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The effects of iron deficiency anemia and its treatment on P wave durations and parameters of diastolic function

Year 2010, , 187 - 194, 01.09.2010
https://doi.org/10.5799/ahinjs.01.2010.03.0039

Abstract

Objectives: We aimed to compare P wave variables and LV diastolic function between patient with iron deficiency anemia (IDA) and healthy control group and to investigate the effects of anemia treatment on these parameters. Materials and methods: The study included 56 patients having IDA without cardiovascular dissease and 50 healthy subjects. The cases were evaluated with clinical examination, ECG and transthoracic echocardiography (TTE) before and after treatment of IDA. Tissue Doppler imaging was assessed in addition to conventional TTE. The difference between maximum (Pmax) and minimum P wave duration on the 12-leads ECG was defined as PWD. Results: Compared to control group left atrium (LA) diameter (p=0.02), left ventricular enddiastolic diameter (LVED) (p=0.001), frequency of LV diastolic dysfunction (LVDD) (p=0.02), Pmax (p=0.002) and PWD (p=0.001) were significantly increased in patients with IDA. Correlations analysis revealed that PWD (r=0.367, p=0.001) and frequency of LVDD(r=0.231, p=0.02) were significantly correlated with severity of anemia. Compared to pre treatment period; LA diameter (p=0.001), LVED (p=0.001), frequency of LVDD (p=0.001), Pmax (p=0.001), Pmin (p=0.001) and PWD (p=0.001) were significantly decreased after treatment. Conclusion: IDA may be associated with increased PWD, left heart dimensions and frequency of LVDD in paralel with severity of anemia. These parameters may improve with treatment of anemia.

References

  • Sarnak MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in the Atherosclero- sis Risk in Communities (ARIC) study. J Am Coll Cardiol 2002;40:27–33.
  • Naito Y, Tsujino T, Matsumoto M, Sakoda T, Ohyanagi M, Masuyama T. Adaptive response of the heart to long-term anemia induced by iron deficiency. Am J Physiol Heart Circ Physiol 2009;296: 585-93
  • Varat MA, Adolph RG, Fowler NO. Cardiovascular effects of anemia. Am Heart J 1972;83:415-26.
  • Beard JL, Tobin BW, Smith SM. Effects of iron repletion and correction of anemia on norepinephrine turnover and thyroid metabolism in iron deficiency. Proc Soc Exp Biol Med 1990;193:306-12.
  • Schultz HD, Sun SY. Chemoreflex function in heart failure. Heart Fail Rev 2000;5:45-6.
  • Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant 2000;15:14 –8.
  • Dilaveris PE, Gialafos EJ, Andrikopoulos GK. Clinical and electrocardiographic predictors of recurrent atrial fibrilla- tion. PACE 2000;23:352-8.
  • Li Z, Hertervig E, Carlson J, Johansson C, Olsson SB, Yuan S. Dispersion of refractoriness in patients with paroxysmal atrial fibrillation. J Electrocardiol 2002;35:227-34.
  • Sahn DJ, DeMaria A, Kisslo J, Weyman A. The commit- tee on M-mode standardization of the American Soci- ety of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographicmeasurements. Circulation 1978;58:1072-83.
  • Hegde N, Rich MW, Gayomali C. The cardiomyopathy of iron deficiency. Tex Heart Inst J 2006;33:340-4.
  • Turner LR, Premo DA, Gibbs BJ, et al. Adaptations of iron deficiency: cardiac functional responsiveness to norepi- nephrine, arterial remodeling, and the beta blockade on car- diac hypertrophy. BMC Physiol 2002;2:1-6.
  • Tanigawa M, Fukatani M, Konoe A, Isomoto S, Kadena M, Hashiba K. Prolonged and fractioned right atrial electro- grams during sinus riytm in patients with paroxymal atrial fibrillation and sick sinus node syndrome. J Am Coll Car- diol 1991; 17:403–8.
  • Chen YJ, Chen SA, Tai CT, et al. Electrophysiologic charac- teristics of dilated atrium in patients with paroxysmal atrial fibrillation. J Intervent Card Electrophysiol 1998; 2:181–6.
  • Spach MS, Dolber PC. Relating extrcellular potentials and their derivatives to anisotropic propagation at a microscopic lecel human cardiac muscle. Evidence for electrical uncou- pling of side-to-side fiber connections with increased age. Circ Res 1986; 58:356-71.
  • Shimizu W, Tsuchioka Y, Karakawa S, et al. Differential effect of pharmacological autonomic blockade on some electrophysiological properties of the human ventricle and atrium. Br Heart J 1994; 71:34-37.
  • Zipes DP. The seventh annual Gordan K. Moe lecture. Atri- al fibrillation: from cell to bedside. J Cardiovasc Electro- physiol, 1997;8:927-38.
  • Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, An- drikopoulos GK, Kyriakidis M. Simple electrocardiograph- ic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart Journal 1998;135:733-8
  • Dilaveris PE, Stefanadis CI. P wave dispersion. A valuable non-invasive marker of vulnerability to atrial arrhythmias. Hospital Chronicles 2006;1:130-37
  • Duru M, Seyfeli E, Kuvandik G, Kaya H, Yalcin F. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes 2006;30: 957-61.
  • Guntekin U, Gunes Y, Tuncer M, Gumrukcuoglu HA, Kaya Y. The Effect of altitude on P-wave and QT duration and dispersion. PACE 2008;31:889–92.
  • Uyarel H, Ozdol C, Karabulut A, Okmen E, Cam N. Acute alcohol intake and P-wave dispersion in healthy men. An- adolu Kardiyol Derg 2005;5:289-93.
  • Caron MF, Song J, Ammar R, Kluger J, White CM. An eval- uation of the change in electrocardiographic P-wave vari- ables after acute caffeine ingestion in normal volunteers. J Clin Pharm Ther 2001;26:145-8.
  • Opie LH. Mechanisma of cardiac contraction and relax- ation. In Zipes D.P, Libby P. Bonow R.O, and Braunwald E. Braunwald’s Heart Diease.Editors. 7 th ed. Philadelphia: 2005: 457-89.
  • Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med 1999;341:577–85.
  • Bahl VK, Malhotra OP, Kumar D, et al. Noninvasive assess- ment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study. Am Heart J 1992; 124:1516-23.
  • Şan M, Demirtaş M, Burgut R, Birand A. Left Ventricular Systolic and Diastolic Functions in Patients With Sickle Cell Anemia. Int J Angiol 1998;7:185-7.
  • Gunduz H, Binak E, Arinc H, et al. The Relationship be- tween P wave dispersion and diastolic dysfunction. Tex Heart Inst J 2005; 32:163–7.
  • Zile M, Brutsaert D. New concepts in diastolic dysfunction and diastolic heart failure: II. Causal mechanisms and treat- ment. Circulation 2002;105: 1503-8.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger J. Effects of autonomic stimulation and blockade on signal-averaged P-wave duration. J Am Coll Cardiol 1990; 26:497–502.
  • Yokusoglu M, Nevruz O, Baysan O, et al. The altered au- tonomic nervous system activity in iron deficiency anemia. Tohoku J Exp Med 2007; 212:397-402.
  • Tuncer M, Gunes Y, Guntekin U, et al. Heart rate variability in patients with iron deficiency anemia. Arq Bras Cardiol 2009;92:368-71.
  • Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardio- graphic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 1994; 89:724–30.
  • Psaty BM, Manolio TA, Kuller LH, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997; 96:2455–61.
  • Guntekin U, Gunes Y, Tuncer M, Gunes A, Sahin M, Simsek H. Long-term Follow-up of P-wave Duration and Dispersion in Patients with Mitral Stenosis. PACE 2008;31:1620–4.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ: Ef- fects of autonomic stimulation and blockade on signal-av- eraged P wave duration. J Am Cofl Cardiol 1995;26:497- 502.

Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri

Year 2010, , 187 - 194, 01.09.2010
https://doi.org/10.5799/ahinjs.01.2010.03.0039

Abstract

Amaç: Bu makalenin amacı kronik demir eksikliği anemisinin (DEA) hastaların sol ventrikül (SV) diyastolik fonksiyon parametreleri ile P dalga sürelerine etkisi ve anemi tedavisinin bu parametreler üzerinde yapabileceği değişiklikleri araştırmaktır. Gereç ve yöntem: Çalışmaya kalp-damar hastalığı olmayan 56 kronik DEA hastası ve 50 sağlıklı birey alındı. Vakalar başlangıçta ve anemi tedavi edildikten sonra anamnez, fizik muayene, elektrokardiyografi (EKG) ve transtorasik ekokardiyografi (TTE) ile değerlendirildi. TTE ile konvansiyonel parametrelerin yanı sıra doku doppler yapıldı. 12 derivasyonlu EKG de en uzun P dalga süresinden (Pmaks) en kısa P dalga süresi (Pmin) çıkarılarak P dalga dispersiyonu (PDD) hesaplandı. Bulgular: Kontrol grubuna göre, DEA hastalarında sol atriyum (SA) çapı (p=0.02), sol ventrikül diastol sonu çapı (LVDÇ) (p=0.001), diastolik disfonksiyon sıklığı (p=0.02), Pmaks (p=0.002) ve PDD (p=0.001) anlamlı derecede artmıştı. Korelasyon analizi ile diastolik disfonksiyon sıklığının (r=0.231, p=0.02) ve PDD\'nin (r=0.367, p=0.001) anemi derinliğiyle anlamlı derecede ilişkili olduğu saptandı. Tedavi öncesiyle kıyaslandığında tedavi sonrasında SA çapı (p=0.001), LVDÇ (p=0.001), diastolik disfonksiyon sıklığı (p=0.001), Pmaks (p=0.001), Pmin ( p=0.001) ve PDD (p=0.001) anlamlı derecede azalmıştı. Sonuç: DEA\'nin şiddetine paralel olarak PDD, sol kalp boyutları ve SV diyastolik disfonksiyon sıklığının arttığı gözlendi. Aneminin tedavisiyle bozulan bu değişkenlerde düzelme sağlandı.

References

  • Sarnak MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in the Atherosclero- sis Risk in Communities (ARIC) study. J Am Coll Cardiol 2002;40:27–33.
  • Naito Y, Tsujino T, Matsumoto M, Sakoda T, Ohyanagi M, Masuyama T. Adaptive response of the heart to long-term anemia induced by iron deficiency. Am J Physiol Heart Circ Physiol 2009;296: 585-93
  • Varat MA, Adolph RG, Fowler NO. Cardiovascular effects of anemia. Am Heart J 1972;83:415-26.
  • Beard JL, Tobin BW, Smith SM. Effects of iron repletion and correction of anemia on norepinephrine turnover and thyroid metabolism in iron deficiency. Proc Soc Exp Biol Med 1990;193:306-12.
  • Schultz HD, Sun SY. Chemoreflex function in heart failure. Heart Fail Rev 2000;5:45-6.
  • Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant 2000;15:14 –8.
  • Dilaveris PE, Gialafos EJ, Andrikopoulos GK. Clinical and electrocardiographic predictors of recurrent atrial fibrilla- tion. PACE 2000;23:352-8.
  • Li Z, Hertervig E, Carlson J, Johansson C, Olsson SB, Yuan S. Dispersion of refractoriness in patients with paroxysmal atrial fibrillation. J Electrocardiol 2002;35:227-34.
  • Sahn DJ, DeMaria A, Kisslo J, Weyman A. The commit- tee on M-mode standardization of the American Soci- ety of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographicmeasurements. Circulation 1978;58:1072-83.
  • Hegde N, Rich MW, Gayomali C. The cardiomyopathy of iron deficiency. Tex Heart Inst J 2006;33:340-4.
  • Turner LR, Premo DA, Gibbs BJ, et al. Adaptations of iron deficiency: cardiac functional responsiveness to norepi- nephrine, arterial remodeling, and the beta blockade on car- diac hypertrophy. BMC Physiol 2002;2:1-6.
  • Tanigawa M, Fukatani M, Konoe A, Isomoto S, Kadena M, Hashiba K. Prolonged and fractioned right atrial electro- grams during sinus riytm in patients with paroxymal atrial fibrillation and sick sinus node syndrome. J Am Coll Car- diol 1991; 17:403–8.
  • Chen YJ, Chen SA, Tai CT, et al. Electrophysiologic charac- teristics of dilated atrium in patients with paroxysmal atrial fibrillation. J Intervent Card Electrophysiol 1998; 2:181–6.
  • Spach MS, Dolber PC. Relating extrcellular potentials and their derivatives to anisotropic propagation at a microscopic lecel human cardiac muscle. Evidence for electrical uncou- pling of side-to-side fiber connections with increased age. Circ Res 1986; 58:356-71.
  • Shimizu W, Tsuchioka Y, Karakawa S, et al. Differential effect of pharmacological autonomic blockade on some electrophysiological properties of the human ventricle and atrium. Br Heart J 1994; 71:34-37.
  • Zipes DP. The seventh annual Gordan K. Moe lecture. Atri- al fibrillation: from cell to bedside. J Cardiovasc Electro- physiol, 1997;8:927-38.
  • Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, An- drikopoulos GK, Kyriakidis M. Simple electrocardiograph- ic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart Journal 1998;135:733-8
  • Dilaveris PE, Stefanadis CI. P wave dispersion. A valuable non-invasive marker of vulnerability to atrial arrhythmias. Hospital Chronicles 2006;1:130-37
  • Duru M, Seyfeli E, Kuvandik G, Kaya H, Yalcin F. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes 2006;30: 957-61.
  • Guntekin U, Gunes Y, Tuncer M, Gumrukcuoglu HA, Kaya Y. The Effect of altitude on P-wave and QT duration and dispersion. PACE 2008;31:889–92.
  • Uyarel H, Ozdol C, Karabulut A, Okmen E, Cam N. Acute alcohol intake and P-wave dispersion in healthy men. An- adolu Kardiyol Derg 2005;5:289-93.
  • Caron MF, Song J, Ammar R, Kluger J, White CM. An eval- uation of the change in electrocardiographic P-wave vari- ables after acute caffeine ingestion in normal volunteers. J Clin Pharm Ther 2001;26:145-8.
  • Opie LH. Mechanisma of cardiac contraction and relax- ation. In Zipes D.P, Libby P. Bonow R.O, and Braunwald E. Braunwald’s Heart Diease.Editors. 7 th ed. Philadelphia: 2005: 457-89.
  • Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med 1999;341:577–85.
  • Bahl VK, Malhotra OP, Kumar D, et al. Noninvasive assess- ment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study. Am Heart J 1992; 124:1516-23.
  • Şan M, Demirtaş M, Burgut R, Birand A. Left Ventricular Systolic and Diastolic Functions in Patients With Sickle Cell Anemia. Int J Angiol 1998;7:185-7.
  • Gunduz H, Binak E, Arinc H, et al. The Relationship be- tween P wave dispersion and diastolic dysfunction. Tex Heart Inst J 2005; 32:163–7.
  • Zile M, Brutsaert D. New concepts in diastolic dysfunction and diastolic heart failure: II. Causal mechanisms and treat- ment. Circulation 2002;105: 1503-8.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger J. Effects of autonomic stimulation and blockade on signal-averaged P-wave duration. J Am Coll Cardiol 1990; 26:497–502.
  • Yokusoglu M, Nevruz O, Baysan O, et al. The altered au- tonomic nervous system activity in iron deficiency anemia. Tohoku J Exp Med 2007; 212:397-402.
  • Tuncer M, Gunes Y, Guntekin U, et al. Heart rate variability in patients with iron deficiency anemia. Arq Bras Cardiol 2009;92:368-71.
  • Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardio- graphic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 1994; 89:724–30.
  • Psaty BM, Manolio TA, Kuller LH, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997; 96:2455–61.
  • Guntekin U, Gunes Y, Tuncer M, Gunes A, Sahin M, Simsek H. Long-term Follow-up of P-wave Duration and Dispersion in Patients with Mitral Stenosis. PACE 2008;31:1620–4.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ: Ef- fects of autonomic stimulation and blockade on signal-av- eraged P wave duration. J Am Cofl Cardiol 1995;26:497- 502.
There are 35 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Hakkı Şimşek This is me

Hasan Ali Gümrükçüoğlu This is me

Yüksel Kaya This is me

Musa Şahin This is me

Mustafa Tuncer This is me

Cengiz Demir This is me

Yılmaz Güneş This is me

Publication Date September 1, 2010
Published in Issue Year 2010

Cite

APA Şimşek, H., Gümrükçüoğlu, H. A., Kaya, Y., Şahin, M., et al. (2010). Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri. Journal of Clinical and Experimental Investigations, 1(3), 187-194. https://doi.org/10.5799/ahinjs.01.2010.03.0039
AMA Şimşek H, Gümrükçüoğlu HA, Kaya Y, Şahin M, Tuncer M, Demir C, Güneş Y. Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri. J Clin Exp Invest. September 2010;1(3):187-194. doi:10.5799/ahinjs.01.2010.03.0039
Chicago Şimşek, Hakkı, Hasan Ali Gümrükçüoğlu, Yüksel Kaya, Musa Şahin, Mustafa Tuncer, Cengiz Demir, and Yılmaz Güneş. “Demir eksikliği Anemisi Ve Tedavisinin P Dalga süreleri Ve Diyastolik Fonksiyon Parametreleri üzerine Etkileri”. Journal of Clinical and Experimental Investigations 1, no. 3 (September 2010): 187-94. https://doi.org/10.5799/ahinjs.01.2010.03.0039.
EndNote Şimşek H, Gümrükçüoğlu HA, Kaya Y, Şahin M, Tuncer M, Demir C, Güneş Y (September 1, 2010) Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri. Journal of Clinical and Experimental Investigations 1 3 187–194.
IEEE H. Şimşek, H. A. Gümrükçüoğlu, Y. Kaya, M. Şahin, M. Tuncer, C. Demir, and Y. Güneş, “Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri”, J Clin Exp Invest, vol. 1, no. 3, pp. 187–194, 2010, doi: 10.5799/ahinjs.01.2010.03.0039.
ISNAD Şimşek, Hakkı et al. “Demir eksikliği Anemisi Ve Tedavisinin P Dalga süreleri Ve Diyastolik Fonksiyon Parametreleri üzerine Etkileri”. Journal of Clinical and Experimental Investigations 1/3 (September 2010), 187-194. https://doi.org/10.5799/ahinjs.01.2010.03.0039.
JAMA Şimşek H, Gümrükçüoğlu HA, Kaya Y, Şahin M, Tuncer M, Demir C, Güneş Y. Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri. J Clin Exp Invest. 2010;1:187–194.
MLA Şimşek, Hakkı et al. “Demir eksikliği Anemisi Ve Tedavisinin P Dalga süreleri Ve Diyastolik Fonksiyon Parametreleri üzerine Etkileri”. Journal of Clinical and Experimental Investigations, vol. 1, no. 3, 2010, pp. 187-94, doi:10.5799/ahinjs.01.2010.03.0039.
Vancouver Şimşek H, Gümrükçüoğlu HA, Kaya Y, Şahin M, Tuncer M, Demir C, Güneş Y. Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri. J Clin Exp Invest. 2010;1(3):187-94.