Subklinik Hipertiroidizm ile Ventriküler Repolarizasyon Belirteçleri Arasındaki İlişki

Abstract

Amaç: Subklinik hipertiroidili (sHT) hastalarda ventriküler repolarizasyon belirteçleri ile repolarizasyon defektlerini ve aritmojenik yatkınlığı değerlendirmek. Gereç ve Yöntemler: Asemptomatik endojen (sHT)’li hastalar ve benzer yaş ve demografik özelliklere sahip sağlıklı katılımcılar çalışmamıza dahil edildi. Laboratuvar testleri ve ekokardiyografik değerlendirmeler yapıldı. Elektrokardiyografide QT, QTc (Bazett formülü ile düzeltilmiş QT inteval) dispersiyonu, Tpeak-Tend (Tp-e) aralığı ve Tp-e/QT ve Tp-e/ QTc oranları gibi spesifik ventriküler repolarizasyon belirteçleri elle elde edildi. Bulgular: Çalışmamıza toplam 90 katılımcı dahil edildi. sHT grubundaki 45 hasta için yaş ortalaması 59.04±13.28 yıl, 45 kontrol grubu için ortalama 57.13±15.87 yıl idi. PR, QT ve QTc dağılımlarının sHT grubunda anlamlı derecede yüksek olduğu bulundu (tümü için p<0.05). PR ve QT aralıkları gruplar arasında anlamlı farklılık göstermezken, QTc (p<0.05) sHT grubunda anlamlı olarak daha yüksekti. Tp-e , Tp-e/QT ve Tp-e/Qtc'nin de sHT grubunda kontrol grubuna göre daha yüksek seviyelerde olduğu bulundu (tümü için p<0.001). Tiroid uyarıcı hormon (TSH) ile Tp-e aralığı, QT, QTc dispersiyonu, Tp-e/QT ve Tp-e/QTc oranı arasında en yüksek korelasyon katsayısına sahip Tp-/QT ile istatistiksel olarak anlamlı negatif korelasyon saptandı (r: -0.298, p=0.004). Sonuç: Sağlıklı bireylerle karşılaştırıldığında, Sht'li hastalar daha uzun Tp-e aralığına ve daha yüksek Tp-e / QT ve Tp-e / QTc oranlarına sahipti. TSH düzeyleri Tp-e aralığı ve Tp-e/QT ve Tp-e/QTc oranları ile negatif korelasyon gösterdi.

Keywords

• Tp-e aralığı
• Tp-e/QT oranı
• subklinik hipertiroidizm
• ventriküler repolarizasyon belirteçleri

Relationship between subclinical hyperthyroidism and ventricular repolarization markers

Abstract

Objective: To evaluate repolarization defects and arrhythmogenic predisposition through ventricular repolarization markers in patients with subclinical hyperthyroidism (sHT). Materials and Methods: Patients with asymptomatic endogenous sHT and healthy participants with similar age and demographic characteristics were included in our study. Laboratory tests and echocardiographic evaluations were performed. Specific ventricular repolarization markers,such as QT, QTc (corrected QT inteval by Bazett formula) dispersion, Tpeak-Tend (Tp-e) interval, and Tp-e/QT and Tp-e/QTc ratios were obtained with manually on electrocardiograpy. Results: A total of 90 participants were included in our study. The mean age was 59.04±13.28 years for the 45 patients in the sHT group and mean 57.13±15.87 years for the 45 controls. The PR, QT and QTc dispersions were found to be significantly higher in the sHT group (p<0.05 for all). While the PR and QT intervals did not significantly differ between the groups, QTc (p<0.05) was significantly higher in the sHT group. Tp-e , Tp-e/QT,and Tp-e/QTc were also found to be at higher levels in the sHT group than in the control group (p<0.001 for all). A statistically significant negative correlation was detected between thyroid-stimulating hormone (TSH) and the Tp-e interval, QT, QTc dispersion, Tp-e/QT, and Tp-e/QTc ratio, with Tp-/QT having the highest correlation coefficient (r: -0.298, p=0.004). Conclusion: Compared with healthy subjects, patients with sHT had a longer Tp-e interval and higher Tp-e/QT and Tp-e/QTc ratios. The TSH levels were negatively correlated with the Tp-e interval and Tp-e/QT and Tp-e/QTc ratios.

Keywords

• Tp-e interval
• Tp-e/QT ratio
• subclinical hyperthyroidism
• ventricular repolarization markers

References

1. 1. Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation. 1993;87:1435-41.
2. 2. Fadel BM, Ellahham S, Ringel MD, Lindsay J Jr, Wartofsky L, Burman KD. Hyperthyroid heart disease. Clin Cardiol. 2000;23:402-8.
3. 3. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001; 15;344(7):501-9.
4. 4. Corona G, Croce L, Sparano C, Petrone L, Sforza A, Maggi M, et al. Thyroid and heart, a clinically relevant relationship. J Endocrinol Invest. 2021;44(12):2535-44.
5. 5. Biondi B, Palmieri EA, Fazio S, Cosco C, Nocera M, Sacca L, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J. Clin. Endocrinol. Metab. 2000;85, 4701–5.
6. 6. H. Vargas-Uricoechea, C.H. Sierra-Torres, Thyroid hormones and the heart. Horm Mol Biol Clin Investig. 2014; 18, 15–26. 7. Geng J, Lu W, Hu T, Tao S, Zhang H, Chen J, et al. Subclinical hyperthyroidism increases risk of coronary heart disease events in type 2 diabetes mellitus. Endocrine. 2015; 49, 557–9.
7. 8. Kaminski G, Makowski K, Michałkiewicz D, Kowal J, Ruchala M, Szczepanek E, et al. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid. 2012;22(5):454-60.
8. 9. Sgarbi JA, Villaca FG, Garbeline B, Villar HE, Romaldini JH, The effects of early antithyroid therapy for endogenous subclinical hyperthyroidism in clinical and heart abnormalities. J. Clin. Endocrinol. Metab. 2003;88, 1672–7.

9. 10. Xia Y, Liang Y, Kongstad O, Holm M, Olsson B, Yuan S. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol 2005;14:79 –87.
10. 11. Tse G, Yan BP. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death. Europace. 2017;19(5):712-21.
11. 12. Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases. 2015;16;3(8):705-20. 13. Ojamaa K, Klein I, Sabet A, Steinberg SF. Changes in adenylyl cyclase isoforms as a mechanism for thyroid hormone modulation of cardiac beta-adrenergic receptor responsiveness. Metabolism. 2000;49(2):275-9.
12. 14. Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35.
13. 15. Wustmann K, Kucera JP, Zanchi A, Burow A, Stuber T, Chappuis B, et al. Activation of electrical triggers of atrial fibrillation in hyperthyroidism. J Clin Endocrinol Metab. 2008 ;93(6):2104-8.
14. 16. Auer J, Scheibner P, Mische T, Langsteger W, Eber O, Eber B. Subclinical hyperthyroidism as a risk factor for atrial fibrillation. Am Heart J 2001;142: 838-42.
15. 17. Collet TH, Gussekloo J, Bauer DC, den Elzen WP, Cappola AR, Balmer P, et al. Thyroid Studies Collaboration. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med. 2012;172(10):799-809.
16. 18. Owecki M, Michalak A, Nikisch E, Sowiński J. Prolonged ventricular repolarization measured by corrected QT interval (QTc) in subclinical hyperthyroidism. Horm Metab Res. 2006;38(1):44-7.
17. 19. Kaminski G, Dziuk M, Szczepanek-Parulska E, Zybek-Kocik A, Ruchala M. Electrocardiographic and scintigraphic evaluation of patients with subclinical hyperthyroidism during workout. Endocrine. 2016;53(2):512-9.
18. 20. Kandel S , Rana BSJ , Prasad PN , Mahotra NB , Shrestha TM . Prolonged QT dispersion in Subclinical Hypothyroid Females: A Study in University Teaching Hospital in Central Nepal. Kathmandu Univ Med J (KUMJ). 2019;17(68):258-62.
19. 21. Gürdal A, Eroğlu H, Helvaci F, Sümerkan MÇ, Kasali K, Çetin Ş, et al. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with subclinical hypothyroidism. Ther Adv Endocrinol Metab. 201;8(3):25-32.