Stabil Koroner Arter Hastalığı Olan Hastalarda Bazal T-Dalgası Pik-Son İntervali ile Kalp Atış Hızı Düzelme İndeksi Arasındaki İlişki

Year 2021, Volume: 11 Issue: 2, 279 - 287, 29.06.2021

Hüseyin Ören

https://doi.org/10.31832/smj.807503

Abstract

AMAÇ: Koroner arter hastalığı olan hastalarda otonom disfonksiyon kötü prognozun göstergesidir. Bu çalışmanın amacı, sol ventrikül ejeksiyon fraksiyonu (EF)>% 50 ve <% 50 olan stabil koroner arter hastalığı olan hastalarda başlangıç T-dalgası tepe-son intervali (Tp-e) ve kalp hızı geri kazanım indeksi (HRR-I) değerlerini karşılaştırmaktır.
GEREÇ VE YÖNTEMLER: Grup 1'de 2 aydan uzun süredir eforlu göğüs ağrısı olan 107 hasta ve koroner anjiyografide EF <% 50 olan sınıf 1-2 anjina, 3 damar hastalığı vardı. Grup 2'de koroner anjiyografide EF>% 50 olan, 3 damar hastalığı olan 76 hasta vardı. Başlangıçta her iki grubun başlangıç Tp-e ve kalp hızı değerleri ölçüldü ve transtorasik ekokardiyogramlar yapıldı. Daha sonra Grup 1 ve 2, Bruce protokolüne göre egzersiz testine tabi tutuldu ve egzersizin zirvesinde ve 1., 2. ve 3. dakikalarında kalp hızları ölçüldü.
BULGULAR: Bazal Tp-e açısından grup 1 [95,8 ± 6,8 msec] ve grup 2 [71,4 ± 5,1 msec] arasında istatistiksel olarak anlamlı fark vardı [P<0,0001]. cTp-e (düzeltilmiş T dalgası tepe-son aralığı) değerleri açısından grup 1 [108,1±7,9] ve grup 2 [79,3±7,7] arasında anlamlı fark vardı [P<0,0001]. 1. dakika iyileşme fazında HRR-I'e bakıldığında [14,4 ± 2,1 vs 20,1 ± 3,5], 2. dakika iyileşme fazında HRR-I'e bakıldığında [26,3 ± 2,2 vs 45,1 ± 2,4], 3. dakika iyileşme fazında HRR-I'e bakıldığında [42,6 ± 2,9 vs 64,1 ± 2,6], gruplar arasında istatistiksel olarak anlamlı bir fark vardı [P<0,00001]. .
SONUÇ: Stabil anjinası olan ve EF <% 50 olan hastalarda otonomik gecikme daha belirgindir, Tp-e aralığı değeri daha yüksek ve HRR-I değerleri daha düşüktür.

Keywords

ateroskleroz, elektrokardiyografi, egzersiz testi, kalp hızı, indeks

The Relatioship Between Basal T-Wave Peak-End Interval and Heart Rate Recovery Index Values in Patients with Stable Coronary Artery Disease

Abstract

OBJECTIVES: Autonomic dysfunction is detected in patients with coronary artery disease and is indicative of poor prognosis. The aim of this study was to compare baseline T peak-end interval (Tp-e) and heart rate recovery index [HRR-I] values in patients with stable coronary artery disease who had a left ventricular ejection fraction [EF] > 50 % and < 50 %.
MATERIALS AND METHODS: In Group 1, there were 107 patients with exertional chest pain for more than 2 months and class 1-2 angina with EF < 50 %, had 3-vessel diseases on coronary angiography. In Group 2, there were 76 patients with EF > 50 %, had 3-vessel diseases on coronary angiography. Baseline Tp-e and heart rate values of both groups were measured and transthoracic echocardiograms were performed at the beginning. Both Group 1 and 2 were then subjected to exercise testing according to the Bruce protocol and heart rates were measured at the peak and 1st, 2nd, and 3rd minutes of exercise.
RESULTS: There was a statistically significant difference between group 1 [95.8 ± 6.8 msec] and group 2 [71.4 ± 5.1 msec] with regard to basal Tp-e [P<0.0001]. There was a significant difference between group 1 [108.1±7.9] and group 2 [79.3±7.7] in terms of corrected Tp-e(cTp-e) values [P<0.0001]. Looking at HRR-I at the 1st-minute recovery phase [14.4 ± 2.1 vs 20.1 ± 3.5], when looking at HRR-I at the 2nd-minute recovery phase [26.3 ± 2.2 vs 45.1 ± 2.4], when looking at HRR-I at the 3rd-minute recovery phase [42.6 ± 2.9 vs 64.1 ± 2.6], there was a statistically significant difference between the groups [P<0.00001].
CONCLUSION: Autonomic delaying is more prominent, the Tp-e interval value was higher and HRR-I values were lower in patients with stable angina with EF < 50%.

Keywords

Atherosclerosis, Electrocardiography, exercise test, heart rate, index

References

• 1) Mehra R. Global public health problem of sudden cardiac death. J Electrocardiol. 2007;40(6 Suppl): S118–S122. https://doi.org/10.1016/j.jelectrocard.2007.06.023
• 2) Fishman GI, Chugh SS, Dimarco JP, Albert CM, Anderson ME, Bonow RO, et al. Sudden cardiac death prediction and prevention: a report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop. Circulation. 2010;122(22): 2335–2348. https://doi.org/10.1161/ CIRCULATIONAHA .110.976092.
• 3) Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300(12):1423– 1431. https://doi.org/10.1001/jama.300.12.1423.
• 4) Sugishi M, Faminaro T. Cigarette smoking is a major risk for coronary spasm. Circulation.1993; 87: 76-79. PMID: 8419026. // Ng GA. Vagal modulation of cardiac ventricular arrhythmia. Exp Physiol. 2014; 99 (2): 295-9. https://doi.org/10.1113/ expphysiol.2013.072652.
• 5) Ng GA. Vagal modulation of cardiac ventricular arrhythmia. Exp Physiol. 2014; 99 (2): 295-9. https://doi.org/10.1113 /expphysiol.2013.072652.
• 6) Pérez-Riera AR, Barbosa-Barros R, Shenasa M. Electrocardiographic Markers of Sudden Cardiac Death (Including Left Ventricular Hypertrophy. Card Electrophysiol Clin. 2017;9(4):605-629. https://doi.org/10.1016/j.ccep.2017.07.011.
• 7) Kors JA, Ritsema van, 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.
• 8) 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. https://doi.org/10.1016 /j.jelectrocard. 2008.07.016.
• 9) Topilski I, Rogowski O, Rosso R, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol 2007;49:320-328
• 10) Watanabe N, Kobayashi Y, Tanno K, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. Journal of Electrocardiology. 2004;37(3):191-200.
• 11) Tse G, Gong M, Wong WT, Georgopoulos S, Letsas KP, Vassiliou VS, et al. The Tpeak-Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis. Heart Rhythm. 2017 Aug;14(8):1131-1137. doi: 10.1016/j.hrthm.2017.05.031. Epub 2017 May 26.
• 12) Lacasse M, Maltais F, Poirier P., et al. Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease. Respir Med. 2005; 99 (7): 877-886. DOI: 10.1016 / j. rmed.2004.11.012.
• 13) Seshadri N, Gildea TR, McCarthy K, Pathier C, Kavuru MS, Lauer MS. Association of an abnormal exercise heart rate recovery with pulmonary function abnormalities. Chest 2004; 125 (4): 1286-1291, PMID: 15078736.
• 14) Deo R, Albert CM. Epidemiology and Genetics of Sudden Cardiac Death. Circulation. 2012 Jan 31; 125 (4): 620-37.
• 15) Racine N, Blanchet M, Ducharme A, et al. Decreased heart rate recovery after exercise in patients with congestive heart failure: effect of β-blocker therapy. J Card Fail 2003; 9: 296-302.
• 16) Vatner DE, Lee DL, Schwarz KR, et al. Impaired cardiac muscarinic receptor function in dogs with heart failure. J Clin Invest 1988; 81: 1836-42.
• 17) Erat M, Doğan M, Sunman H, Dinç Asarcıklı L, Efe TH, Bilgin M, et al. Evaluation of heart rate recovery index in heavy smokers. Anatol J Cardiol. 2016 Sep;16(9):667-72.
• 18) Taşolar H, Ballı M, Bayramoğlu A, Otlu YÖ, Cetin M, Altun B, et al. Effect of smoking on Tp-e interval, Tp-e/QT and Tp-e/QTc ratios as indices of ventricular arrhythmogenesis. Heart Lung Circ. 2014;23(9):827-32. https://doi.org/10.1016/j.hlc.2014.03.016).
• 19) Yamaguchi M, Shimizu M, Ino H, Terai H, Uchiyama K, Oe K, Mabuchi T, et al. T-wave peak-to-end interval and QT dispersion in acquired long QT syndrome: A new index for arrhythmogenicity. Clin Sci (Lond) 2003; 105:671–676.
• 20) Castro Hevia J, Antzelevitch C, Tornes Barzaga F, Dorantes SM, Zayas MR, Quinones Perez MA, et al. TpeakTend 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.
• 21) Shimizu M, Ino H, Okeie K, Emoto Y, Yamaguchi M, Yasuda T, Kokado H, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with cardiac troponin I mutation than QT dispersion. Clinical Cardiology 2002; 25:335–339.
• 22) Antzelevitch C, Shimizu W. Cellular mechanisms underlying the long QT syndrome. Curr Opin Cardiol. 2002;17:43–51.
• 23) Yaniel Castro-Torres, Raimundo Carmona-Puerta, Richard E Katholi. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice.World J Clin Cases. Aug 16, 2015; 3(8): 705-720, Published online Aug 16, 2015. doi: 10.12998 /wjcc.v3.i8.705
• 24) Tatlisu MA, Özcan KS, Güngör B, Ekmekçi A, Çekirdekçi EI, Aruğarslan E, et al. Can the T-peak to T-end interval be a predictor of mortality in patients with ST-elevation myocardial infarction? Coron Artery Dis. 2014 Aug;25(5):399-404. doi: 10.1097/MCA.0000000000000101.
• 25) 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.
• 26) Savalieva I, Yag YP, Yi G, et al: Comparative reproducibility of QT, QT peak, and Tpeak-Tend intervals and dispersion in normal subjects with hypertrophic cardiomyopathy. Pacing Clin Electrophysiol. 1998;21: Pt II.
• 27) Lubinski A, Kornacewaichs-jach Z, Wnuk-Wojnar AM, et al. The termination of the T wave: A new electrocardiographic marker of risk of ventricular arrhythmias. Pacing Clin Electrophysiol. 2000;23 Pt II:1957.
• 28) Bilsel T, Terzi S, Akbulut T, Sayar N, Hobikoglu G, Yesilcimen K. Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients. Int Heart J. 2006 May;47(3]:431-40.