Diyabetik Retinopati Kardiyak Ekseni Değiştirir mi?

Öz

Amaç: Bu yazıdaki amacımız, Diyabetik retinopatili (DRP) hastalarda kardiyak ileti sisteminin etkilenip etkilenmediğini ve frontal QRS-T açısı (F-QRS-T-A) ile DRP arasındaki bağlantıyı araştırmaktır. Materyal ve Metod:Çalışmaya, hastanemiz göz hastalıkları bölümüne başvuran Tip-2 diyabetes mellitus (DM) olup, DRP olmayan 40 hasta, DRP olan (proliferatif ve non-proliferatif) 48 hasta, DM olmayan kontrol grubu 88 kişi olmak üzere toplam 176 hasta alındı. Hastalar kardiyovasküler açıdan muayene edildi. Bütün veriler demografik ve klinik özellikleri açısından karşılaştırıldı. F-QRS-T-A, elektrokardiyografik olarak QRS ile T arasındaki açı farkı alınarak hesap-landı. Sonuçlarda, p <0.05 değeri anlamlı olarak değerlendirildi. Bulgular:Bütün gruplarda yaş, hipertansiyon, sigara kullanımı benzerdi. DRP olanlarda, olmayanlara göre diyabet sü-resi, glukoz ve HbA1c, kalp atımı, trigliserit, F-QRS-T-A değeri anlamlı olarak daha yüksek saptandı (p<0.001). Tek değişkenli lojistik regresyon analizlerinde, DM süresi (OR: 2,098, %95 GA , 1,521-2,894, p<0.001), serum glukoz düzeyi (OR: 1,078, %95 GA, 1,049-1,108, p<0.001), HbA1c düzeyi (OR: 35,328, %95 GA , 4,067-36,893, p=0.001), F-QRS-T-A (OR: 1,074, %95 GA ,1,048-1,100, p<0.001), trigliserit düzeyleri (OR: 1,006, %95 GA ,1,002-1,011, p=0.006), DRP için bağımsız birer öngördürücü olarak bulundu. Alıcı İşletim Karakteristiği (ROC) eğrisinde, F-QRS-T-A değerinin 27,5 derece üzerindeki değerlerin DRP risk artışı ile ilişkili olduğu bulundu. Sonuç:Çalışma sonucunda, DRP olanlarda, olmayan gruplara göre F-QRS-T-A’nın, yani kalbin elektriksel aksının daha fazla artmış olduğunu bulduk. Aynı zamanda, serum glukoz düzeyi, DM süresi, HbA1c düzeyi, trigliserit düzeyi artışının DRP için artmış bağımsız birer risk faktörü olduğunu saptadık. Düzensiz ve yüksek seyreden kan şekerinin hem kalp hem göz dokusu için olumsuz olaylarla bağlantılı olduğunu bir kez daha göstermiş olduk

Anahtar Kelimeler

• Diyabetik retinopati
• elektrokardiyografi
• frontal QRS-T açısı

Does Diabetic Retinopathy Alter the Cardiac Axis?

Öz

Background: This study aimed to investigate whether the cardiac conduction system is affected in patients with diabetic retinopa-thy (DRP) and the relationship between frontal QRS-T angle (F-QRS-T-A) and DRP. Materials and Methods:A total of 176 patients, including 40 patients with type-2 diabetes mellitus (DM) without DRP, 48 patients with DRP (proliferative and non-proliferative), and 88 patients in the control group without DM were included in the study. Patients were examined for the cardiovascular system. All data are compared in terms of de-mographic and clinical characteristics. F-QRS-T-A was calculated by taking the angle difference between QRS and T electrocardiographically. In the results, a value of p < 0.05 was considered significant. Results: Age, hypertension, and smoking were similar in all groups. Duration of DM, glucose and HbA1c, heart rate, triglycerides, and F-QRS-T-A value were found to be significantly higher in patients with DRP compared with those without DRP (p<0.001). In univariate logistic regression analyses, duration of DM (OR: 2,098, %95 GA, 1,521 - 2,894, p<0.001), serum glucose level (OR: 1,078, %95 GCI, 1.049 – 1.108, , p<0.001), HbA1c level (OR: 35.328, %95 CI ,4.067 – 36.893, p=0.001), F-QRS-T-A (OR: 1.074, %95 CI , 1.048 – 1.100, p<0.001), triglyceride level (OR: 1.006, %95 CI, 1.002 – 1.011, p=0.006) were independent predictors of DRP. In the Receiver Operating Characteristic (ROC) curve, values above 27.5 degrees of F-QRS-T-A were associated with an increased risk of DRP Conclusion: As a result of the study, we found that F-QRS-T-A, the electrical axis of the heart, was more elevated in patients with DRP than in those without DRP. We also found that serum glucose levels, duration of DM, HbA1c levels and triglyceride levels were independent risk factors for DRP. We have again shown that irregular and high blood glucose levels are associated with adverse events for both heart and eye tissue

Anahtar Kelimeler

• Diabetic retinopathy
• electrocardiography
• frontal QRS angle

Kaynakça

1. Van Hecke MV, Dekker JM, Nijpels G, Moll AC, Heine RJ, Bouter LM, et al. Inflammation and endothelial dysfunction are associated with retinopathy: the Hoorn study. Diabetologia. 2005;48(7):1300–1306.
2. Oehler A, Feldman T, Henrikson CA, Tereshcenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014;19(6):534-542.
3. Gunduz R, Usalp S. Predictive value of frontal QRS-T angle after cardiac resynchronisation therapy. J Electrocardiol. 2021 Sep-Oct;68:24-29.
4. Aro AL, Huikuri HV, Tikkanen JT, Rissanen HA, Reunanen A, Anttonen. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace.2012;14(6):872–876.
5. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S20-S42.
6. Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, et al. Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-1682.
7. 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(5):844–849. Usalp ZO, Usalp S. Does the eosinophil-to-monocyte ratio predict inflammation in patients with diabetic retinopathy. Diabetic retinopathy and Eosinophil-to-monocyte ratio. İJCMBS. 2024;4(1):10-14.
8. May O, Graversen C, Johansen M, Arildsen H. A large frontal QRS-T angle is a strong predictor of the long-term risk of myocardial infarction and all-cause mortality in the diabetic population. J Diabetes Complications. 2017;31(3):551–555.

9. Fiorentini A, Perciaccante A, Valente R, Paris A, Serra P, Tubani L.The correlation among QTc interval, hyperglycaemia and the impaired autonomic activity. Auton Neurosci. 2010;154(1-2):94–98.
10. Tamayo M, Fulgencio-Covián A, Navarro-García JA, Val-Blasco A, Ruiz-Hurtado G, Gil-Fernández M, et al. Intracellular calcium mishandling leads to cardiac dysfunction and ventricular arrhythmias in a mouse model of propionic acidemia. Biochim Biophys Acta Mol Basis Dis. 2020;1866(1):165586.
11. Huang C, Lee J, Lin TK, Tsai NW, Huang CR, Chen SF, et al. Diabetic Retinopathy Is Strongly Predictive of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes. J Diabetes Res. 2016;2016:6090749.
12. Usalp S, Taşin B, Kemal HS, Yaman B, Akpınar O, Cerit L,et al. Kalp Hızı Değişkenliği ve Serebrovasküler Olaylar. Harran Üniversitesi Tıp Fakültesi Dergisi. 2020;17(3):378-82.
13. Tanrıverdi Z, Besli F, Gungören F, Tascanov MB. What is the normal range of the frontal QRS-T angle? Diabetes Res Clin Pract. 2020;160:107645.
14. Zhang YT, Li HY, Sun XT, Tong XW, Shan YY, Xu YX, et al. Relationship Between Index of Cardiac Electrophysiological Balance, Frontal QRS-T Angle and Retinopathy in People with Type 2 Diabetes. Diabetes Metab Syndr Obes. 2023;16:861-871.
15. Tascanov MB, Tanrıverdi Z, Gungoren F, Besli F, Bicer yesilay A, Altıparmak HI, et al. The effect of propofol on frontal QRS-T angle in patients undergoing elective colonoscopy procedure. J Clin Pharm Ther. 2020;45:185-190.