Effect of anti-TNFα treatment on Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis: A case-control study

Abstract

Aim: Ankylosing spondylitis (AS) is an axial spondyloarthropathy with multisystemic involvement. Anti-TNFα agents play a significant role in treatment options of this disease. In the literature, there is contradictory data about the effects of AS disease and anti-TNFα therapy on ventricular repolarization parameters. In this present study, we examined whether electrocardiographic parameters which reflect ventricular repolarization like QT, QTc, Tp-e, Tp-e/QT and Tp-e/QTc are different in AS patients than the control group and the effect of anti-TNFα agents on these parameters.
Methods: Sixty patients diagnosed with AS (33 patients treated with anti-TNFα, 27 patients treated with non-anti-TNFα) and 60 healthy subjects were included in the study. Demographic, biochemical, electrocardiographic, and echocardiographic parameters of the study and control groups were compared. Tp-e interval was measured as the time interval between the T wave’s peak point and down slope tangent intersecting with the isoelectric line.
Results: Heart rate, QT, QTc, and QRS were similar in both groups (P=0.232, P=0.660, P=0.220, and P=0.846, respectively); Tp-e (P=0.013), Tp-e/QT (P=0.006), and Tp-e/QTc (P=0.041) values were higher in the study group. Comparison analysis performed between groups treated with anti-TNFα and non-anti-TNFα showed no statistically significant difference in terms of heart rate, QT, QTc, QRS, Tp-e, Tpe/QT, and Tp-e/QTc values (P=0.916, P=0.655, P=0.335, P=0.999, P=0.731, P=0.848, and P=0.901, respectively).
Conclusion: Although QT and QTc values were similar between AS patients and the control group, Tp-e, Tp-e/QT, and Tp-e/QTc values were higher in AS patients. Additionally, anti-TNFα treatment had a neutral effect on these parameters.

Keywords

• Ankylosing spondylitis,T peak-to-end,Tp-e/QT,Anti-TNFα treatment

Ankilozan spondilit hastalarında anti-TNFα tedavinin Tp-e mesafesi ve Tp-e/QT oranı üzerine etkisi: Bir vaka-kontrol çalışması

Öz

Amaç: Ankilozan spondilit (AS) multisistemik tutulumla seyredebilen bir aksiyal spondiloartropatidir. Anti-TNFα ajanlar bu hastalığın tedavisinde önemli bir rol oynarlar. Literatürde AS hastalığı ve anti-TNFα tedavinin ventriküler repolarizasyon parametreleri üzerine etkileri hakkında çelişkili veriler mevcuttur. Sunulan bu çalışmada, QT, QTc, Tp-e, Tp-e/QT ve Tp-e/QTc gibi ventriküler repolarizasyonu gösteren elektrokardiyografik parametrelerin AS hastalarında, kontrol grubuna göre farklı olup olmadığını ve anti-TNFα ajanların bu parametreler üzerinde etkili olup olmadığını araştırdık.
Yöntemler: AS tanılı 60 hasta (anti-TNFα ile tedavi edilen 33 hasta, non-anti-TNFα ile tedai edilen 27 hasta) ve 60 sağlıklı gönüllü çalışmaya dahil edildi. Çalışma ve kontrol grubunun demografik, biyokimyasal, elektrokardiyografik ve ekokardiyografik parametreleri karşılaştırıldı. Tp-e aralığı, T dalgasının tepe noktası ile izoelektrik çizgiyle kesişen aşağı eğim teğeti arasındaki zaman aralığı olarak ölçüldü.
Bulgular: Kalp hızı, QT, QTc ve QRS her iki grupta benzer iken (P=0,232, P=0,660, P=0,220 ve P=0,846, sırasıyla); Tp-e (P=0,013), Tp-e/QT (P=0,006) ve Tp-e/QTc (P=0,041) değerleri çalışma grubunda istatistiksel anlamlı olarak daha yüksekti. Anti-TNFα ajanlar ile tedavi edilen ve non-anti-TNFα ajanlar ile tedavi edilen gruplar arasında karşılaştırma analizi yapıldığında ise, kalp hızı, QT, QTc, QRS, Tp-e, Tp-e/QT ve Tp-e/QTc değerlerinde istatistiksel anlamlı farklılık izlenmedi (P=0,916, P=0,655, P=0,335, P=0,999, P=0,731, P=0,848 ve P=0,901, sırasıyla).
Sonuç: QT ve QTc değerleri AS hastaları ile kontrol grubu arasında benzer iken; Tp-e, Tp-e/QT ve Tp-e/QTc değerleri çalışma grubunda daha yüksek idi. Ek olarak, anti-TNFα ajanlar bu parametreler üzerine nötral etkiliydi.

Anahtar Kelimeler

• Ankilozan spondilit,Tp-e,Tp-e/QT,Anti-TNFα tedavi

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