Evaluation of Electrocardiographic and Echocardiographic Findings In Patients Diagnosed with Polycythemia Vera and Essential Thrombocythemia

Yıl 2024, , 51 - 56, 29.02.2024

Bahattin Engin Kaya , Sinan Demircioğlu , Atakan Tekinalp , Ahmet Lütfü Sertdemir , Mustafa Çağrı Ergün , Ali Kürşat Tuna , Şerif Ahmet Kandemir , Abdullah İçli , Özcan Çeneli

https://doi.org/10.54005/geneltip.1342363

Öz

Background/Aims: Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative diseases. Along with the increase in myeloproliferative cell lines, they can cause various clinical outcomes such as arterial and venous thrombosis, pulmonary hypertension, and myocardial infarction. This study was designed to evaluate the cardiac effects of these diseases via electrocardiography and echocardiography.
Methods: A total of 50 patients with a diagnosis of PV, 50 patients with a diagnosis of ET, and 50 healthy individuals as a control group were included in this study. Data on patient demographics were recorded in all subjects. All patients and control subjects had electrocardiography (ECG) recordings and routine transthoracic echocardiographic examination. Pulse wave velocity (PWV) was assessed with a Holter blood pressure device.
Results: In total, 50 PV patients, 50 ET patients, and 50 control group were included in the study. The demographic characteristics of the PV, ET and control groups were similar. The PR interval was significantly shorter in control subjects than in PV and ET patients (p:0.007, p:0.024). Although the measured values were within normal limits, diastolic posterior wall thickness was significantly lower in the control group compared to PV and ET patients (p:0.019, p:0.009). PWV was significantly higher in ET patients compared to the control group (p:0.012).
Conclusion: In this study, evaluating the effects of PV and ET on electrocardiography and transthoracic echocardiography; ECG parameters used to predict ventricular arrhythmias (QT, QTc, Tp-Te, Tp-Te/QT) and Pulmonary Artery Pressure showed no significant change, in opposition to existing literature. Nonetheless, similar to previous publications, PV and ET were found to negatively affect the diastolic function parameters on transthoracic echocardiography. While the aortic stiffness was significantly higher in ET patients compared to the control group, no significant difference was noted between PV patients and control subjects in terms of aortic stiffness.

Anahtar Kelimeler

Polycythemia vera, Essential thrombocythemia, electrocardiography, echocardiography

Polistemi Vera ve Esansiyel Trombositemi Tanısı Alan Hastalarda Elektrokardiyografik ve Ekokardiyografik Bulgularının Değerlendirilmesi

Öz

Amaç: Polisitemia vera (PV) ve Esansiyel trombositemi (ET) kronik myeloproliferatif hastalıklardır. Myeloproliferatif seride artışla beraber arterial ve venöz trombozlar, pulmoner hipertansiyon, miyokarda infarktüsü gibi çeşitli klinik sonuçlar oluşturabilmektedirler. Çalışmamızda bu hastalıkların kalp üzerine etkilerini elektrokardiyografi ve ekokardiyografi ile değerlendirme amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza PV tanılı 50 hasta ET tanılı 50 hasta ve kontrol grubu olarak sağlıklı 50 kişi alındı. Hasta demografik bilgilerine ilişkin veriler tüm deneklerde kaydedildi. Tüm hastalara ve kontrollere elektrokardiyografi (EKG) kayıtları ve rutin transtorasik ekokardiyografik inceleme yapıldı. Nabız dalga hızı (PWV), bir Holter kan basıncı cihazı ile değerlendirildi.
Bulgular: Çalışmaya toplam 50 PV hastası, 50 ET hastası ve 50 kontrol grubu dahil edildi. PV, ET ve kontrol gruplarının demografik özellikleri benzerdi. PR aralığı, kontrol olgularında PV ve ET hastalarına göre anlamlı olarak daha kısaydı (p = 0.007, p = 0.024). Ölçülen değerler normal sınırlarda olmasına rağmen kontrol grubunda diyastolik arka duvar kalınlığı PV ve ET hastalarına göre anlamlı olarak düşüktü (p = 0,019, p = 0,009). PWV, ET hastalarında kontrol grubuna göre anlamlı olarak yüksekti (p = 0.012).
Sonuç: Ventriküler aritmileri öngörmek için kullanılan EKG parametreleri (QT, QTc, Tp-Te, Tp-Te/QT) ve Pulmoner Arter Basıncı mevcut literatürün aksine anlamlı bir değişiklik göstermedi. Bununla birlikte, önceki yayınlara benzer şekilde, transtorasik ekokardiyografide PV ve ET’nin diyastolik fonksiyon parametrelerini olumsuz etkilediği bulundu. Aort sertliği ET hastalarında kontrol grubuna göre anlamlı olarak yüksek bulunurken, PV hastaları ile kontrol grubu arasında aort sertliği açısından anlamlı fark saptanmadı.

Anahtar Kelimeler

Polisitemia vera, Esansiyel trombositemi, elektrokardiyografi, ekokardiyografi, Pulse Wave Velosite

Kaynakça

• Spivak JL, Barosi G, Tognoni G, Barbui T, Finazzi G, Marchioli R, et al. Chronic myeloproliferative disorders. Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program. 2003.
• Demircioglu S, Budancamanak S, Dogan A. Can Serum B12 Level Be Used As An Effective Differential Criterion in Differential Diagnosis of Primary and Secondary Polycythemia. Selcuk Tip Dergisi. 2020 Mar 1;1(36):22–6.
• Gökgöz Z, Özdemirkıran F, Cömert M, Saydam G. Kronik Miyeloproliferatif Neoplazi Tanılı 114 Hastanın İncelemesi. Selçuk Tıp Dergisi. 2014;30(4):169–71.
• Watson K V., Key N. Vascular complications of essential thrombocythaemia: a link to cardiovascular risk factors. Br J Haematol. 1993;198–203.
• Tefferi A, Rumi E, Finazzi G, Gisslinger H, Vannucchi AM, Rodeghiero F, et al. Survival and prognosis among 1545 patients with contemporary polycythemia vera: An international study. Leukemia. 2013;
• Vianello F, Battisti A, Cella G, Marchetti M, Falanga A. Defining the thrombotic risk in patients with myeloproliferative neoplasms. TheScientificWorldJournal. 2011.
• Elliott MA, Tefferi A. Thrombosis and haemorrhage in polycythaemia vera and essential thrombocythaemia. British Journal of Haematology. 2005. p. 275–90.
• Besses C, Cervantes F, Pereira A, Florensa L, Solé F, Hernández-Boluda JC, et al. Major vascular complications in essential thrombocythemia: A study of the predictive factors in a series of 148 patients. Leukemia. 1999;
• Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F, et al. Hydroxyurea for Patients with Essential Thrombocythemia and a High Risk of Thrombosis. New England Journal of Medicine. 1995;
• Gao W, Shen W, Luo X, Shi H, Jiang X, Pan J. ST-segment elevation myocardial infarction in patient with essential thrombocythemia without associated risk. Int J Cardiol. 2015;
• Barbui T, Finazzi G, De Gaetano G, Marchioli R, Tognoni G, Patrono C, et al. Polycythemia vera: The natural history of 1213 patients followed for 20 years. Ann Intern Med. 1995;
• Skretteberg PT, Bodegård J, Kjeldsen SE, Erikssen G, Thaulow E, Sandvik L, et al. Interaction between inflammation and blood viscosity predicts cardiovascular mortality. Scandinavian Cardiovascular Journal. 2010;
• Cho Y Il, Cho DJ. Hemorheology and microvascular disorders. Korean Circulation Journal. 2011.
• Cetin MS, Cetin EHO, Balci KG, Aydin S, Ediboglu E, Bayraktar MF, et al. The association between whole blood viscosity and coronary collateral circulation in patients with chronic total occlusion. Korean Circ J. 2016;
• Li RY, Cao ZG, Li Y, Wang RT. Increased whole blood viscosity is associated with silent cerebral infarction. Clin Hemorheol Microcirc. 2015;
• Caimi G, Messina L, Alfano R, Canincr B, Fabbiano A, Cammarata AM, et al. Haemorheological profile in subjects with nonvalvular atrial fibrillation. Clin Hemorheol Microcirc. 1999;
• Naghedi-Baghdar H, Nazari SM, Taghipour A, Nematy M, Shokri S, Mehri MR, et al. Effect of diet on blood viscosity in healthy humans: a systematic review. Electron Physician. 2018;
• Schafer AI. Bleeding and thrombosis in the myeloproliferative disorders. Blood. 1984.
• Bellucci S, Janvier M, Tobelem G, Flandrin G, Charpak Y, Berger R, et al. Essential thrombocythemias. Clinical evolutionary and biological data. Cancer. 1986;
• Hoffman R SM. Hematology: Basic Principles and Practice. Ann Intern Med. 1991;
• Rossi C, Randi ML, Zerbinati P, Rinaldi V, Girolami A. Acute coronary disease in essential thrombocythemia and polycythemia vera. J Intern Med. 1998;
• Arellano-Rodrigo E, Alvarez-Larrán A, Reverter JC, Villamor N, Colomer D, Cervantes F. Increased platelet and leukocyte activation as contributing mechanisms for thrombosis in essential thrombocythemia and correlation with the JAK2 mutational status. Haematologica. 2006;
• Falanga A, Marchetti M, Vignoli A, Balducci D, Barbui T. Leukocyte-platelet interaction in patients with essential thrombocythemia and polycythemia vera. Exp Hematol. 2005;
• Antzelevitch C. Heterogeneity and cardiac arrhythmias: An overview. Heart Rhythm. 2007;
• Okutucu S, Karakulak UN, Aksoy H, Sabanoglu C, Hekimsoy V, Sahiner L, et al. Prolonged Tp-e interval and Tp-e/Qt correlates well with modified Rodnan skin severity score in patients with systemic sclerosis. Cardiol J. 2016;
• Yan GX, Martin J. Electrocardiographic T wave: A symbol of transmural dispersion of repolarization in the ventricles. Journal of Cardiovascular Electrophysiology. 2003.
• Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. Tp-e/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;
• 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;
• Kayrak M, Acar K, Gul EE, Abdulhalikov T, Baǧlicaklioǧlu M, Sonmez O, et al. Electrocardiographic findings in patients with polycythemia vera. Int J Med Sci. 2011;
• Krishnamoorthy P, Kalla A, Gopalakrishnan A, Mittal V, Garg J, Patel NC, et al. Polycythemia vera is associated with increased atrial fibrillation compared to the general population: Results from the national inpatient sample database. Circulation. 2016;
• Ibrahime, Osama A, Muhamad R. Abdel Hameed MMF. Diastolic Dysfunction in Patients with Myeloproliferative Neoplasms. The Journal of the Egyptian Society of Haematology & Research. 2014;10(1).
• Kayrak M, Acar K, Gul EE, Baǧlicaklioǧlu M, Kaya Z, Sonmez O, et al. Assessment of left ventricular myocardial performance by tissue doppler echocardiography in patients with polycythemia vera. Echocardiography. 2011;
• Sethi S, Rivera O, Oliveros R, Chilton R. Aortic stiffness: Pathophysiology, clinical implications, and approach to treatment. Integrated Blood Pressure Control. 2014.
• Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness. A Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2010;