Frontal QRS-T angle in scorpion sting

Yıl 2022, Cilt: 4 Sayı: 3, 83 - 87, 31.12.2022

İbrahim Halil Yasak Mustafa Yılmaz

https://doi.org/10.51262/ejtox.1206665

Öz

Introduction: The aim of this study was to investigate the change in frontal QRS-T angle in different clinical stages of scorpion stings.
Materials-Method: In this retrospective study, laboratory data of patients and T angle, QRS duration (ms), QT duration (ms), and QTc duration (ms) of the patients who presented with scorpion sting were calculated and recorded in the data file. The results were analyzed.
Findings: Eighty patients who applied to the emergency department with the complaint of scorpion sting were included in our study. Forty-four patients were evaluated as Stage I, 26 as Stage II, and 10 as Stage III. The patient groups did not differ in age (p = 0.605) and sex (p = 0.432). No significant difference was observed between the laboratory findings of the patients at the time of admission. ECG findings showed a considerable difference in frontal QRS-T angles between scorpion sting stages (p < 0.001). Pairwise comparison of the stages with post-hoc analysis revealed a non-significant difference between Stages I and II (p = 0.143), and a significant difference between Stages I and III (p < 0.001) and Stages II and III (p = 0.003). Correlation analysis results showed that the frontal QRS-T angle was negatively correlated with age (r = −0.281, p = 0.016) and positively correlated with the clinical stage (r = 0.384, p = 0.001). Multivariate linear regression analysis was performed to identify independent predictors of frontal QRS-T angle, and the stage of the scorpion sting was identified as an independent predictor (p = 0.001).
Conclusion: The increase in frontal QRS-T angle in scorpion stings may be used as a parameter that can help both early detections of cardiac involvement and clinical staging

Anahtar Kelimeler

Emergency department, Arthropods, Scorpion sting, frontal QRS-T angle, Electrocardiography

Akrep sokmasında frontal QRS-T açısı

Öz

Giriş: Bu çalışmanın amacı, akrep sokmalarının farklı klinik evrelerinde frontal QRS-T açısındaki değişimi araştırmaktır.
Gereç-Yöntem: Bu retrospektif çalışmada akrep sokması ile başvuran hastaların laboratuvar verileri ile T açısı, QRS süresi (ms), QT süresi (ms), QTc süresi (ms) hesaplanarak veri dosyasına kaydedilmiştir. Sonuçlar analiz edilmiştir.
Bulgular: Çalışmamıza akrep sokması şikayeti ile acil servise başvuran 80 hasta dahil edildi. Hastaların 44'ü Evre I, 26'sı Evre II ve 10'u Evre III olarak değerlendirildi. Hasta grupları arasında yaş (p=0.605) ve cinsiyet (p=0.432) açısından fark yoktu. Hastaların başvuru anındaki laboratuvar bulguları arasında anlamlı fark izlenmedi. Elektrokardiyografi (EKG) bulguları, akrep sokması evreleri arasında frontal QRS-T açılarında anlamlı farklılık gösterdi (p < 0.001). Evremelerin post-hoc analiz ile ikili olarak karşılaştırılması, Evre I ve II (p = 0.143) arasında anlamlı bir fark olmazken ve Evre I ve III (p 0.001) ile Evre II ve III (p = 0.003) arasında anlamlı bir fark ortaya koymuştur. Korelasyon analizi sonuçları, frontal QRS-T açısının yaş ile negatif (r = −0.281, p = 0.016) ve klinik evre ile pozitif korelasyon (r = 0.384, p = 0.001) olduğunu gösterdi. Frontal QRS-T açısının bağımsız belirleyicilerini belirlemek için çok değişkenli doğrusal regresyon analizi yapıldı ve akrep sokmasının evresi bağımsız bir belirleyici olarak belirlendi (p = 0.001).
Sonuç: Akrep sokmalarında frontal QRS-T açısındaki artış hem kardiyak tutulumun erken saptanmasına hem de klinik evrelemeye yardımcı olabilecek bir parametre olarak kullanılabilir.

Anahtar Kelimeler

Acil servis, Eklembacaklılar, Akrep sokması, frontal QRS-T açısı, Elektrokardiyografi

Kaynakça

• Santos MS, Silva CG, Neto BS, Grangeiro Júnior CR, Lopes VH, Teixeira Júnior AG, et al. Clinical and Epidemiological Aspects of Scorpionism in the World: A Systematic Review. Wilderness Environ Med 2016;27:504-518.
• Celik E, Caglar A, Celik SF. Clinical Effects and Predictive Factors Affecting the Clinical Severity of Scorpion Envenomations in Western Turkey. J Trop Pediatr 2021;67.
• Fukuhara YD, Reis ML, Dellalibera-Joviliano R, Cunha FQ, Donadi EA. Increased plasma levels of IL-1beta, IL-6, IL-8, IL-10 and TNF-alpha in patients moderately or severely envenomed by Tityus serrulatus scorpion sting. Toxicon 2003;41:49-55.
• Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med 2014;371:457-463.
• Gueron M, Ilia R, Sofer S. The cardiovascular system after scorpion envenomation. A review. J Toxicol Clin Toxicol 1992;30:245-258.
• Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014;19:534-542.
• Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM, ARIC Research Group. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol 2007;100:844-849.
• Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanen A, et al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace 2012;14:872-876.
• Cardoso CR, Leite NC, Salles GF. Factors associated with abnormal T-wave axis and increased QRS-T angle in type 2 diabetes. Acta Diabetol 2013;50:919-925.
• Ocak M, Tascanov MB, Kemer Z, Yasak İH, Fedai Ü. Examination of ECG characteristics of patients admitted to emergency department with conversive attack. Am J Emerg Med 2021;48:110-113.
• Hocanli I, Tanriverdi Z, Kabak M, Gungoren F, Tascanov MB. The relationship between frontal QRS-T angle and the severity of newly diagnosed chronic obstructive pulmonary disease. Int J Clin Pract 2021;75:e14500.
• Topaloglu O, Cimci M. The frontal QRS-T angle in patients with incidentally discovered nonfunctional adrenal adenomas. Eur Rev Med Pharmacol Sci 2021;25:3028-3037.
• HI H. Arthropods. 10 ed. New York: Mc Graw Hill Education, 2015.
• Reis MB, Zoccal KF, Gardinassi LG, Faccioli LH. Scorpion envenomation and inflammation: Beyond neurotoxic effects. Toxicon 2019;167:174-179.
• Ismail M. The treatment of the scorpion envenoming syndrome: the Saudi experience with serotherapy. Toxicon 1994;32:1019-1026.
• Bahloul M, Chaari A, Dammak H, Samet M, Chtara K, Chelly H, et al. Pulmonary edema following scorpion envenomation: mechanisms, clinical manifestations, diagnosis and treatment. Int J Cardiol 2013;162:86-91.
• Bayar N, Küçükseymen S, Yüksel IO, Arslan S. [Rapidly improving acute myocarditis after a scorpion sting]. Turk Kardiyol Dern Ars 2013;41:629-632.
• Borleffs CJ, Scherptong RW, Man SC, van Welsenes GH, Bax JJ, van Erven L, et al. Predicting ventricular arrhythmias in patients with ischemic heart disease: clinical application of the ECG-derived QRS-T angle. Circ Arrhythm Electrophysiol 2009;2:548-554.
• Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, et al. Effects of Newly Developed Right Versus Left Bundle Branch Block on the QRS Axis, T-wave Axis and Frontal QRS-T Angle in Patients with a Narrow QRS. Intern Med 2021;60:25-30.
• Bawaskar HS, Bawaskar PH. Scorpion sting. J Assoc Physicians India 1998;46:388-392.
• Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm? Int J Cardiol 2006;110:7-14.
• Abroug F, Souheil E, Ouanes I, Dachraoui F, Fekih-Hassen M, Ouanes Besbes L. Scorpion-related cardiomyopathy: Clinical characteristics, pathophysiology, and treatment. Clin Toxicol (Phila) 2015;53:511-518.
• Tanriverdi Z, Unal B, Eyuboglu M, Bingol Tanriverdi T, Nurdag A, Demirbag R. The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens 2018;40:318-323.
• Elffers TW, Trompet S, de Mutsert R, Maan AC, Lamb HJ, Macfarlane PW, et al. Electrocardiographic Detection of Left Ventricular Hypertrophy; Adding Body Mass Index and Spatial QRS-T Angle: A Cross-Sectional Study. Cardiol Ther 2019;8:345-356.