Genç Erişkinlerde Kardiyak Elektrofizyolojik Denge İndeksinin Sigara İçimi ile İlişkisi

Yıl 2020, Cilt: 4 Sayı: 3, 60 - 65, 12.12.2020

Mustafa Çelik Serkan Sivri Alp Yıldırım Murat Erer Ahmet Kıvrak

https://doi.org/10.46332/aemj.728508

Öz

Amaç: Sigara içmek kardiyovasküler hastalıklar için güçlü bir risk teşkil etmekte olup mortalite ve morbidite ile ilişkilidir. Kardiyak elektrofizyolojik denge endeksi (iCEB), ventriküler aritmiyi öngörebilecek yeni ve basit bir EKG belirtecidir. QT, düzeltilmiş QT (QTc), Tp-Te aralığı ve iCEB gibi yeni ventriküler repolarizasyon parametrelerinin sigara içen ve sigara içmeyen genç erkeklerde uzayıp uzamadığını araştırdık.

Araçlar ve Yöntem: Çalışmamız retrospektif olarak dizayn edilmiştir. Çalışmaya dahil edilen hastalar Haziran 2019 - Ekim 2019 tarihleri arasında hastanemiz kardiyoloji polikliniğine başvuran 20-30 yaşları arası erkeklerdi. Sigara içen (n: 91) ve sigara içmeyenler (n: 118) olarak 2 gruba ayrıldı. . QT aralığı, QRS başlangıcı ile T dalgasının sonuna kadar QT aralığı ölçüldü. Bazett formülleri kullanılarak hesaplandı. Daha sonra, Tp-e / QTc, Tp-e / QT,QTc / QRS ve QT/QRS oranları hesaplandı. iCEB, yüzey EKG'sinden hesaplanan QT'nin QRS'ye (QT / QRS) oranı olarak hesaplandı.

Bulgular: QT, QT / QRS (iCEB), Tp-Te, QTc, QRS, QTc / QRS ve Tp-Te / QTc değerleri gruplar arasında anlamlı farklılık göstermedi. Sigara içenlerin beyaz küre ortalamaları ve lenfosit değerleri sigara içmeyenlere göre istatistiksel olarak anlamlıydı (p <0.05)

Sonuç: Çalışmamızda genç erkek sigara içicilerinde, sigara içmeyenlere göre T peak- T end, Tp-Te / QT, iCEB ve Tp-Te / QTc’ nin değişmediğini gösterdik. Bildiğimiz kadarıyla, bu çalışma sigara içen gençlerde ICEB değerlerini araştıran ilk çalışmadır.

Anahtar Kelimeler

T peak-to-end, Tpe / QT, sigara

Relationship of Index of Cardiac Electrophysiological Balance with Cigarette Smoking in Young Adults

Öz

Purpose: Cigarette smoking constitutes a robust risk for cardiovascular diseases, and is associated with mortality and morbidity. Index of cardiac electrophysiological balance (iCEB), is calculated from surface ECG. It is a new and simple ECG marker capable of predicting ventricular arrhythmogenesis. We investigated whether QT, corrected QT (QTc), Tp-Te interval as well as new ventricular repolarization parameters such as iCEB are prolonged or not in the smoking and non-smoking young males.

Materials and Methods: Our study was designed retrospectively. The included patients were between 20-30 of age-old males who admitted to our hospital’s cardiology outpatient clinic between June 2019 and October 2019. They were divided into 2 groups as smokers (n:91) and non-smokers (n:118). From the beginning of the QRS complex to the end of the T wave, QT interval was measured and QT interval was corrected using the Bazett’s formulae. Then, QTc/QRS, Tp-e/QTc, QT/QRS, and Tp-e/QT ratios were calculated. iCEB, namely the ratio of QT to QRS (QT/QRS) was calculated from surface ECG.

Results: QT/QRS (iCEB), Tpeak-Tend, QTc, Tp-Te/QT, QT, Tp-Te/QTc, QRS, and QTc/QRS values were not significantly different between the groups. The mean white Blood Cell (WBC) and lymphocyte counts of the smokers were higher compared to non-smokers, which was statistically significant (p<0.05).

Conclusion: We showed that Tp-Te interval, iCEB, Tp-Te/QT and Tp-Te/QTc did not change significantly in the otherwise healthy young male smokers as compared to the nonsmokers. As far as we know, this study is the first to investigate the ICEB values in young smoker subjects.

Anahtar Kelimeler

T peak-to-end, Tpe/QT, smoking

Kaynakça

• 1. Tonstad S, Andrew Johnston J. Cardiovascular risks associated with smoking: a review for clinicians. Eur J Cardiovasc Prev Rehabil. 2006;13(4):507-514.
• 2. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86-97.
• 3. Schrör K, Zimmermann KC, Tannhäuser R. Augmented myocardial ischaemia by nicotine--mechanisms and their possible significance. Br J Pharmacol. 1998;125(1):79-86.
• 4. Mehta MC, Jain AC, Mehta A, Billie M. Cardiac Arrhythmias Following Intravenous Nicotine: Experimental Study in Dogs. J Cardiovasc Pharmacol Ther. 1997;2(4):291-298.
• 5. Hayashi H, Omichi C, Miyauchi Y, Mandel WJ, Lin SF, Chen PS, et al. Age-related sensitivity to nicotine for inducible atrial tachycardia and atrial fibrillation. Am J Physiol Heart Circ Physiol. 2003;285(5):2091-2098.
• 6. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41(6):575-580.
• 7. 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(6):567-574.
• 8. 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.
• 9. Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases. 2015;3(8):705-720.
• 10. Castro Hevia J, Antzelevitch C, TornésBárzaga 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(9):1828-1834.
• 11. Haarmark C, Graff C, Andersen MP, et al. Reference values of electrocardiogram repolarization variables in a healthy population. J Electrocardiol. 2010;43(1):31-39.
• 12. Charbit B, Samain E, Merckx P, Funck-Brentano C. QT interval measurement: evaluation of automatic QTc measurement and new simple method to calculate and interpret corrected QT interval. Anesthesiology. 2006;104(2):255-260.
• 13. Perou R, Bitsko RH, Blumberg SJ, et al. Centers for Disease Control and Prevention (CDC). Mental health surveillance among children--United States, 2005-2011. MMWR Suppl. 2013;62(2):1-35.
• 14. Benowitz NL, Hansson A, Jacob P 3rd. Cardiovascular effects of nasal and transdermal nicotine and cigarette smoking. Hypertension. 2002;39(6):1107-1112.
• 15. D'Alessandro A, Boeckelmann I, Hammwhöner M, Goette A. Nicotine, cigarette smoking and cardiac arrhythmia: an overview. Eur J Prev Cardiol. 2012;19(3):297-305. 16. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41(6):575-580.
• 17. Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M, Huber K, et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol. 2011;44(3):301-308.
• 18. Erikssen G, Liestøl K, Gullestad L, Haugaa KH, Bendz B, Amlie JP. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17(2):85-94.
• 19. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011;4(4):441-447.
• 20. İlgenli,T.F, Tokatlı A, Akpınar O, Kılıçaslan F. The Effects of Cigarette Smoking on the Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc RatioAdv Clin Exp Med. 2015;24(6):973–978.
• 21. Kayali S, Demir F. The effects of cigarette smoking on ventricular repolarization in adolescents. Einstein (Sao Paulo). 2017;15(3):251–255.
• 22. Hallstrom AP, Cobb LA, Ray R. Smoking as a risk factor for recurrence of sudden cardiac arrest. N Engl J Med. 1986;314(5):271-275.
• 23. Taşolar H, Ballı M, Bayramoğlu A, 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):827-832.
• 24. 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(2):250-259.
• 25. Yumurtacı O, Kurt C, Ucar FM, Ozturk C. Usefulness of electrocardiographic markers to predict ventricular arrhythmia in acute myocarditis. Turkish Med Stud J. 2017;4(1):6-10.
• 26. Sivri S, Çelik M. Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease. J Electrocardiol. 2019;54:72-75.
• 27. Özdemir L, Sökmen E. Effect of habitual cigarette smoking on the index of cardiac electrophysiological balance in apparently healthy individuals. J Electrocardiol. 2020;59:41‐44.
• 28. Grasser EK, Ernst B, Thurnheer M, Schultes B. QT Interval Shortening After Bariatric Surgery Depends on the Applied Heart Rate Correction Equation. Obes Surg. 2017;27(4):973-982.