Düşük ejeksiyon fraksiyonlu kalp yetersizliğinde sakubutril/valsartan'ın Tp-e, QT, QTc, Tp-e/QTc parametreleri üzerine etkisi

Year 2024, Volume: 49 Issue: 1, 47 - 53, 29.03.2024

Ahmet Genç Gülsüm Meral Yılmaz Öztekin

https://doi.org/10.17826/cumj.1377925

Abstract

yetersizliği (HFrEF) hastalarında Sakubutril/Valsartan-Anjiyotensin reseptör neprilisin inhibitörünün (ARNI) tedavisi öncesi, tedavi sonrası birinci ve altıncı aylarda ventriküler repolarizasyonu değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya anjiyotensin dönüştürücü enzim inhibitörlerinden veya anjiyotensin reseptör blokerlerinden (ACE-I/ARB) ARNI tedavisine geçen 49 HFrEF hastası dahil edildi. ARNI tedavisi öncesinde, birinci ve altıncı aylarda 12 derivasyonlu elektrokardiyografi (EKG) değerlendirildi. Demografik, klinik ve laboratuvar parametrelerinin yanı sıra ilaçlar ve EKG verileri, kalp atış hızı, QT, QTc, Tp-e, hesaplanan Tp-e (Tp-ec), Tp-ec/QTc, Tp-e/QT ve Tp-e/QTc değerlendirildi.
Bulgular: ARNI tedavisi aldıktan sonra ventriküler repolarizasyon indekslerinde tedavi öncesine göre birinci ve altıncı ayda anlamlı azalma görüldü. Spesifik olarak QTc değerleri 457.6 ms'den 443.8 ms'ye, Tp-e/QT oranı ise 0.21±0,03'ten 0.19±0.03'e düştü. Ayrıca QTc değerleri 457.6 ms'den 444.9 ms'ye, Tp-e/QT oranı ise 0.21±0.03'ten 0.18±0.03'e düştü. Ancak ARNI tedavisi altında birinci ve altıncı aylar karşılaştırıldığında anlamlı fark saptanmadı (QTc: 443.8 ms vs. 444.9 ms, Tp-e/QT: 0.19±0.03 vs. 0.18±0.003).
Sonuç: HFrEF'de ARNI tedavisi ile ventriküler repolarizasyonun göstergeleri olan QTc, Tp-e ve Tp-ec aralıklarında ve Tp-e/QT, Tp-e/QTc ve Tp-ec/QTc oranlarında olumlu etkilendi. Üstelik bu etki 1. ayda başlayıp 6. ayda da devam etti.

Keywords

Ani kardiyak ölüm, Anjiyotensin reseptörü neprilisin inhibitörü, Tp-e; Tp-e/QTc oranı; QTc, Ventriküler repolarizasyon.

Effect of sacubutril/valsartan on Tp-e, QT, QTc, Tp-e/QTc parameters in heart failure with reduced ejection fraction

Abstract

Purpose: The purpose of this study is to evaluate ventricular repolarization before, at the first month, and sixth month after Sacubutril/Valsartan, an angiotensin receptor neprilysin inhibitor (ARNI) treatment in heart failure patients with reduced ejection fraction (HFrEF).
Materials and Methods: We included 49 patients with HFrEF who switched to ARNI therapy. The 12-lead electrocardiography (ECG) was evaluated before ARNI therapy and also during the first and sixth months of the therapy. We evaluated demographic, clinical, and laboratory parameters, as well as medications and ECG data, including heart rate. Additionally, we examined QT, QTc, Tp-e, Tp-e calculated (Tp-ec), Tp-ec/QTc, Tp-e/QT, and Tp-e/QTc.
Results: After receiving ARNI treatment, ventricular repolarization indices were significantly reduced in the first and sixth months compared to before treatment. Specifically, the QTc values decreased from 457.6 ms to 443.8 ms, and the Tp-e/QT ratio decreased from 0.21±0.03 to 0.19±0.03. Additionally, the QTc values decreased from 457.6 ms to 444.9 ms, and the Tp-e/QT ratio decreased from 0.21±0.03 to 0.18±0.03. However, when the first and sixth months under ARNI treatment were compared, no significant difference was found (QTc: 443.8 ms vs. 444.9 ms, Tp-e/QT: 0.19±0.03 vs. 0.18±0.003).
Conclusion: ARNI treatment in HFrEF positively affected QTc, Tp-e, and Tp-ec intervals and Tp-e/QT, Tp-e/QTc, and Tp-ec/QTc ratios, which are indicators of ventricular repolarization. Moreover, this effect started in the first month and continued in the sixth month.

Keywords

Angiotensin receptor neprilysin inhibitor, Tp-e, Tp-e/QTc ratio, QTc, Sudden cardiac death, Ventricular repolarization

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