TY - JOUR T1 - Broadening the Diagnostic Horizon in Carbon Monoxide Poisoning: Reflections on Tp-e/QTc and Lactate as Early Markers AU - Ardahanlı, İsa AU - Aslan, Ramazan AU - Zeytun, Nurdan PY - 2025 DA - August Y2 - 2025 DO - 10.51262/ejtox.1695357 JF - Eurasian Journal of Toxicology JO - Eurasian J Tox PB - Acil Tıp Uzmanları Derneği WT - DergiPark SN - 2667-8675 SP - 19 EP - 20 VL - 7 IS - 2 LA - en AB - This letter offers a critical yet appreciative perspective on the recent case report exploring the Tp-e/QTc ratio and blood lactate levels as early indicators of cardiac ischemia in carbon monoxide poisoning. While acknowledging the clinical relevance of the proposed markers, we suggest enriching the discussion with additional context on electrophysiological mechanisms, reference values, and patient outcomes. We commend the authors for drawing attention to an often-overlooked diagnostic challenge and highlight the need for future prospective validation. KW - Carbon monoxide poisoning KW - Cardiac ischemia KW - Tp-e/QTc ratio KW - Blood lactate KW - Early cardiac biomarkers CR - Bozatlı SBH, Öztürk C, Çeliktürk E, Sayhan MB. Can Tp-e/QTc Ratio and Blood Lactate Levels Serve as an Earlier Indicator Than Troponin for Detecting Cardiac Ischemia in Patients With Carbon Monoxide Poisoning in the Emergency Department?. Eurasian J Tox. 2025;7(1):11-4. doi.org/10.51262/ejtox.1644742. CR - Li D, Weng Y, Zhen G, Jiang L. Tp-Te interval and Tp-Te/QT ratio are valuable tools in predicting poor outcome in sepsis patients. Front Cardiovasc Med. 2022;9:879085. doi: 10.3389/fcvm.2022.879085. CR - Tse G, Yan BP. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death. Europace. 2017;19(5):712–721. https://doi.org/10.1093/europace/euw280. CR - Ardahanli I, Celik M. Comparison of Tp-e interval, QTc interval and Tp-e/QTc ratios between non-diabetic and prediabetic population. Ann Med Res 2020;27(12):3117-22. doi: 10.5455/annalsmedres.2020.09.949. CR - Zhao X, Xie Z, Chu Y, Yang L, Xu W, Yang X, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol. 2012;35(9):559-64. doi: 10.1002/clc.22022. CR - Haliga RE, Morărașu BC, Șorodoc V, Lionte C, Sîrbu O, Stoica A, et al. Rare Causes of Acute Coronary Syndrome: Carbon Monoxide Poisoning. Life (Basel). 2022;12(8):1158. doi: 10.3390/life12081158. CR - Henry CR, Satran D, Lindgren B, et al. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006;295(4):398–402. https://doi.org/10.1001/jama.295.4.398. CR - Ardahanli I, Akyuz O. The effect of hemodialysis treatment on ventricular arrhythmogenesis parameters in electrocardiography. Selcuk Med J 2021;37(1): 5-10. doi: 10.30733/std.2021.01491. UR - https://doi.org/10.51262/ejtox.1695357 L1 - https://dergipark.org.tr/en/download/article-file/4852068 ER -