Atrial Conduction Time in Patients with Pseudoexfoliation Syndrome

Öz

Pseudoexfoliation syndrome (PEX) is a systemic disorder characterized by the accumulation of an abnormal fibrillar material in various ocular and extraocular tissues. Significant associations between PEX and cardiovascular, and cerebrovascular diseases were found. There is some evidence suggesting an increased risk of cardiac arrhythmias including atrial fibrillation (AF) in patients with PEX. Impaired atrial electromechanical function plays a significant role in the development of AF. This study aims to evaluate atrial electromechanical delay (EMD) times in patients with PEX. Thirty-four PEX patients and 29 age-matched and sex-matched healthy controls who had no PEX material were included. Fasting blood samples were taken, transthoracic echocardiography and tissue Doppler imaging were performed to determine atrial EMD times. The S-wave velocity at the septal annulus, the S-wave velocity at the lateral annulus, and the isovolumetric contraction velocity at the lateral annulus were lower in patients with PEX than in controls (p=0.010, 0.025 and 0.014, respectively). Tissue Doppler imaging measurements showed that the atrial electromechanical coupling time (PA) lateral, PA septal, and PA tricuspid were higher in patients with PEX than in controls (p<0.001, 0.010 and 0.046, respectively). Interatrial EMD [39.00 ms (28.00-44.00) vs 28.00 ms (23.50-33.00), p=0.001] and intra-left atrial EMD [17.00 ms (15.00-23.25) vs 11.00 ms (10.00-17.50), p=0.003] were higher in patients with PEX.  Pseudoexfoliation syndrome is associated with prolonged atrial EMD times. In addition, myocardial systolic velocities are lower in patients with PEX.

Anahtar Kelimeler

• Pseudoexfoliation syndrome,atrial fibrillation,atrial electromechanical delay

Psödoeksfoliasyon Sendromlu Hastalarda Atriyal İleti Zamanı

Öz

Pseudoeksfoliasyon sendromu (PES) göz ve göz dışı pek çok dokuda anormal hücre dışı fibriler mataryelin birikimi ile karakterize sistemik bir hastalıktır. Pseudoeksfoliasyon sendromu ile kardiyovasküler ve serebrovasküler hastalıklar arasında ciddi ilişkiler bulunmuştur. Atriyal fibrilasyonun  (AF) da dahil olduğu kardiyak aritmi riskinin PES hastalarında arttığına dair bazı deliller mevcuttur. Bozulmuş atriyal elektromekanik fonksiyon AF gelişiminde önemli bir rol oynar. Bu çalışma PES hastalarında atriyal elektromekanik gecikme (EMG) sürelerinin değerlendirilmesini amaçlamaktadır. Otuz dört PES hastası ve PES materyeli olmayan 29 yaş ve cinsiyet uyumlu sağlıklı kontrol çalışmaya alındı. Açlık kan örnekleri alındı, transtorasik ekokardiyografi ve atriyal EMG sürelerini belirlemek için doku Doppler inceleme yapıldı. Septal anulusta S dalga hızı, lateral anulusta S dalga hızı, lateral anulusta izovolümetrik kasılma hızı PES olan grupta kontrol grubuna göre daha düşüktü (sırasıyla p=0.010, 0.025 ve 0.014). Doppler ekokardiyografi ölçümleri atriyal elektromekanik bağlama süresi (PA) lateral, septal ve trikuspit’in PES hastalarında kontrollerden daha fazla olduğunu gösterdi (sırasıyla p<0.001, 0.010 ve 0.046). İnteratriyal EMG [39.00 ms (28.00-44.00) vs 28.00 ms (23.50-33.00), p=0.001] ve intra-sol atriyal EMG [17.00 ms (15.00-23.25) vs 11.00 ms (10.00-17.50), p=0.003] PES hastalarında daha fazlaydı.Pseudoeksfoliasyon sendromu uzamış atriyal EMG süreleri ile ilişkilidir. Ayrıca miyokardiyal sistolik hızlar PES hastalarında daha düşüktür. 

Anahtar Kelimeler

• Pseudoeksfoliasyon sendromu,atriyal fibrilasyon,atriyal elektromekanik gecikme

Kaynakça

1. Referans 1. Ritch R, Schlotzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol 2001; 45: 265–315.
2. Referans 2. Wang W, He M, Zhou M, Zhang X. Ocular Pseudoexfoliation Syndrome and Vascular Disease: A Systematic Review and Meta-Analysis. PLoS One. 2014; 9: e92767.
3. Referans 3. Tarkkanen A. Is exfoliation syndrome a sign of systemic vascular disease? Acta Ophthalmol 2008; 86: 832–6.
4. Referans 4. Schumacher S, Schlötzer-Schrehardt U, Martus P, Lang W, Naumann GO. Pseudoexfoliation syndrome and aneurysms of the abdominal aorta. Lancet 2001; 357: 359-60.
5. Referans 5. Demir N, Ulus T, Yucel OE, Kumral ET, Singar E, Tanboga HI. Assessment of myocardial ischaemia using tissue Doppler imaging in pseudoexfoliation syndrome. Eye (Lond). 2011; 25: 1177-80.
6. Referans 6. Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with increased vascular risk. Am J Ophthalmol 1997; 124: 685-7.
7. Referans 7. Repo LP, Teräsvirta ME, Koivisto KJ. Generalized transluminance of the iris and the frequency of the pseudoexfoliation syndrome in the eyes of transient ischemic attack patients. Ophthalmology 1993; 100: 352-5.
8. Referans 8. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications forrhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA 2001; 285: 2370-5.

9. Referans 9. Brajkovic J, Kalauz-Surac I, Ercegovic A, Miletic-Juric A, Susic N, Buric Z. Ocular pseudoexfoliation syndrome and internal systemic diseases. Acta Clin Croat 2007; 46: 57-61.
10. Referans 10. Schlötzer-Schrehardt U, Koca MR, Naumann GO, Volkholz H. Pseudoexfoliation syndrome: ocular manifestation of a systemic disorder? Arch Ophthalmol. 1992; 110: 1752–6.
11. Referans 11. Aung T, Ozaki M, Mizoguchi T, Allingham RR, Li Z, Haripriya A, et al. A common variant mapping to CACNA1A is associated with susceptibility to exfoliation syndrome. Nat Genet. 2015; 47: 387-92.
12. Referans 12. Schlotzer-Schrehardt U, Kortje KH, Erb C. Energy-filtering transmission electron microscopy (EFTEM) in the elemental analysis of pseudoexfoliative material. Curr Eye Res. 2001; 22: 154–62.
13. Referans 13. Zenkel M, Lewczuk P, Junemann A, Kruse FE, Naumann GO, Schlötzer-Schrehardt U. Proinflammatory cytokines are involved in the initiation of the abnormal matrix process in pseudoexfoliation syndrome/glaucoma. Am J Pathol 2010; 176: 2868–79.
14. Referans 14. Zakrzewski PA, Mackenzie PJ, Tsai G, Warner SJ, Levin A, Mikelberg FS. Does an association exist between pseudoexfoliation syndrome and chronic kidney disease? J Glaucoma 2012; 21: 562–6.
15. Referans 15. Perzanowski C, Ho AT, Jacobson AK. Increased P-wave dispersion predicts recurrent atrial fibrillation after cardioversion. J Electrocardiol 2005; 38: 43–6.
16. Referans 16. Deniz A, Sahiner L, Aytemir K, Kaya B, Kabakci G, Tokgozoglu L, et al. Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time. Cardiol J 2012; 19: 487–93.
17. Referans 17. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al; American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004; 17: 1086-19.
18. Referans 18. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613–8.
19. Referans 19. Cui QQ, Zhang W, Wang H, Sun X, Wang R, Yang HY, et al. Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol 2008; 31: 74-8.
20. Referans 20. Yildirim N, Yasar E, Gursoy H, Colak E. Prevalence of pseudoexfoliation syndrome and its association with ocular and systemic diseases in Eskisehir, Turkey. Int J Ophthalmol 2017; 10: 128-34.
21. Referans 21. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, et al; Document Reviewers. EHRA/ HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18: 1455–90.
22. Referans 22. Cai BZ, Gong DM, Liu Y, Pan ZW, Xu CQ, Bai YL, et al. Homocysteine inhibits potassium channels in human atrial myocytes. Clin Exp Pharmacol Physiol 2007; 34: 851–5.
23. Referans 23. Cai B, Shan L, Gong D, Pan Z, Ai J, Xu C, et al. Homocysteine modulates sodium channel currents in human atrial myocytes. Toxicology 2009; 256: 201–6.