Is there a relationship between TP-e/QT ratio and cardiovascular events due to spinal anesthesia in pregnant women?

Year 2023, , 662 - 671, 01.10.2023

İlker Coşkun

https://doi.org/10.31362/patd.1346427

Abstract

Purpose: Prolonged TPe interval has been reported to reflect the abnormal distribution of ventricular repolarization which can be used as a marker of ventricular arrhythmias. Since prolonged TPe/QT ratio is associated with cardiac pathologies, it is thought that it may also be associated with cardiovascular adverse events that occur during and after spinal anesthesia. The aim of this study is to investigate whether there is a relationship between prolonged TPe/QT ratio, which is routine preoperative non-invasive patient data that can be evaluated easily, and perioperative adverse cardiovascular events during cesarean section in pregnant women undergoing spinal anesthesia.
Materials and methods: Voluntary consent was obtained for our study in which 144 pregnant women who were planned for elective cesarean section were included. QT interval was measured based on the initial point where the Q wave or the R wave in the absence of the Q wave started to the last point where the T wave ended. TPe interval measurement was based on the peak point of the T wave and the end point of the T wave convexity. Lead V5 was primarily used for TPe measurement. TPe/QT ratios were calculated in Microsoft office excel program. Patients' demographic characteristics, heart rate, systolic, diastolic and mean arterial pressures were recorded every five minutes intraoperatively.
Results: A weak positive correlation was found between the height variable and the Tpe/QT ratio (p=0.022, r=0.191). As the height increased, the TPe/QT ratio increased. Although it did not reach the level of statistical significance, we found that the TPe/QT ratio was longer in cases with intraoperative bradycardia and hypotension than in cases without complications. The TPe/QT ratio was above 0.21 in patients who developed bradycardia and hypotension. Examination of the correlation between the amount of ephedrine use and TPe/QT ratio revealed a weak positive correlation (p=0.012, r=0.208).
Conclusion: TPe/QT ratio is a novel cardiac marker with high predictive power, is non-invasive, quite inexpensive, and very practical to measure in the early detection of cardiac events, especially arrhythmia. This novel predictive marker can be used in anesthesia practice, preoperative examination and patient follow-up in the intraoperative operating room to predict fatal cardiac arrhythmias or intraoperative hypo/hypertension.

Keywords

Spinal anesthesia, pregnancy, TPe/QT ratio, cardiovascular event

Project Number

yok

Gebelerde TP-e / QT oranı ile spinal anesteziye bağlı gelişen kardiyovasküler olaylar arasında ilişki var mıdır?

Abstract

Amaç: Tp-e süresinin uzaması, ventriküler repolarizasyonun anormal dağılımını yansıttığı ve ventriküler aritmilerin belirteci olarak kullanılabileceği bildirilmiştir. Uzamış TP-e/QT oranının kardiyak patolojiler ile ilişkisinin olması nedeniyle spinal anestezi sırasında ve sonrasında meydana gelen kardiyovasküler istenmeyen olaylar ile de ilişkisinin olabileceği akla gelmektedir. Bu çalışmadaki amacımız; noninvazif ve kolay değerlendirilebilen rutin bir preoparatif bir hasta verisi olan uzamış TP-e/QT oranı ile spinal anestezi uygulanan gebelerde sezaryen sırasında perioperatif istenmeyen kardiyovasküler olaylar arasında bir ilişki olup olmadığını araştırmaktır.
Gereç ve yöntem: Çalışmamıza gönüllü onamı alınmış, 144 elektif sezaryen operasyonu planlanan gebe dahil edilmiştir. QT intervalinin ölçümü, Q dalgasının veya Q dalgası yokluğunda R dalgasının başladığı ilk nokta ile T dalgasının bittiği son nokta baz alınarak yapılmıştır. Tp-e süresi ölçümü için, T dalgasının en zirve noktası ile T dalga konveksitesinin bittiği son nokta baz alınmıştır. Tp-e ölçümü için öncelikle V5 derivasyonu kullanılmıştır. Tp-e/QT oranları Microsoft office excel programında hesaplanmıştır. Hastaların demografik özellikleri, intraoperatif dönemde her beş dakikada bir olmak üzere nabız, sistolik, diastolik ve ortalama arter basınç değerleri kaydedilmiştir.
Bulgular: Boy değişkeni ile Tpe/QT oranı arasında pozitif yönde zayıf düzey korelasyon tespit ettik (p=0,022, r=0,191). Boy arttıkça Tp-e/QT oranı artmaktaydı. İstatistiksel anlamlılık düzeyine ulaşmasa da intraoperatif bradikardi, hipotansiyon gelişen olgulardaki TPe/QT oranının, komplikasyon gelişmeyen olgulara göre daha uzun olduğunu tespit ettik. Bradikardi ve hipotansiyon gelişen olgularda TP-e/QT oranı 0,21‘in üzerinde idi. Efedrin kullanım miktarı TPe/QT oranı arasındaki korelasyon incelendiğinde yine pozitif yönde zayıf düzey korelasyon tespit ettik (p=0,012, r=0,208).
Sonuç: Tp-e/QT oranı en başta aritmi olmak üzere, kardiyak olayların erken tespitinde prediktivite gücü yüksek, non-invazif, oldukça ucuz, ölçüm yapılması oldukça pratik, yeni bir kardiyak markırdır. Bu yeni prediktif markır; anestezi pratiğinde, preoperatif muayenede ve intraoperatif ameliyathanede hasta takibinde, fatal kardiyak aritmileri ya da intraoperatif hipo/hipertansiyonu öngörmede kullanılabilir.

Keywords

Spinal anestezi, gebelik, TPe/QT oranı, kardiyovasküler olay

Supporting Institution

yok

Project Number

yok

Thanks

yok

References

• 1. Ekinci M, Alici HA, Ahiskalioglu A, et al. The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks. J Clin Anesth 2017;37:82-85. https://doi.org/10.1016/j.jclinane.2016.10.014
• 2. Pu X, Sun JM. General anesthesia vs spinal anesthesia for patients undergoing totalhip arthroplasty: a meta-analysis. Medicine (Baltimore) 201998:e14925. https://doi.org/10.1097/MD.0000000000014925
• 3. Martin Flores M. Epidural and spinal anesthesia. Vet Clin North Am Small Anim Pract 2019;49:1095-1108. https://doi.org/10.1016/j.cvsm.2019.07.007
• 4. Massoth C, Töpel L, Wenk M. Hypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy. Curr Opin Anaesthesiol. 2020;33:291-298. https://doi.org/10.1097/ACO.0000000000000848
• 5. Holte K, Foss NB, Svensén C, Lund C, Madsen JL, Kehlet H. Epidural anesthesia, hypotension, and changes in intravascular volume. Anesthesiology 2004;100:281-286. https://doi.org/10.1097/00000542-200402000-00016
• 6. Küpeli İ, Subaşı F, Eren N, Arslan YK. Evaluating the relationship between the pleth variability index and hypotension and assessing the fluid response in geriatric hip fracture under spinal anaesthesia: an observational study. Turk J Anaesthesiol Reanim 2020;48:208-214. https://doi.org/10.5152/TJAR.2019.59251
• 7. Zhang H, Yuan H, Yu H, Zhang Y, Feng S. Correlation between pleth variability index and ultrasonic inferior vena cava-collapsibility index in parturients with twin pregnancies undergoing cesarean section under spinal anesthesia. Eur J Med Res 2022;27:139. https://doi.org/10.1186/s40001-022-00771-3
• 8. Kaptein MJ, Kaptein EM. Inferior vena cava collapsibility index: clinical validation and application for assessment of relative intravascular volume. Adv Chronic Kidney Dis 2021;28:218-226. https://doi.org/10.1053/j.ackd.2021.02.003
• 9. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008;41: 575-580. https://doi.org/10.1016/j.jelectrocard.2008.07.030
• 10. Castro Hevia J, Antzelevitch C, Tomes Barzaga F, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006;47:1828-1834. https://doi.org/10.1016/j.jacc.2005.12.049
• 11. Haarmark C, Hansen PR, Vedel Larsen E, et al. The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol 2009;42:555-560. https://doi.org/10.1016/j.jelectrocard.2009.06.009
• 12. Gupta P, Patel C, Patel H, et al. Tp-e/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567-574. https://doi.org/10.1016/j.jelectrocard.2008.07.016
• 13. Letsas KP, Weber R, Astheimer K, Kalusche D, Arentz T. Tpeak-Tend interval and Tpeak-Tend/QT ratio as markers of ventricular tachycardia inducibility in subjects with Brugada ECG phenotype. Europace 2010;12:271-274. https://doi.org/10.1093/europace/eup357
• 14. Zehir R, Karabay CY, Kalaycı A, Akgün T, Kılıçgedik A, Kırma C. Evaluation of Tpe interval and Tpe/QT ratio in patients with slow coronary flow. Anatol J Cardiol 2015;15:463-467. https://doi.org/10.5152/akd.2014.5503
• 15. Çaltekin İ, Hidayet Ş. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in blunt chest trauma patients. Ulus Travma Acil Cerrahi Derg 2020;26:526-530. https://doi.org/10.14744/tjtes.2020.45642
• 16. Guo D, Zhou J, Zhao X, et al. L-type calcium channel recovery kinetics versusventricular repolarization: preserved membranestabilizing mechanism across species. Heart Rhythm 2008;5:271-279. https://doi.org/10.1016/j.hrthm.2007.09.025
• 17. Tekinalp N, Guney F, Tekinalp M. TPE, TPE Dispersion and TPE/QT ratio as risk indicators of malign ventricular arrhythmia in acute cerebrovascular event. Van Med J 2022;29:371-380. https://doi.org/10.5505/vtd.2022.57701
• 18. Alsancak Y, GürbüzAS, Saklı B, İçli A. Evaluation of index of cardio-electrophysiological balance and Tp-e/QT ratio in patients with coronary artery ectasia. J Surg Med 2019;3:223-226. https://doi.org/10.28982/josam.485247
• 19. Kayali S, Demir F. The effects of cigarette smoking on ventricular repolarization in adolescents. Einstein 2017;15:251-255. https://doi.org/10.1590/S1679-45082017AO3945
• 20. Hidayet Ş, Demir V, Turan Y, Gürel G, Taşolar MH. Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with Behçet's disease. Anatol J Cardiol 2019;22:85-90. https://doi.org/10.14744/AnatolJCardiol.2019.70019
• 21. Ucar FM, Ozturk C, Yılmaztepe MA. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with acute myocarditis. BMC Cardiovasc Disord 2019;19:232(e1-7). https://doi.org/10.1186/s12872-019-1207-z