HLA-B27 and an Electrocardiographic Peculiarity

Abstract

Introduction: An increased cardiovascular mortality has been described in patients with spondyloarthropathies due to HLA-B27. Numerous cardiovascular afflictions are currently known to be associated with HLA-B27. These include aortic root dilation, aortic regurgitation, mitral regurgitation, myocarditis, heart failure, pericarditis, pericardial effusion, atrioventricular conduction block and more recently, the presence of J-waves. Materials and methods: 48 HLA-B27 positive patients (23 men and 25 women) were included in this observational study. A 12-lead electrocardiogram and a signal-averaged electrocardiogram was recorded in every patient in order to detect any possible J-waves and ventricular late potentials respectively. Results: 27 out of these 48 patients demonstrated a visible J-wave in the inferolateral leads. It was revealed that there is a likelihood ratio of 11.386 (p=0.00074) to demonstrate a visible J-wave if the duration of low-amplitude signals is less than 30 ms. Conclusion: HLA-B27 positive patients has a high incidence of inferolateral cardiac J-waves. There is a high probability of demonstrating such a J-wave on the 12-lead electrocardiogram if the duration of ventricular late potentials is less than 30 ms. The possible mechanisms of this electrocardiographic paradox is discussed.