Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

SK: Strong Risk Predictor of Developing AV Block

Clin Cardiol; ePub 2017 Nov 23; Roshdy, et al

Any population with a total intrinsic skin aging score of >6 is at high risk for developing advanced-degree atrioventricular (AV) block, according to a recent study, which found that seborrheic keratosis (SK) was the strongest independent predictor. It is recommended that such persons should undergo periodic electrocardiography (ECG) for early detection of any conduction disturbance in the early asymptomatic stages to minimize sudden cardiac death. This study included 97 patients divided into 2 groups; group D comprised 49 patients with advanced-degree AV block, and group C comprised the 48 matched control group. All were subjected to full history taking, thorough clinical examination, calculation of intrinsic skin aging score, and resting 12-lead surface ECG. Researchers found:

  • Patients in group D had = higher percentages of uneven pigmentation, fine skin wrinkles, lax appearance, SK, total score >7 (38 [77.55%] vs 10 [20.83%]), mitral annular calcification score of 33 (67.34%) vs 5 (10.41%), aortic sclerosis score of 21 (42.85%) vs 4 (8.33%), and mean left atrium diameter of 39.98 ± 5.52 vs 36.21 ± 3 mm.
  • Total score >6 is the best cutoff value to predict advanced-degree heart block with 89.79% sensitivity and 64.58% specificity.

Citation:

Roshdy HS, Soliman MH, El-Dosouky II, Ghonemy S. Skin aging parameters: A window to heart block. [Published online ahead of print November 23, 2017]. Clin Cardiol. doi:10.1002/clc.22848.

Commentary:

The authors endeavored to find the relation between skin aging parameters and the incidence of degenerative AV block. They concluded that any population with a total intrinsic skin aging score of >6 is at high risk for developing advanced-degree AV block, and should undergo periodic ECG follow-up for early detection of any conduction disturbance in the early asymptomatic stages to minimize sudden cardiac death. In this analysis, it is most likely that the presence of seborrheic keratosis is associated with aging, and not specifically with AV block themselves. However, this is an interesting observation.

Jeffrey M. Weinberg, MD, FAAD
Assistant Clinical Professor of Dermatology, Columbia University College of Physicians and Surgeons, NYC
Director, Clinical Research Center/Dermatopharmacology, St. Luke's-Roosevelt Hospital Center, NYC
Acting Director, Division of Dermatology, Jamaica Hospital Medical Center, NYC

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