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁴ Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark.
⁵ Center for Rheumatic Research Aalborg (CERRA), Aalborg University, Aalborg, Denmark, Hospital.
⁶ Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark.
⁷ Prehospital Center, Region Zealand, Næstved, Denmark.
⁸ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁹ Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
¹⁰ Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
¹¹ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
¹² Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
¹³ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

PMID: 39133192
DOI: 10.1093/rheumatology/keae434

Abstract

Objectives: Current guidelines provide limited evidence for cardiovascular screening in ANCA-associated vasculitis (AAV). This study aimed to investigate the prevalence of electrocardiogram (ECG) abnormalities and associations between no, minor or major ECG abnormalities with cardiovascular mortality in AAV patients compared with matched controls.

Method: Using a risk-set matched cohort design, patients diagnosed with granulomatosis with polyangiitis or microscopic polyangiitis with digital ECGs were identified from Danish registers from 2000-2021. Patients were matched 1:3 to controls without AAV on age, sex, and year of ECG measurement. Associated hazards of cardiovascular mortality according to ECG abnormalities were assessed in Cox regression models adjusted for age, sex, and comorbidities, with subsequent computation of 5-year risk of cardiovascular mortality standardized to the age- and sex-distribution of the sample.

Results: A total of 1431 AAV patients were included (median age: 69 years, 52.3% male). Median follow-up was 4.8 years. AAV was associated with higher prevalence of left ventricular hypertrophy (17.5% vs 12.5%), ST-T deviations (10.1% vs 7.1%), atrial fibrillation (9.6% vs 7.5%), and QTc prolongation (5.9% vs 3.6%). Only AAV patients with major ECG abnormalities demonstrated significantly elevated risk of cardiovascular mortality [HR 1.99 (1.49-2.65)] compared with controls. This corresponded to a 5-year risk of cardiovascular mortality of 19.14% (16-22%) vs 9.41% (8-11%).

Conclusion: Patients with AAV demonstrated a higher prevalence of major ECG abnormalities than controls. Notably, major ECG abnormalities were associated with a significantly increased risk of cardiovascular mortality. These results advocate for the inclusion of ECG assessment into routine clinical care for AAV patients.

Keywords: ANCA-Associated Vasculitis; Cardiovascular mortality; Danish Nationwide Electrocardiogram Cohort; Electrocardiogram; Electrocardiographic Abnormalities; Epidemiology; Granulomatosis with polyangiitis; Marquette 12SL; Microscopic polyangiitis; Registry.