Koroner Arter Ektazisi olan hastalarda Kardiyo-elektrofizyolojik denge indeksi ve Tp-e/QT oranının değerlendirilmesi

Öz

Amaç: QRS süresine bölünmüş QT intervali olarak hesaplanan, kardiyak elektrofizyolojik denge indeksi (iCEB), malign ventriküler aritmileri öngörmek için yeni bir risk belirleyicisi olarak tanımlanmıştır. iCEB'nin artmış seviyeleri torsades de pointes (TdP) ve azalan iCEB düzeylerinin ise torsades de pointes olmayan ventriküler taşikardi veya ventriküler fibrilasyona neden olduğunu öngörmektedir. Bu çalışmanın amacı koroner ektazisi (KAE) olan hastalarda iCEB kullanılarak, bu hastalardaki aritmojenik riski değerlendirmektir.

Yöntemler: Vaka kontrolü olarak tasarlanan çalışmamıza polikliniğimize başvuran 130 hasta dahil edildi. İzole KAE'si olan 75 hasta (çalışma grubu) ve 55 sağlıklı birey (kontrol grubu) çalışmaya dahil edildi. Her iki gruba da 12 adet standart elektrokardiyografi çekildi. Tp-Te intervali, QT intervali, QRS intervali, Tp-Te / QT oranı ve QT / QRS oranları (iCEB) kaydedilerek gruplar arasında karşılaştırma yapıldı.

Bulgular: Tp-e intervalleri ve Tp-e / QT oranı çalışma grubunda anlamlı olarak daha yüksek saptandı (p=0,001). Ayrıca iCEB'in, çalışma grubunda sayısal olarak daha yüksek olma eğilimi olduğu bulunmuştur, ancak gruplar arasında istatistiksel olarak anlamlı bir fark bulunamamıştır (p=0,118). Tp-e ve Tpe / QT oranı, iki veya üç damar KAE'si olan hastalarda, tek damar ektazisi olanlardan daha yüksekti (Tp-e için p≤0,024 ve Tpe/QT oranı için p=0,028). iCEB, etkilenen koroner arter sayısı ile daha yüksek bulunmasına rağmen, gruplar arasında istatistiksel olarak fark saptanmadı.

Sonuç: Bulgularımız, KAE hastalarının sağlıklı kontrollere göre daha yüksek Tp-Te ve Tp-Te / QT değerlerine sahip olduğunu göstermektedir. KAE'li bireyler için iCEB kullanılarak artmış aritmojenik riski göstermek için daha fazla çalışmaya ihtiyacımız vardır.

Anahtar Kelimeler

• Aritmi,Koroner arter ektazisi,iCEB,QT/QRS oranı

Evaluation of index of cardio-electrophysiological balance and Tp-e/QT ratio in patients with coronary artery ectasia

Abstract

Aim: Index of cardiac electrophysiological balance (iCEB), calculated as QT interval divided by QRS duration, has been described as a novel risk marker for predicting malignant ventricular arrhythmia. Increased levels of iCEB predict to torsades de pointes (TdP) and decreased levels of iCEB predict to non-torsades de pointes mediated ventricular tachycardia or ventricular fibrillation. The aim of this study is to evaluate arrhythmogenic risk by using iCEB in patients with coronary ectasia (CAE).

Methods: Our study, designed as case-control, included 130 patients who were admitted to our outpatient clinic. 75 patients with isolated CAE (study group) and 55 healthy subjects (control group) were included in the study. Both groups underwent a standard 12-lead surface electrocardiogram and Tp-Te interval, QT interval, QRS interval, Tp-Te/QT ratio and QT/QRS ratio (iCEB) of patients were recorded and compared between groups.

Results: Tp-e intervals and Tp-e/QT ratio is significantly higher in study group (p=0.001). And, İCEB was found as tend to be numerically higher in study group, but we could not match a statistically difference between groups (p=0.118). Tp-e and Tpe/QT ratio were higher in patients with two or three vessels CAE than one vessel (p value; for Tp-e p=0.024 and Tpe/QT ratio p=0.028). Although iCEB was found as higher with affected number of coronary artery, there was no statistically difference between groups.

Conclusion: Our results demonstrate that CAE patients have significantly higher values of Tp-Te and Tp-Te/QT than controls. We need further studies to show increased arrhythmogenesis risk using iCEB for individuals with CAE.

Keywords

• Arrhythmia,Coronary artery ectasia,iCEB,QT/QRS ratio

Kaynakça

1. 1. Sultana R, Sultana N, Ishaq M, Samad A. The prevalence and clinical profile of angiographic coronary ectasia. J Pak Med Assoc. 2011;61:372-5.
2. 2. Demopoulos VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, Adamopoulou E, et al. The natural history of aneurysmal coronary artery disease. Heart. 1997;78(2):136-41.
3. 3. Karakaya O, Saglam M, Barutcu I, Esen AM, Turkmen M, Kargin R, et al. Effects of isolated coronary artery ectasia on electrocardiographic parameters reflecting ventricular heterogeneity. J Electrocardiol. 2007;40(2):203-6.
4. 4. Doi T, Kataoka Y, Noguchi T, Shibata T, Nakashima T, Kawakami S, et al. Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol. 2017;37(12):2350-5.
5. 5. Amit Malviya, Pravin K.Jha, Animesh Mishra. Isolated coronary artery ectasia: Clinical, angiographic, and follow up characteristics. Indian Heart Journal. 2017;69:619–23.
6. 6. Kruger D, Ulrich S, Herrmann G, Simon R, Sheikhzadeh A. Exercise-induced myocardial ischemia in isolated coronary artery ectasia and aneurysms (dilated coronopathy). J Am Coll Cardiol. 1999;34:1461-70.
7. 7. Davies MJ. Pathological view of sudden cardiac death. Br Heart J. 1981;45:88-97.
8. 8. Karaagac K, Yontar OC, Tenekecioglu E, Vatansever F, Ozluk OA, Tutuncu A, et al. Evaluation of Tp-Te interval and Tp-Te/QTc ratio in patients with coronary artery ectasia. Int J Clin Exp Med. 2014;15;7(9): 2865-70.

9. 9. 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;68:250–9.
10. 10. 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.
11. 11. Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia, its prevalence and clinical significance in 4993 patients. Br Heart J. 1985;54:392-5.
12. 12. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol. 1976;37:217-22. 13. Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R, et al. Tpeak-Tend and Tpeak-Tend dis¬persion as risk factors for ventricular tachycar¬dia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006;47:1828-34.
13. 14. Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol. 2002;25(7):335-9.
14. 15. Girouard SD, Rosenbaum DS. Role of wavelength adaptation in the initiation, maintenance, and pharmacologic suppression of reentry. J Cardiovasc Electrophysiol. 2001;12(6):697-607.
15. 16. Yumurtacı O, Kurt C, Ucar MF, O Cihan. Usefulness Of Electrocardiographic Markers To Predict Ventricular Arrhythmias In Acute Myocarditis Patients. Turkish Med. Stud. J. 2017;4:6-10.
16. 17. Ucar FM, Yılmaztepe MA, Taylan G. Evaluation of Index of Cardioelectrophysiological Balance (iCEB) in Patients with Rheumatoid Arthritis. Erciyes Med J. 2018;40(1):8-12.
17. 18. Nafakhi H, Al-Mosawi AA, Alareedh M, Al-Nafakh HA. Index of cardiac electrophysiological balance and transmural dispersion of the repolarization index relationships with pericardial fat volume and coronary calcification. Biomark Med. 2018;12(4):321-8.
18. 19. Sengul C, Özveren O. Epicardial adipose tissue: a review of physiology, pathophysiology, and clinical applications. Anadolu Kardiyol Derg. 2013;13(3):261-5.
19. 20. Hetland M, Haugaa KH, Sarvari SI, Erikssen G, Kongsgaard E, Edvardsen T. A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann. Noninvasive Electrocardiol. 2014;19;330–7.
20. 21. 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;41:567–74.
21. 22. Akyurek O, Berkalp B, Sayin T, Kumbasar D, Kervancioğlu C, Oral D. Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J. 2003;145:66-72.
22. 23. Suzuki H, Takeyama Y, Hamazaki Y, Namiki A, Koba S, Matsubara H, et al. Coronary spasm in patients with coronary ectasia. Cathet Cardiovasc Diagn. 1994;32:1-7.
23. 24. Perlman PE, Ridgeway NA. Thrombus and anticoagulation therapy in coronary ectasia. Clin Cardiol. 1989;12:541-2.
24. 25. Güleç S, Atmaca Y, Kılıçkap M, Akyürek O, Aras O, Oral D. Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia. Am J Cardiol. 2003;91:996-9.