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Akut iskemik inmeli hastalarda repolarizasyon parametreleri ile inme şiddeti arasındaki ilişki

Year 2019, Volume: 44 Issue: Supplement 1, 539 - 546, 29.12.2019
https://doi.org/10.17826/cumj.572533

Abstract

Amaç:  Bu çalışmanın amacı, akut iskemik inmeli hastalarda NIHSS ile repolarizasyon parametreleri arasındaki ilişkiyi araştırmak.

Gereç ve Yöntem: Çalışmaya akut iskemik inme geçiren 97 hasta (erkek,42; kadın,55; yaş, 65 ± 16) alındı. 17 hasta çalışmadan çıkarıldı. NIHSS skoruna göre hastalar iki gruba ayrıldı (Grup 1, NIHSS skor <16; Grup 2, NIHSS skoru ≥ 16).  Bütün hastalardan demografik, klinik ve laboratuvar verileri toplandı. Hastaların 12 derivasyonlu EKG’leri nöroloji yoğun bakım ünitesine yatırıldıktan hemen sonra çekildi. Ölçümler cetvelle yapıldı. QTc, QTd, QTcd, Tpe, Tpe/QT parametreleri ölçüldü.

Bulgular: Hastaların demografik özellikleri açısından gruplar arasında anlamlı farklılık saptanmadı. Hastaların QTc, QTd, QTcd, Tpe, Tpe/QT parametreleri, Grup 2 hastalarında, Grup 1 hastalarına göre anlamlı derecede daha yüksek bulundu.

Sonuç: Yapmış olduğumuz bu çalışmada, akut iskemik inmeli hastalarda repolarziasyon parametrelerinin inme şiddeti ile ilişkili olduğu sonucuna varılabilir. Bu çalışmada, akut iskemik inmenin repolarizasyon parametrelerinde değişikliğe neden olduğunu bulduk. Repolarizasyon parametreleri, akut iskemik inmeli hastaların yatış esnasındaki inme şiddeti ile ilişkilidir. Repolarizasyon parametrelerinin dispersiyonundaki artış, akut iskemik inmeli hastalarda aritmik kardiyak ölüm riskine bağımsız bir şekilde katkıda bulunmaktadır. Bu nedenle, özellikle ciddi iskemik inmeli hastaların, ilk 24 saatte yakın kardiyak monitorizasyonunu önermekteyiz.


References

  • 1- Rojek A, Gąsecki D, Fijalkowski M, Kowalczyk K, Kwarciany M, Wolf J, et al. Left ventricular ejection fraction and aortic stiffness are independent predictors of neurologicaloutcome in acute ischemic stroke. J Hypertens 2016;34(12):2441-8.
  • 2- Malik AN, Gross BA, Rosalind Lai PM, Moses ZB, Du R, et al. Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2015;83(6):880-5.
  • 3- Kerro A, Woods T, Chang JJ. Neurogenic stunned myocardium in subarachnoid hemorrhage. J Crit Care 2017:38:27-34.
  • 4- Ermis E, Demirelli S, Ceylan M, et al: The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography. J Clin Ultrasound 2016:44(5):305-311.
  • 5- Kim H, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, et al. Usefulness of tissue Doppler imagingmyocardial performance index inthe evaluation of diastolicdysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011;34(8):494-9.
  • 6- Ozturk O, Ulgen MS, Tekes S, Ozturk U, Toprak N. Influence of the Angiotensin Converting Enzyme I/D Gene Polymorphisms on Right Ventricular Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction. Circ J 2005;69:211-5.
  • 7- Öztürk Ö, Toprak N. Akut Anteriyor Miyokard İnfarktüslü Hastalarda Geliş Miyokardiyal Performans İndeksi ile Lökositoz Arasındaki İlişki. Dicle Med J 2004;(2): 36-41.
  • 8- Lyden P. Using the National Institutes of Health Stroke Scale: A Cautionary Tale. Stroke 2017:48(2):513-519.
  • 9- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28(1):1-39.
  • 10- Zawadka-Kunikowska M, Slominski K, Slomko J, Tafil-Klawe M, Klawe JJ, Sokołowski L et al. Comprehensive non-nvasive cardiac and autonomic assessment in acute ischaemic strokepatients: pilot study. Minerva Cardioangiol 2018;66(4):376-85.
  • 11- Vemmos K, Ntaios G, Savvari P, Vemmou AM, Koroboki E, Manios E, et al: Stroke etiology and predictors of outcome in patients with heart failure and acute stroke: a 10-year follow-up study. Eur J Heart Fail 2012;14:211-8.
  • 12- Holmström A, Fu ML, Hjalmarsson C, Bokemark L, Andersson B. Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurol 2013;13:122.
  • 13- Ripoll JG, Blackshear JL, Díaz-Gómez JL. Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am 2018;29(2):281-97.
  • 14- Constantinescu V, Matei D, Cuciureanu D, Corciova C, Ignat B, Popescu CD etal.Cortical modulation of cardiac autonomic activity in ischemic stroke patients. Acta Neurol Belg 2016;116(4):473-80.
  • 15- Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, Figueredo V, et al. A Review of Neurogenic Stunned Myocardium. Cardiovasc Psychiatry Neurol 2017; 2017:5842182.
  • 16- Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiol Intensive Ther 2015:47(2):175-80.
  • 17- Chao CC, Wang TL, Chong CF, Lin YM, Chen CC, Tang GJ, et al. Prognostic value of QT parameters in patients with acute hemorrhagic stroke: a prospective evaluation with respect to mortality and post-hospitalization bed confinement. J Chin Med Assoc 2009;72:124–32.
  • 18- Familoni OB, Odusan O, Ogun SA. The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke. J Natl Med Assoc 2006;98:1758–62.
  • 19- Castro Hevia J, Antzelevitch C, Torne´s Ba´rzaga F, Dorantes Sa´nchez M, Dortico´s Balea F, Zayas Molina R et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006;47:1828–34.
  • 20- Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 1990;47:513–9.
  • 21- Afsar NA, Fak AS, Metzger J, Van Melle G, Kappenberger L, Bogousslavsky J. Acute stroke increases QT dispersion in patients without known cardiac disease. Arch Neurol 2003;60:346–50.
  • 22- Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Crit Care 2002;11:48–56.
  • 23- Purushothaman S, Salmani D, Prarthana KG, Bandelkar SM, Varghese S. Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents. J Nat Sci Biol Med 2014;5(2):434–36.
  • 24- Lazar J, Manzella S, Moonjelly J, Wirkowski E, Cohen TJ. The prognostic value of QT dispersion in patients presenting with acute neurological events. J Invasive Cardiol 2003;15:31–5.
  • 25- Emektar E, Çorbacıoğlu ŞK, Korucu O, Ramadan S, Uzunosmanoğlu H, Kan E, et al. The evaluation of a new marker of transmyocardial repolarization parameters in ischemic strokepatients; T peak-T end (T p-e), T p-e/QTc. Acta Neurol Belg 2017;117(2):461-7.
  • 26- Bonardo P, Pantiú F, Ferraro M, Chertcoff A, Bandeo L, Cejas LL, et al. Impact of Infarct Size on Blood Pressure in Young Patients with Acute Stroke. J Vasc Interv Neurol 2018;10(1):14-6.
  • 27- Hendrix P, Sofoluke N, Adams MD, Kunaprayoon S, Zand R, Kolinovsky AN, et al. Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion. Stroke 2019;50(5):1074-80.
  • 28- Chang A, Ricci B, Grory BM, Cutting S, Burton T, Dakay K, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2019;doi: 10.1016/j.jstrokecerebrovasdis (in press).
  • 29- Lindsberg JP, Roine RO. Hyperglycaemia in acute stroke. Stroke 2004;35:363-4.
  • 30- Ryu WS, Bae EK, Park SH, , Jeong SW, Schellingerhout D, Nahrendorf M, et al. Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. J Stroke Cerebrovasc Dis 2018;27(5):1275-82.
  • 31- Mostofsky E, Wellenius GA, Noheria A, Levitan EB, Burger MR, Schlaug G, et al. Cerebrovasc Dis 2009;28(1):88-94.

Relationship between stroke severity and repolarization parameters in patients with acute ischemic stroke

Year 2019, Volume: 44 Issue: Supplement 1, 539 - 546, 29.12.2019
https://doi.org/10.17826/cumj.572533

Abstract

Purpose: The aim of this study was to investigate the relationship between repolarization parameters and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke. 

Materials and Methods: The study comprised 97 patients (males, 42; females, 55; 65 ± 16 years) with acute ischemic stroke. 17 patients were excluded. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score < 16; Group 2, NIHSS score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. A 12-lead resting ECG was recorded at admission to the neurology care unit in patients with acute ischemic stroke and were manually measured with a ruler. QTc, QTd, QTcd, Tpe, Tpe/QT parameters were measured. 

Results: There were no significant differences among demographic parameters of patients. We found that QTc, QTd, QTcd, Tpe, Tpe/QT parameters were significantly higher in Group 2 than Group 1 patients. 

Conclusion: In this study, we found that acute ischemic stroke has been shown to cause changes in repolarization parameters. Repolarization parameters are associated with stroke severity on admission in patients with acute ischemic stroke. Increased dispersion of repolarization parameters make independent contributions to the risk of arrhythmic cardiac death in patients with acute ischemic stroke. We suggested that especially severe ischemic stroke patients closely using cardiac monitoring during the first 24 h. 


References

  • 1- Rojek A, Gąsecki D, Fijalkowski M, Kowalczyk K, Kwarciany M, Wolf J, et al. Left ventricular ejection fraction and aortic stiffness are independent predictors of neurologicaloutcome in acute ischemic stroke. J Hypertens 2016;34(12):2441-8.
  • 2- Malik AN, Gross BA, Rosalind Lai PM, Moses ZB, Du R, et al. Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2015;83(6):880-5.
  • 3- Kerro A, Woods T, Chang JJ. Neurogenic stunned myocardium in subarachnoid hemorrhage. J Crit Care 2017:38:27-34.
  • 4- Ermis E, Demirelli S, Ceylan M, et al: The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography. J Clin Ultrasound 2016:44(5):305-311.
  • 5- Kim H, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, et al. Usefulness of tissue Doppler imagingmyocardial performance index inthe evaluation of diastolicdysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011;34(8):494-9.
  • 6- Ozturk O, Ulgen MS, Tekes S, Ozturk U, Toprak N. Influence of the Angiotensin Converting Enzyme I/D Gene Polymorphisms on Right Ventricular Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction. Circ J 2005;69:211-5.
  • 7- Öztürk Ö, Toprak N. Akut Anteriyor Miyokard İnfarktüslü Hastalarda Geliş Miyokardiyal Performans İndeksi ile Lökositoz Arasındaki İlişki. Dicle Med J 2004;(2): 36-41.
  • 8- Lyden P. Using the National Institutes of Health Stroke Scale: A Cautionary Tale. Stroke 2017:48(2):513-519.
  • 9- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28(1):1-39.
  • 10- Zawadka-Kunikowska M, Slominski K, Slomko J, Tafil-Klawe M, Klawe JJ, Sokołowski L et al. Comprehensive non-nvasive cardiac and autonomic assessment in acute ischaemic strokepatients: pilot study. Minerva Cardioangiol 2018;66(4):376-85.
  • 11- Vemmos K, Ntaios G, Savvari P, Vemmou AM, Koroboki E, Manios E, et al: Stroke etiology and predictors of outcome in patients with heart failure and acute stroke: a 10-year follow-up study. Eur J Heart Fail 2012;14:211-8.
  • 12- Holmström A, Fu ML, Hjalmarsson C, Bokemark L, Andersson B. Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurol 2013;13:122.
  • 13- Ripoll JG, Blackshear JL, Díaz-Gómez JL. Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am 2018;29(2):281-97.
  • 14- Constantinescu V, Matei D, Cuciureanu D, Corciova C, Ignat B, Popescu CD etal.Cortical modulation of cardiac autonomic activity in ischemic stroke patients. Acta Neurol Belg 2016;116(4):473-80.
  • 15- Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, Figueredo V, et al. A Review of Neurogenic Stunned Myocardium. Cardiovasc Psychiatry Neurol 2017; 2017:5842182.
  • 16- Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiol Intensive Ther 2015:47(2):175-80.
  • 17- Chao CC, Wang TL, Chong CF, Lin YM, Chen CC, Tang GJ, et al. Prognostic value of QT parameters in patients with acute hemorrhagic stroke: a prospective evaluation with respect to mortality and post-hospitalization bed confinement. J Chin Med Assoc 2009;72:124–32.
  • 18- Familoni OB, Odusan O, Ogun SA. The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke. J Natl Med Assoc 2006;98:1758–62.
  • 19- Castro Hevia J, Antzelevitch C, Torne´s Ba´rzaga F, Dorantes Sa´nchez M, Dortico´s Balea F, Zayas Molina R et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006;47:1828–34.
  • 20- Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 1990;47:513–9.
  • 21- Afsar NA, Fak AS, Metzger J, Van Melle G, Kappenberger L, Bogousslavsky J. Acute stroke increases QT dispersion in patients without known cardiac disease. Arch Neurol 2003;60:346–50.
  • 22- Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Crit Care 2002;11:48–56.
  • 23- Purushothaman S, Salmani D, Prarthana KG, Bandelkar SM, Varghese S. Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents. J Nat Sci Biol Med 2014;5(2):434–36.
  • 24- Lazar J, Manzella S, Moonjelly J, Wirkowski E, Cohen TJ. The prognostic value of QT dispersion in patients presenting with acute neurological events. J Invasive Cardiol 2003;15:31–5.
  • 25- Emektar E, Çorbacıoğlu ŞK, Korucu O, Ramadan S, Uzunosmanoğlu H, Kan E, et al. The evaluation of a new marker of transmyocardial repolarization parameters in ischemic strokepatients; T peak-T end (T p-e), T p-e/QTc. Acta Neurol Belg 2017;117(2):461-7.
  • 26- Bonardo P, Pantiú F, Ferraro M, Chertcoff A, Bandeo L, Cejas LL, et al. Impact of Infarct Size on Blood Pressure in Young Patients with Acute Stroke. J Vasc Interv Neurol 2018;10(1):14-6.
  • 27- Hendrix P, Sofoluke N, Adams MD, Kunaprayoon S, Zand R, Kolinovsky AN, et al. Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion. Stroke 2019;50(5):1074-80.
  • 28- Chang A, Ricci B, Grory BM, Cutting S, Burton T, Dakay K, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2019;doi: 10.1016/j.jstrokecerebrovasdis (in press).
  • 29- Lindsberg JP, Roine RO. Hyperglycaemia in acute stroke. Stroke 2004;35:363-4.
  • 30- Ryu WS, Bae EK, Park SH, , Jeong SW, Schellingerhout D, Nahrendorf M, et al. Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. J Stroke Cerebrovasc Dis 2018;27(5):1275-82.
  • 31- Mostofsky E, Wellenius GA, Noheria A, Levitan EB, Burger MR, Schlaug G, et al. Cerebrovasc Dis 2009;28(1):88-94.
There are 31 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Ünal Öztürk 0000-0002-8341-5070

Önder Öztürk 0000-0003-4204-0599

Yusuf Tamam This is me 0000-0002-9886-2017

Publication Date December 29, 2019
Acceptance Date August 16, 2019
Published in Issue Year 2019 Volume: 44 Issue: Supplement 1

Cite

MLA Öztürk, Ünal et al. “Relationship Between Stroke Severity and Repolarization Parameters in Patients With Acute Ischemic Stroke”. Cukurova Medical Journal, vol. 44, 2019, pp. 539-46, doi:10.17826/cumj.572533.