Sarkoidozlu Hastalarda Kardiyak-Elektrofizyolojik Denge İndeksinin ve Elektrokardiyografik Değişimlerin Değerlendirilmesi

Year 2021, , 193 - 200, 22.03.2021

Yakup Alsancak , Celalettin Korkmaz

https://doi.org/10.31832/smj.810675

Abstract

Amaç: Kardiyak sarkoidoz (KS) farklı klinik bulgularla ortaya çıkabilir ve kötü bir prognoza sahiptir, ancak kalp nadiren tek başına etkilenir.Bu çalışmamızda, kalp tutulumu olan veya olmayan hastalarda elektrokardiyografi (EKG) kullanarak sarkoidozun aritmojenik etkilerini değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Pulmoner sarkoidoz nedeniyle takip edilen toplam 61 hasta retrospektif olarak incelendi ve 50 sağlıklı gönüllü çalışmaya alındı. Sarkoidoz hastaları da kalp tutulumu olan veya olmayan olarak gruplandırıldı (n = 11 / n = 35). QRS, QT, Tp-e, P dalga morfolojisi manuel olarak ölçüldü. Daha sonra Tp-e / QT, Tp-e / QTc, QT / QRS (kardiyak elektrofizyolojik denge indeksi) ve QTc / QRS oranları hesaplandı ve gruplar arası karşılaştırıldı.
Bulgular: EKG'de kalp hızı, QT / QTc aralığı, Tp-e aralıkları ve Tp-e / QT oranı ve PWD anlamlı olarak yüksek (p değerleri <0,018), QT / QRS oranı ile elde edilen iCEB veya iCEBc değerleri sarkoidoz grubunda daha düşüktü (p = 0.001). Kardiyak sarkoidozu olan ve olmayan grupta ise QTc, Tp-e / QT oranı ve iCEB dahil EKG parametreleri arasında bir ilişki bulamadık (sırasıyla p = 0.501, p = 0.753 ve p = 0.490).
Sonuçlar: Bu çalışma sarkoidoz hastalarında daha düşük bir iCEB değeri ve daha yüksek repolarizasyon bulguları olduğunu göstermiştir. Bununla birlikte, kalp tutulumu olan veya olmayan arasında hiçbir fark yoktur.

Keywords

Aritmi,, elektrokardiyografi, iCEB, sarkoidoz

Evaluation of Index of Cardiac-Electrophysiological Balance and Electrocardiographic Alternations in Patients with Sarcoidosis

Abstract

Objective: Cardiac sarcoidosis (CS) can manifest with different clinical signs and has a poor prognosis, but the heart is rarely affected alone. We aim to evaluate the arrhythmogenic effects of sarcoidosis by using electrocardiography (ECG) in patients with or without cardiac involvement.
Materials and Methods: A total of 61 patients under follow-up for pulmonary sarcoidosis were retrospectively reviewed and 50 healthy volunteers were enrolled in the study. Sarcoidosis patients were also grouped as with or without cardiac involvement (n=11/ n=35). QRS, QT, Tp-e, P wave morphology were measured manually. Then, Tp-e/QT, Tp-e/QTc, QT/QRS (index of cardiac electrophysiological balance), and QTc/QRS ratios were calculated and compared between groups.
Results: Heart rate on ECG, QT/QTc interval, Tp-e intervals and Tp-e/QT ratio and PWD were significantly higher (p values < 0.018) and iCEB or iCEBc values, obtained with the QT/QRS ratio, were lower in the sarcoidosis group (p = 0.001). And we could not find a relationship between non-cardiac and CS and ECG parameters including QTc, Tp-e/QT ratio and iCEB (p= 0.501, p= 0.753 and p=0.490, respectively).
Conclusion: The present study demonstrated a lower iCEB value and higher repolarization findings in sarcoidosis patient. However, there are no differences between with or without cardiac involvement.

Keywords

Arrhythmia,, electrocardiography, iCEB, sarcoidosis

References

• Referans1- Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet PY, Muller-Quernheim J. Sarcoidosis. Lancet 2013;385:1155–1167.
• Referans2- Oliver SJ. Nonpulmonary manifestations of sarcoidosis. Curr Rheumatol Rep 2002;4(2):170-178.
• Referans3- Kim JS, Judson MA, Donnino R, Gold M, Cooper LT, Prystowsky EN, et al. Cardiac sarcoidosis. Am Heart J 2009;157:9–21.
• Referans4- R.P. Baughman, A.S. Teirstein, M.A. Judson, Rossman MD, Yeager H Jr, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. American Journal of Respiratory and Critical Care Medicine 2001;15:1885–1889.
• Referans5- Iwai K, Tachibana T, Takemura T, Matsui Y, Kitaichi M, Kawabata Y. Pathological studies on sarcoidosis autopsy. I. Epidemiological features of 320 cases in Japan. Acta Pathol Jpn 1993;43:372-376.
• Referans6- Dubrey SW, Falk RH. Diagnosis and management of CS. Prog Cardiovasc Dis 2010;52:336-346.
• Referans7- Winters SL, Cohen M, Greenberg S, Stein B, Curwin J, Pe E, et al. Sustained ventricular tachycardia associated with sarcoidosis: assessment of the underlying cardiac anatomy and the prospective utility of programmed ventricular stimulation, drug therapy and an implantable antitachycardia device. J Am Coll Cardiol 1991;18:937–943.
• Referans8- Lam CS, Tolep KA, Metke MP, Glockner J, Cooper LT Jr. Coronary sarcoidosis presenting as acute coronary syndrome. Clin Cardiol 2009;32(6):68-71.
• Referans9- Garrett J, O’Neill H, Blake S. Constrictive pericarditis associated with sarcoidosis. Am Heart J 1984;107:394.
• Referans10- Uyarel H, Uslu N, Okmen E, Tartan Z, Kasikcioglu H, Dayi SU, et al. QT dispersion in sarcoidosis. Chest 2005;128(4):2619-2625.
• Referans11- Hetland M, Haugaa KH, Sarvari SI, Erikssen G, Kongsgaard E, Edvardsen T. A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann. Noninvasive Electrocardiol 2014;19:330–337.
• Referans12- Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J. Electrocardiol 2008;41:567–574.
• Referans13- Kasapkara HA, Sentürk A, Bilen E, Ayhan H, Karaduman BD, Turinay ZS, et al. Evaluation of QT dispersion and T-peak to T-end interval in patients with early-stage sarcoidosis. Rev Port Cardiol 2017;36(12):919-924.
• Referans14- Lu HR, Yan GX, Gallacher DJ. A new biomarker–index of cardiac electrophysiological balance (iCEB)–plays an important role in drug-induced cardiac arrhythmias: Beyond QT-prolongation and torsades de pointes (TdPs). J Pharmacol Toxicol Methods 2013;68:250–259.
• Referans15- Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, et al. Evaluation of Index of Cardio-Electrophysiological Balance (iCEB) as a New Biomarker for the Identification of Patients at Increased Arrhythmic Risk. Ann Noninvasive Electrocardiol 2016;21(3):294-304.
• Referans16- Birnie DH, Kandolin R, Nery PB, Kupari M. Cardiac manifestations of sarcoidosis: diagnosis and management. European Heart Journal 2017;38:2663–2670.
• Referans17- Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733–778.
• Referans18- Malik M and Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749–1766.
• Referans19- Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R, 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.
• Referans20- M.M. Sadek, D. Yung, D.H. Birnie, Beanlands RS, Nery PB et al. Corticosteroid therapy for Cardiac Sarcoidosis: a systematic review. Canadian Journal of Cardiology 2013;29:1034–1041.
• Referans21- Al-Kindi SG, Oliveira GH. Letter by Al-Kindi and Oliveira regarding article “Cardiac Sarcoidosis: epidemiology, characteristics, and outcome over 25 years in a nationwide study”. Circulation 2015;132:211.
• Referans22- Nery PB, Beanlands RS, Nair GM, Green M, Yang J, McArdle BA, et al. Atrioventricular block as the initial manifestation of CS in middle-aged adults. J Cardiovasc Electrophysiol 2014;25:875–881.
• Referans23- Sharma S. Cardiac imaging in myocardial sarcoidosis and other cardiomyopathies. Curr Opin Pulm Med 2009;15:507-512.
• Referans24- Viles-Gonzalez JF, Pastori L, Fischer A, Wisnivesky JP, Goldman MG, Mehta D. Supraventricular arrhythmias in patients with Cardiac Sarcoidosis prevalence, predictors, and clinical implications. Chest 2013;143:1085–1090.
• Referans25- H. Furushima, M. Chinushi, H. Sugiura, Kasai H, Washizuka T, Aizawa Y. Ventricular tachyarrhythmia associated with Cardiac Sarcoidosis: its mechanisms and outcome. Clinical Cardiology 2004;27:217–222.
• Referans26- Nery PB, Mc Ardle BA, Redpath CJ, Leung E, Lemery R, Dekemp R, et al. Prevalence of CS in patients presenting with monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2014;37:364–374.
• Referans27- Tung R, Bauer B, Schelbert H, Lynch JP III, Auerbach M, Gupta P, et al. Incidence of abnormal positron emission tomography in patients with unexplained cardiomyopathy and ventricular arrhythmias: the potential role of occult inflammation in arrhythmogenesis. Heart Rhythm 2015;12:2488–498.
• Referans28- Mehta D, Lubitz SA, Frankel Z, Wisnivesky JP, Einstein AJ, Goldman M, et al. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest 2008;133:1426–1435.
• Referans29- Buyukoglan H, Kaya MG, Ardic I, Yarlioglues M, Dogdu O, Bol C, et al. Assessment of atrial conduction time in patients with sarcoidosis. J Investig Med 2011;59(1):15-21.
• Referans30- Patel AR, Klein MR, Chandra S, Spencer KT, Decara JM, Lang RM, et al. Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study. Eur J Heart Fail 2011;13:1231–1237.