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P Wave and QT Dispersion in Patients with Generalized Anxiety Disorder

Year 2013, Volume: 16 Issue: 3, 214 - 219, 01.03.2012
https://doi.org/10.5578/kkd.6072

Abstract

Introduction: The aim of this study is to investigate P wave dispersion (Pd) and QT dispersion (QTd), non-invasive predictors of atrial fi brillation and ventricular arrhythmia or sudden cardiac death, respectively, in patients with generalized anxiety disorder (GAD). Patients and Methods: A total of 40 outpatients diagnosed as GAD and 29 healthy control subjects were included in the study. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were administered and 12-lead ECG measurements were obtained. Pd and QTd measurements were performed by blinded cardiologists. Results: BAI scores (26.6 ± 11.8 vs. 3.4 ± 3.3, p< 0.001) and BDI scores (12.6 ± 4 vs. 3.7 ± 4.5, p< 0.001) were signifi cantly higher in the patient group compared to the controls. P wave dispersion (Pd) [50.0 ± 17.5 miliseconds (ms) vs. 23.4 ± 7.7 ms, p< 0.001] and mean QT dispersion (QTd) (50.5 ± 18.1 ms vs. 28.3 ± 11.4 ms, p< 0.001) signifi cantly increased in the GAD patient group compared to the controls. Conclusion: Increase in Pd may suggest that GAD patients have increased risk of atrial fi brillation. Similarly, increased QTd may show that these patients have a higher risk of ventricular arrhythmia.

References

  • Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society Depress Anxiety 2002;16:162-71.
  • Hayward C. Psychiatric illness and cardiovascular disease risk. Epidemiol Rev 1995;17:129-38.
  • Tully PJ, Cosh SM. Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: a meta analysis. J Health Psychol 2013;18:1601-16.
  • Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM- IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593-602.
  • Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annu Rev Public Health 2008;29:115-29.
  • 6 Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Preva- lence of anxiety disorders in men and women with established cor- onary heart disease. J Cardiopulm Rehabil Prev 2007;27:86-91.
  • American Psychiatric Association. Diagnostic and Statistical Man- ual of Mental Disorders. 4thed. Washington, DC: Am Psychiatr Press, 1994.
  • Frasure-Smith N, Lespérance F. Depression and anxiety as pre- dictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 2008;65:62-71.
  • Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 1994;90:2225-9.
  • Gur M, Yilmaz R, Demirbag R, Akyol S, Altiparmak H. Relation between P-wave dispersion and left ventricular geometric pat- terns in newly diagnosed essential hypertension. J Electrocardiol 2008;41:54.1-6. Epub 2006 Oct 5.
  • Yavuzkir M, Atmaca M, Dagli N, Balin M, Karaca I, Mermi O, et al. P wave dispersion in panic disorder Psychosom Med 2007;69: 344-7.
  • Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fi brillation. Pacing Clin Electrophysiol 2000; 23:1109-12.
  • Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopou- los GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fi brillation. Am Heart J 1998;135:733-8.
  • Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fi bril- lation. Med Clin North Am 2008;92:17-40.
  • Day CP, Mc Comb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4.
  • Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT disper- sion and sudden unexpected death in chronic heart failure. Lancet 1994;343:327-9.
  • Nahshoni E, Gur S, Marom S, Levin JB, Weizman A, Hermesh H. QT dispersion in patients with social phobia. J Affect Disord 2004;78:21-6.
  • Çorapçıoğlu A, Aydemir Ö, Yıldız M ve ark. DSM-IV Eksen I Bozuklukları (SCID-I) İçin Yapılandırılmış Klinik Görüşme. Hekim- ler Yayın Birliği, Ankara: Klinik Versiyon; 1999.
  • Beck AT, Epstein N, Brown G, Steer RA. An Inventory for measur- ing clinical anxiety: psychometric properties. J Consul Clin Psychol 1988;56:893-7.
  • Ulusoy M, Şahin N, Erkman H. Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cognitive Psychotherapy Int Quaterly 1998;12:28-35.
  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inven- tory for measuring depression. Arch Gen Psychiatry 1961;4:561- 71.
  • Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji Derg 1989;7:3-13.
  • Fan AZ, Strine TW, Jiles R, Mokdad AH. Depression and anxiety associated with cardiovascular disease among persons aged 45 years and older in 38 states of the United States, 2006. Prev Med 2008;46:445-50.
  • Morrison V, Pollard B, Johnston M, MacWalter R. Anxiety and de- pression 3 years following stroke: demographic, clinical, and psy- chological predictors. J Psychosom Res 2005;59:209-13.
  • Peacock J, Whang W. Psychological distress and arrhythmia: risk prediction and potential modifi ers. Prog Cardiovasc Dis 2013;55:582-9. doi: 10.1016/j.pcad.2013.03.001. Epub 2013 Apr 6.
  • Dogan SM, Buyukates M, Kandemir O, Aydin M, Gursurer M, Acik- goz S,et al. Predictors of atrial fi brillation after coronary artery by- pass surgery. Coron Artery Dis 2007;18:327-31.
  • Ucar HI, Atalar E, Oc M, Akbulut B, Oc B, Dogan OF, et al. The role of surface ECG and transthoracic echocardiography for pre- dicting postoperative atrial fi brillation after coronary artery bypass surgery. Saudi Med J 2008;29:352-6.
  • Uyarel H, Kasikcioglu H, Dayi SU, Tartan Z, Karabulut A, Uzunlar B, et al. Anxiety and P wave dispersion in a healthy young popula- tion. Cardiology 2005;104:162-8.
  • Can I, Aytemir K, Demir AU, Deniz A, Ciftci O, Tokgozoglu L, et al. P-wave duration and dispersion in patients with obstructive sleep apnea. Int J Cardiol 2009;133:e85-9.
  • Sari I, Davutoglu V, Ozbala B, Ozer O, Baltaci Y, Yavuz S, et al. Acute sleep deprivation is associated with increased electrocar- diographic P-wave dispersion in healthy young men and women. Pacing Clin Electrophysiol 2008;31:438-42.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P-wave duration. J Am Coll Cardiol 1995;26:497-502.
  • Hansson A, Madsen-Härdig B, Olsson SB. Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fi brillation: a study based on interviews with 100 patients seeking hospital as- sistance. BMC Cardiovasc Disord 2004;3;4:13.
  • Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB, Sr. Ben- jamin EJ. Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fi brillation, and to- tal mortality: the Framingham Offspring Study. Psychosom Med 2005;67:692-6.
  • Piccirillo G, Viola E, Bucca C, Santagada E, Raganato P, Tondo A, et al. QT interval dispersion and autonomic modulation in subjects with anxiety. J Lab Clin Med 1999;133:461-8.
  • Uyarel H, Okmen E, Cobanoglu N, Karabulut A, Cam N. Effects of anxiety on QT dispersion in healthy young men. Acta Cardiol 2006;61:83-7.
  • Piccirillo G, Viola E, Nocco M, Santaqada E, Durante M, Bucca C, et al. Autonomic modulation and QT interval dispersion in hyper- tensive subjects with anxiety. Hypertension 1999;34:242-6.
  • Takimoto Y, Yoshiuchi K, Akabayashi A. Effect of mood states on QT interval and QT dispersion in eating disorder patients. Psychia- try Clin Neurosci 2008;62:185-9.
  • Nahshoni E, Aizenberg D, Strasberg B, Dorfman P, Sigler M, Imbar S, et al. QT dispersion in the surface electrocardiogram in elderly patients with major depression. J Affect Disord 2000;60:197-200.

Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu

Year 2013, Volume: 16 Issue: 3, 214 - 219, 01.03.2012
https://doi.org/10.5578/kkd.6072

Abstract

Giriş: Çalışmamızın amacı; yaygın anksiyete bozukluğu (YAB) olan hastalarda, ventriküler aritmi ve ani kardiyak ölümün noninvaziv belirleyicisi olan QT dispersiyonu ile atriyal aritminin noninvaziv belirleyicisi olan P dispersiyonunu araştırmaktır. Hastalar ve Metod: Ayaktan 40 YAB olan hasta ve 29 sağlıklı kontrol çalışmaya dahil edildi, Beck Anksiyete Envanteri (BAE) ve Beck Depresyon Envanteri (BDE) uygulandı ve 12 derivasyonlu EKG ölçümleri elde edildi. Pd ve QTd ölçümleri tek kör kardiyolog tarafından yapıldı. Bulgular: BAE puanları (26.6 ± 11.8 vs. 3.4 ± 3.3, p< 0.001) ve BDE puanları (12.6 ± 4 vs 3.7 ± 4.5, p< 0.001) kontrol grubuna göre hasta grubunda anlamlı olarak daha yüksekti. P dispersiyonu (Pd) [50.0 ± 17.5 milisaniye (ms) vs. 23.4 ± 7.7 ms, p< 0.001] ve ortalama QT dispersiyonu (QTd) (50.5 ± 18.1 msn vs. 28.3 ± 11.4 msn, p< 0.001)'nda kontrol grubuna göre hasta grubunda anlamlı olarak daha yüksekti. Sonuç: Pd ve QTd belirgin olarak YAB hastalarında artmıştır. Bu sonuçlar, YAB olan hastalarda artmış Pd'nin atriyal aritmi riskini artırabileceğini, artmış QTd'nin ise ventriküler aritminin artmış riskini düşündürmektedir

References

  • Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society Depress Anxiety 2002;16:162-71.
  • Hayward C. Psychiatric illness and cardiovascular disease risk. Epidemiol Rev 1995;17:129-38.
  • Tully PJ, Cosh SM. Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: a meta analysis. J Health Psychol 2013;18:1601-16.
  • Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM- IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593-602.
  • Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annu Rev Public Health 2008;29:115-29.
  • 6 Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Preva- lence of anxiety disorders in men and women with established cor- onary heart disease. J Cardiopulm Rehabil Prev 2007;27:86-91.
  • American Psychiatric Association. Diagnostic and Statistical Man- ual of Mental Disorders. 4thed. Washington, DC: Am Psychiatr Press, 1994.
  • Frasure-Smith N, Lespérance F. Depression and anxiety as pre- dictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 2008;65:62-71.
  • Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 1994;90:2225-9.
  • Gur M, Yilmaz R, Demirbag R, Akyol S, Altiparmak H. Relation between P-wave dispersion and left ventricular geometric pat- terns in newly diagnosed essential hypertension. J Electrocardiol 2008;41:54.1-6. Epub 2006 Oct 5.
  • Yavuzkir M, Atmaca M, Dagli N, Balin M, Karaca I, Mermi O, et al. P wave dispersion in panic disorder Psychosom Med 2007;69: 344-7.
  • Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fi brillation. Pacing Clin Electrophysiol 2000; 23:1109-12.
  • Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopou- los GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fi brillation. Am Heart J 1998;135:733-8.
  • Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fi bril- lation. Med Clin North Am 2008;92:17-40.
  • Day CP, Mc Comb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4.
  • Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT disper- sion and sudden unexpected death in chronic heart failure. Lancet 1994;343:327-9.
  • Nahshoni E, Gur S, Marom S, Levin JB, Weizman A, Hermesh H. QT dispersion in patients with social phobia. J Affect Disord 2004;78:21-6.
  • Çorapçıoğlu A, Aydemir Ö, Yıldız M ve ark. DSM-IV Eksen I Bozuklukları (SCID-I) İçin Yapılandırılmış Klinik Görüşme. Hekim- ler Yayın Birliği, Ankara: Klinik Versiyon; 1999.
  • Beck AT, Epstein N, Brown G, Steer RA. An Inventory for measur- ing clinical anxiety: psychometric properties. J Consul Clin Psychol 1988;56:893-7.
  • Ulusoy M, Şahin N, Erkman H. Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cognitive Psychotherapy Int Quaterly 1998;12:28-35.
  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inven- tory for measuring depression. Arch Gen Psychiatry 1961;4:561- 71.
  • Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji Derg 1989;7:3-13.
  • Fan AZ, Strine TW, Jiles R, Mokdad AH. Depression and anxiety associated with cardiovascular disease among persons aged 45 years and older in 38 states of the United States, 2006. Prev Med 2008;46:445-50.
  • Morrison V, Pollard B, Johnston M, MacWalter R. Anxiety and de- pression 3 years following stroke: demographic, clinical, and psy- chological predictors. J Psychosom Res 2005;59:209-13.
  • Peacock J, Whang W. Psychological distress and arrhythmia: risk prediction and potential modifi ers. Prog Cardiovasc Dis 2013;55:582-9. doi: 10.1016/j.pcad.2013.03.001. Epub 2013 Apr 6.
  • Dogan SM, Buyukates M, Kandemir O, Aydin M, Gursurer M, Acik- goz S,et al. Predictors of atrial fi brillation after coronary artery by- pass surgery. Coron Artery Dis 2007;18:327-31.
  • Ucar HI, Atalar E, Oc M, Akbulut B, Oc B, Dogan OF, et al. The role of surface ECG and transthoracic echocardiography for pre- dicting postoperative atrial fi brillation after coronary artery bypass surgery. Saudi Med J 2008;29:352-6.
  • Uyarel H, Kasikcioglu H, Dayi SU, Tartan Z, Karabulut A, Uzunlar B, et al. Anxiety and P wave dispersion in a healthy young popula- tion. Cardiology 2005;104:162-8.
  • Can I, Aytemir K, Demir AU, Deniz A, Ciftci O, Tokgozoglu L, et al. P-wave duration and dispersion in patients with obstructive sleep apnea. Int J Cardiol 2009;133:e85-9.
  • Sari I, Davutoglu V, Ozbala B, Ozer O, Baltaci Y, Yavuz S, et al. Acute sleep deprivation is associated with increased electrocar- diographic P-wave dispersion in healthy young men and women. Pacing Clin Electrophysiol 2008;31:438-42.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P-wave duration. J Am Coll Cardiol 1995;26:497-502.
  • Hansson A, Madsen-Härdig B, Olsson SB. Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fi brillation: a study based on interviews with 100 patients seeking hospital as- sistance. BMC Cardiovasc Disord 2004;3;4:13.
  • Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB, Sr. Ben- jamin EJ. Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fi brillation, and to- tal mortality: the Framingham Offspring Study. Psychosom Med 2005;67:692-6.
  • Piccirillo G, Viola E, Bucca C, Santagada E, Raganato P, Tondo A, et al. QT interval dispersion and autonomic modulation in subjects with anxiety. J Lab Clin Med 1999;133:461-8.
  • Uyarel H, Okmen E, Cobanoglu N, Karabulut A, Cam N. Effects of anxiety on QT dispersion in healthy young men. Acta Cardiol 2006;61:83-7.
  • Piccirillo G, Viola E, Nocco M, Santaqada E, Durante M, Bucca C, et al. Autonomic modulation and QT interval dispersion in hyper- tensive subjects with anxiety. Hypertension 1999;34:242-6.
  • Takimoto Y, Yoshiuchi K, Akabayashi A. Effect of mood states on QT interval and QT dispersion in eating disorder patients. Psychia- try Clin Neurosci 2008;62:185-9.
  • Nahshoni E, Aizenberg D, Strasberg B, Dorfman P, Sigler M, Imbar S, et al. QT dispersion in the surface electrocardiogram in elderly patients with major depression. J Affect Disord 2000;60:197-200.
There are 38 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Cüneyt Cüneyt This is me

Okan Kemal Kaplan This is me

Melek Zeynep Soner Saygın This is me

Bülent Uzunlar This is me

Hüseyin Uyarel This is me

Mecit Çalışkan This is me

Publication Date March 1, 2012
Published in Issue Year 2013 Volume: 16 Issue: 3

Cite

APA Cüneyt, C. ., Kaplan, O. K. ., Saygın, M. Z. S. ., Uzunlar, B. ., et al. (2012). Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu. Koşuyolu Kalp Dergisi, 16(3), 214-219. https://doi.org/10.5578/kkd.6072
AMA Cüneyt C, Kaplan OK, Saygın MZS, Uzunlar B, Uyarel H, Çalışkan M. Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu. Koşuyolu Kalp Dergisi. March 2012;16(3):214-219. doi:10.5578/kkd.6072
Chicago Cüneyt, Cüneyt, Okan Kemal Kaplan, Melek Zeynep Soner Saygın, Bülent Uzunlar, Hüseyin Uyarel, and Mecit Çalışkan. “Yaygın Anksiyete Bozukluğu Olan Hastalarda P Ve QT Dispersiyonu”. Koşuyolu Kalp Dergisi 16, no. 3 (March 2012): 214-19. https://doi.org/10.5578/kkd.6072.
EndNote Cüneyt C, Kaplan OK, Saygın MZS, Uzunlar B, Uyarel H, Çalışkan M (March 1, 2012) Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu. Koşuyolu Kalp Dergisi 16 3 214–219.
IEEE C. . Cüneyt, O. K. . Kaplan, M. Z. S. . Saygın, B. . Uzunlar, H. . Uyarel, and M. . Çalışkan, “Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu”, Koşuyolu Kalp Dergisi, vol. 16, no. 3, pp. 214–219, 2012, doi: 10.5578/kkd.6072.
ISNAD Cüneyt, Cüneyt et al. “Yaygın Anksiyete Bozukluğu Olan Hastalarda P Ve QT Dispersiyonu”. Koşuyolu Kalp Dergisi 16/3 (March 2012), 214-219. https://doi.org/10.5578/kkd.6072.
JAMA Cüneyt C, Kaplan OK, Saygın MZS, Uzunlar B, Uyarel H, Çalışkan M. Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu. Koşuyolu Kalp Dergisi. 2012;16:214–219.
MLA Cüneyt, Cüneyt et al. “Yaygın Anksiyete Bozukluğu Olan Hastalarda P Ve QT Dispersiyonu”. Koşuyolu Kalp Dergisi, vol. 16, no. 3, 2012, pp. 214-9, doi:10.5578/kkd.6072.
Vancouver Cüneyt C, Kaplan OK, Saygın MZS, Uzunlar B, Uyarel H, Çalışkan M. Yaygın Anksiyete Bozukluğu Olan Hastalarda P ve QT Dispersiyonu. Koşuyolu Kalp Dergisi. 2012;16(3):214-9.