Effect of Surgical Revascularization on QT Dispersion Time in Patients Who Do Not Have Necrotic/Fibrotic Myocardium in Transthoracic Echocardiography

Abstract

Introduction: Prolonged QT dispersion time is known to be associated with cardiac arrhythmias and sudden cardiac death. It was proved previously that electrical heterogenity caused by myocardial ischemia, hypertrophic cardiomyopathy, electrolyte imbalance, heart failure prolongs QT dispersion time. The aim of this study was to investigate the effect of surgical revascularization on QT dispersion time in ischemic patients not having necrotic/fi brotic segments in transthoracic echocardiography. Patients and Methods: Data of patients treated with surgical revascularization due to coronary artery disease are evaluated retrospectively. 247 patients were enrolled into the study after application of exclusion criteria. Patients' electrocardiographic records were evaluated and values of preoperative (QTcd0), postoperative fi rst (QTcd1), postoperative third (QTcd3) and postoperative seventh (QTcd7) day corrected QT dispersion time calculated and compared with each other. Results: There were statistically signifi cant differences between QTcd0 (83.6 ± 2.2) and QTcd1 (55.3 ± 1.7), QTcd3 (50.4 ± 1.2) and QTcd7 (45.3 ± 1.1) (p< 0.001, p< 0.001, p< 0.001 respectively). There was also statistically signifi cant difference between QTcd1 (55.3 ± 1.7) and QTcd7 (45.3 ± 1.1) (p< 0.001), and also between QTcd3 (50.4 ± 1.2) and QTcd7 (45.3 ± 1.1) (p< 0.001). There was no signifi cant difference between QTcd1 (55.3 ± 1.7) and QTcd3 (50.4 ± 1.2) (p= 0.078). Conclusion: Surgical revascularization of non-necrotic/non-fi brotic ischemic myocardium causes statistically signifi cant decrease in QT dispersion time from the postoperative fi rst day.

Keywords

• Ischemia, myocardial revascularization; necrosis; myocardium; echocardiography

Transtorasik Ekokardiyografi de Nekrotik/ Fibrotik Miyokart İçermeyen Hastalarda Cerrahi Revaskülarizasyonun QT Dispersiyon Süresi Üzerine Etkisi

Abstract

Giriş: QT dispersiyon süresindeki uzamanın kardiyak aritmiler ve ani kardiyak ölümle ilişkili olduğu bilinmektedir. Miyokardiyal iskemi, hipertrofi k kardiyomiyopati, elektrolit dengesizlikleri, kalp yetersizliği gibi durumların sebep olduğu elektriksel heterojenite QT dispersiyon süresini uzatır. Çalışmanın amacı, transtorasik ekokardiyografi de nekrotik doku içermeyen iskemik miyokardda cerrahi revaskülarizasyonun QT dispersiyon süresi üzerine etkisini incelemektir. Hastalar ve Yöntem: Koroner arter hastalığı nedeniyle cerrahi revaskülarizasyon yapılan hastalar retrospektif olarak tarandı. Dışlama kriterleri uygulandıktan sonra 247 hasta çalışmaya dahil edildi. Hastaların elektrokardiyografi leri incelendi. Preoperatif (QTcd0), postoperatif birinci (QTcd1), postoperatif üçüncü (QTcd3) ve postoperatif yedinci (QTcd7) gün düzeltilmiş QT dispersiyon süreleri hesaplandı ve birbirleriyle karşılaştırıldı. Bulgular: QTcd0 (83.6 ± 2.2) ile QTcd1 (55.3 ± 1.7), QTcd3 (50.4 ± 1.2) ve QTcd7 (45.3 ± 1.1) arasında istatistiksel olarak anlamlı fark vardı (sırasıyla p< 0.001, p< 0.001, p< 0.001). QTcd1 (55.3 ± 1.7) ile QTcd7 (45.3 ± 1.1), QTcd3 (50.4 ± 1.2) ile QTcd7 (45.3 ± 1.1) arasında da istatistiksel olarak anlamlı fark mevcuttu (p< 0.001). QTcd1 (55.3 ± 1.7) ile QTcd3 (50.4 ± 1.2) arasında ise istatistiksel olarak anlamlı fark yoktu (p= 0.078). Sonuç: Nekrotik/fi brotik doku içermeyen iskemik miyokardın cerrahi olarak revaskülarizasyonu postoperatif birinci günden itibaren QT dispersiyon süresinde anlamlı kısalmaya neden olmaktadır.

Keywords

• Iskemi; miyokardiyal revaskülarizasyon; nekroz; kalp kası; ekokardiyografi

References

1. Berul CI, Sweeten TL, Dubin AM, Shah MJ, Vetter VL. Use of the n rate corrected JT interval for prediction of repolarization abnorma- lities in children. Am J Cardiol 1994;74:1254-7.
2. Amhroggi LD, Negroni MS, Monza E, Bertoni T Schwarz PJ. Dis- persion of ventricular repolarization in the long QT syndrome. Am J Cardiol 1991;68:614-20.
3. Hingham PD, Campell RWF. QT dispertion: a review. Br J Anaesth 1994;71:508-10.
4. Barr C, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersi- on and sudden un expected death in chronic heart failure. Lancet 1994;343:327-9.
5. Gur M, Yılmaz R, Demirbag R, Yıldız A, Akyol S. Relationship bet- ween the elastic properties of aorta and QT dispersion in newly diagnosed arterial adult hypertensives. Anadolu Kardiyol Derg 2007;7:275-80.
6. Glancy JM, Garrat CJ, Woods KL, de Bono DP. QT dispersion and mortality after myocardial infarction. Lancet 1995;345:945-8.
7. Schneider CA, Voth E, Baer FM, Horst M, Wagner R, Sechtum U. QT dispersion is determined by the extend of viable myocardium in patients with chronic Q-wave myocardial infarction. Circulation 1997;96:3913-20.
8. Atak R, Turhan H, Sezgin AT, Yetkin O, Senen K, İleri M, et al. Effects of slow coronary artery fl ow on QT interval duration and dispersion. Ann Noninvasive Electrocardiol 2003;8:107-11.

9. Carella MJ, Mantz SL, Rovner DR, Willis PW 3rd, Gossain VV, Bouknight RR, et al. Obesity, adiposity, and lengthening of the QT interval: improvement after weight loss. Int J Obes Relat Metab Disord 1996;20:938-42.
10. Monshizadeh E, Arefi H, Moqhadam M, Hassanijirdehi M. QT dis- persion before and after coronary artery angioplasty: a case study from Iran. Ann Cardiol Angeiol (Paris) 2011 Aug 17 (Epub ahead of print).
11. Bilen E, Yasar AS, Bilge M, Yuksel IO, Aslantas U, Kurt M, et al. Ef- fect of primary percutaneous coronary intervention on myocardial repolarization. J Cardiovasc. Med (Hagerstown) 2011;12:795-9.
12. Ilkay E, Yavuzkır M, Karaca I, Akbulut M, Pekdemir M, Aslan N. The effect of ST resolution on QT dispersion after interventional treat- ment in acute myocardial infarction. Clin Cardiol 2004;27:159-62.
13. Tıkız H, Terzi T, Balbay Y, Demir AD, Soylu M, Keleş T, et al. QT dispersion in single coronary artery disease: is there a relation between QT dispersion and diseased coronary artery or lesion lo- calization? Angiology 2001;52:43-51.
14. Bazett HC. An analysis of the time relation of electrocardiogram 1920;7:353.
15. Higham PD, Furniss SS, Campbell RWF. QT dispersion and com- ponents of the QT interval in ischemia and infarction. Br Heart J 1995;73:32-6.
16. Giedrimiene D, Giri S, Giedrimas A, Kiernan F, Kluger J. Effects of ischemia on repolarization in patients with single and multivessel coronary disease. Pacing Clin Electrophysiol 2003;26:390-3.
17. Kelly RF, Parillo JF, Hollenberg SM. Effect of coronary angioplasty on QT dispersion. Am Heart J 1997;134:399-405.
18. Pan KL, Hsu JT, Chang ST, Chung CM, Chen MC. Prognostic va- lue of QT dispersion change following primary percutaneous co- ronary intervention in acute ST elevation myocardial infarction. Int Heart J 2011;52:207-11.
19. Mehta NJ, Khan IA, Mehta RN, Burgonio B, Lakhanpal G. Effect of thrombolytic therapy on QT dispersion in elderly versus younger patients with acute myocardial infarction. Am J Ther 2003;10:7-11.
20. Moreno FL, Villanueva T, Karagounis LA, Anderson JL. Reducti- on in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators. Circula- tion 1994; 90: 94-100.
21. Gulcan O, Sezgin AT, Demircan S, Atalay H, Turkoz R. Effect of coronary artery bypass grafting and aneurysmectomy on QT dis- persion in moderate or severe left ventricular dysfunction. Am He- art J 2005;149:917-20.
22. Kosar F, Nisanoglu V, Aksoy Y, Colak C, Erdil N, Battaloglu B. Effects of coronary revascularization and concomitant aneury- smectomy on QT interval duration and dispersion. J Electrocardiol 2006;39:194-8.
23. Takase B, Masaki N, Hattori H, Ishihara M, Kurita A. Usefulness of automatic QT dispersion measurement for detecting exercise-indu- ced myocardial ischemia. Anadolu Kardiyol Derg 2009;9:189-95.
24. Ilkay E, Yavuzkır M, Karaca I, Akbulut M, Pekdemir M, Aslan N. The effect of ST resolution on QT dispersion after interventional treat- ment in acute myocardial infarction. Clin Cardiol 2004;27:159-62.