Akut iskemik inmeli hastalarda QT dispersiyonun zamansal değişimi

Year 2023, Volume: 28 Issue: 2, 208 - 215, 23.05.2023

Serhan Özyıldırım Gülümser Heper

https://doi.org/10.21673/anadoluklin.1225540

Abstract

Amaç: İskemik inme, önemli bir morbidite ve mortalite nedenidir ve temel kardiyak patoloji olmadan ölümcül aritmilere neden olabilir. Bu çalışmanın amacı, akut iskemik inmenin QT dispersiyonu üzerindeki etkisini ve zaman içindeki değişimlerini araştırmaktır.

Yöntemler: Çalışmaya, reperfüzyon tedavisi almayan 124 akut iskemik inme hastası dahil edildi. İlk 12 saat ve 48 saat sonra alınan 12 derivasyonlu yüzey elektrokardiyogramlarından düzeltilmiş QT dispersiyonu (QTcd) değerleri elde edildi. Bu değerler, 93 yaş ve cinsiyet açısından eşleştirilmiş kontrol grubu ile karşılaştırıldı. Diyabet ve lezyon lateralizasyonunun QT dispersiyonu üzerindeki etkileri de analiz edildi. Lezyonları net bir şekilde sağ veya sol hemisfere lokalize olan inme hastaları iki alt gruba ayrıldı. İzlem dönemi boyunca QT dispersiyonundaki değişim de belirlendi.

Bulgular: Çalışmaya, ortalama yaşları 67±11 yıl olan 124 akut iskemik inme hastası (54 kadın ve 70 erkek) ve ortalama yaşları 69±8 yıl olan 93 kontrol grubu (49 kadın ve 44 erkek) dahil edildi. İlk 12 saatte, inme grubunun QTcd değerleri kontrol grubuna göre önemli ölçüde daha uzundu. Ancak 48 saat sonra, inme grubunun QTcd değerleri azaldı ve iki grup arasındaki fark istatistiksel olarak anlamsız hale geldi. Diyabet varlığı QT dispersiyonunda daha belirgin bir artışa neden oldu ve 48 saat sonra, diyabetik inme hastalarının QTcd değerleri hala anlamlı ölçüde daha uzundu. Sol hemisferik lezyonları olan hastaların QTcd değerleri, sağ hemisferik lezyonları olan hastaların değerlerinden önemli ölçüde daha uzundu ve bu fark 48 saat sonra da devam etti.

Sonuç: Bu çalışma, iskemik inmenin ilk saatlerinde QT dispersiyonunun arttığını ve tedavi dönemi boyunca azaldığını buldu. Bu artış, diyabetik ve sol hemisferik lezyonları olan inme hastalarında daha belirgin ve daha uzun sürdü. Sonuçlar, QT dispersiyonunun akut iskemik inme hastaları için kullanışlı bir prognostik gösterge olabileceğini düşündürmektedir.

Keywords

Elektrokardiyografi, miyokard, inme

Temporal changes of QT dispersion in patients with acute ischemic stroke

Abstract

Aim: Ischemic stroke is a significant cause of morbidity and mortality and can lead to fatal arrhythmias even in the absence of underlying cardiac pathology. The objective of this study was to investigate the impact of acute ischemic stroke on QT dispersion and its temporal changes over time.

Methods: A total of 124 patients with acute ischemic stroke who did not receive any reperfusion treatment were included in the study. Corrected QT dispersion (QTcd) values were obtained from 12-lead surface electrocardiograms taken within the first 12 hours and after 48 hours of stroke onset. These values were compared with those of 93 age and sex-matched control subjects. The effects of diabetes and lesion lateralization on QT dispersion were also analyzed. Stroke patients whose lesions were clearly localized to either the right or left hemisphere were divided into two subgroups. The change in QT dispersion overtime during the follow-up period was also determined.

Results: The study included 124 patients with acute ischemic stroke (54 females and 70 males) with a mean age of 67±11 years, as well as a control group of 93 subjects (49 females and 44 males) with a mean age of 69±8 years. The QTcd values of the stroke group were significantly longer than the control group in the first 12 hours of symptom onset. However, after 48 hours, the QTcd values of the stroke group decreased and the difference between the two groups was not statistically significant. The presence of diabetes mellitus caused a more significant increase in QT dispersion, and after 48 hours, the QTcd values of diabetic stroke patients were still significantly longer. The QTcd values of patients with left hemispheric lesions were significantly longer than those of patients with right hemispheric lesions, and this difference persisted after 48 hours.

Conclusion: This study found that QT dispersion increases during the first few hours of ischemic stroke and decreases during the treatment period. This increase is more obvious and lasts longer in stroke patients with diabetes and left hemispheric lesions. The results suggest that QT dispersion may be a useful prognostic indicator for patients with acute ischemic stroke.

Keywords

Electrocardiography, myocardium, stroke

References

• Go AS, Mozaffarian D, Roger VL et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.
• Hachinski VC. The clinical problem of brain and heart. Stroke. 1993;24(12 Suppl):I1-I12.
• Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Heart. 1990;63(6):342-4.
• Glancy JM, Garratt CJ, de Bono DP. Dynamics of QT dispersion during myocardial infarction and ischaemia. Int J Cardiol. 1996;57(1):55-60.
• Bonnar CE, Davie AP, Caruana L, et al. QT dispersion in patients with chronic heart failure: beta blockers are associated with a reduction in QT dispersion. Heart. 1999;81(3):297-302.
• Mayet J, Shahi M, McGrath K, et al. Left ventricular hypertrophy and QT dispersion in hypertension. Hypertension. 1996;28(5):791-6.
• Eckardt M, Gerlach L, Welter FL. Prolongation of the frequency-corrected QT dispersion following cerebral strokes with involvement of the insula of Reil. Eur Neurol.1999;42(4):190-3.
• 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(1):31-5
• Naas AA, Davidson NC, Thompson C, et al. QT and QTc dispersion are accurate predictors of cardiac death in newly diagnosed non-insulin dependent diabetes: cohort study. BMJ. 1998;316(7133):745-6.
• Klingelhöfer J, Sander D. Cardiovascular consequences of clinical stroke. Baillieres Clin Neurol. 1997;6(2):309-35.
• Rautaharju PM. Why did QT dispersion die? Card Electrophysiol Rev. 2002;6(3):295-301.
• Malik M, Acar B, Gang YI, Yap YG, Hnatkova K, Camm AJ. QT dispersion does not represent electrocardiographic interlead heterogeneity of ventricular repolarization. J Cardiovasc Electrophysiol. 2000;11(8):835-43.
• Samuels MA. The brain–heart connection. Circulation. 2007;116(1):77-84.
• Myers MG, Norris JW, Hachniski VC, Sole MJ. Plasma norepinephrine in stroke. Stroke 1981;12:200-4.
• Lazar JM, Salciccioli L. Prognostic value of QT dispersion in acute stroke. Int J Cardiol. 2008;129(1):1-2.
• Sato K, Kato M, Yoshimoto T. QT intervals and QT dispersion in patients with subarachnoid hemorrhage. J Anesth. 2001;15(2):74-7.
• Eckardt M, Gerlach L, Welter FL. Prolongation of the frequency-corrected QT dispersion following cerebral strokes with involvement of the insula of Reil. Eur Neurol. 1999;42(4):190-3.
• Afsar N, Fak AS, Metzger JT, Van Melle G, Kappenberger L, Bogousslavsky J. Acute stroke increases QT dispersion in patients without known cardiac diseases. Arch Neurol. 2003;60(3):346-50.
• Lane RD, Wallace JD, Petrosky PP, Schwartz GE, Gradman AH. Supraventricular tachycardia in patients with right hemisphere strokes. Stroke. 1992;23(3):362-6.
• Tokgözoglu SL, Batur MK, Topçuoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke. 1999;30(7):1307-11.
• Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF. Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death? Brain Res. 1991;550(1):115-21.
• Algra A, Gates PC, Fox AJ, Hachinski V, Barnett HJ. Side of brain infarction and long-term risk of sudden death in patients with symptomatic carotid disease. Stroke. 2003;34(12):2871-5.
• Lai SM, Alter M, Friday G, Sobel E. Prognosis for survival after an initial stroke. Stroke. 1995; 26(11), 2011-5.
• Pfeifer MA, Weinberg CR, Cook DL et al. Autonomic neural dysfunction in recently diagnosed diabetic subjects. Diabetes Care. 1984;7(5):447-53.
• Cavallini A, Micieli G, Marcheselli S, Quaglini S. Role of monitoring in management of acute ischemic stroke patients. Stroke. 2003;34(11):2599-603.