HİPERTANSİF SOL VENTRİKÜL HİPERTROFİSİNİN VENTRİKÜLER REPOLARİZASYON ÜZERİNE ETKİSİ

Yıl 2022, Cilt: 24 Sayı: 1, 16 - 22, 30.04.2022

Hayati Eren Ahmet Seyfeddin Gürbüz Ülker Kaya

https://doi.org/10.24938/kutfd.945436

Öz

Amaç: T dalgasının tepe ve sonu aralığı (Tp-e), Tp-e/QT oranı ve Tp-e/QTc oranı ventriküler repolarizasyonun yeni indeksleridir ve ventriküler aritmiler ile ilişkilendirilmiştir. Hem hipertansiyon hem de sol ventriküler hipertrofi varlığının ventriküler aritmi gelişimi ve ani kardiyak ölüm için bir risk faktörü olduğu bilinmektedir. Bu çalışmada, hipertansiyon hastalarında sol ventriküler hipertrofi varlığının Tp-e aralığı, Tp-e/QT oranı ve Tp-e/QTc oranı üzerindeki etkisini belirlemeyi hedefledik.

Gereç ve Yöntemler: Yeni tanı alan 346 hipertansiyon hastası çalışmaya dahil edildi. Hipertansiyon hastaları ekokardiyografik sol ventriküler hipertrofi varlığına göre iki gruba ayırıldı. Daha sonra yaş ve cinsiyet eşitlemesi yapılan 175 kontrol hastası belirlendi. Tüm hastaların Tp-e aralığı, Tp-e/QT ve Tp-e/QTc oranları, QT ve QTc değerleri 12 derivasyonlu elektrokardiyografi ile ölçülerek gruplar arasında karşılaştırıldı.

Bulgular: Her üç grup arasında bazal özellikler açısından istatistiksel olarak anlamlı bir fark bulunmadı. Tp-e aralığı, Tp-e/QT ve Tp-e/QTc oranının sol ventriküler hipertrofi gelişen hipertansiyon grubunda hem kontrol gurubuna göre hem de sol ventriküler hipertrofi olmayan hipertansiyon grubuna göre daha uzun olduğu tespit edildi. Benzer şekilde geleneksel parametreler olan QT ve QTc değerlerinin de sol ventriküler hipertrofi olan grupta diğer iki gruba göre uzun olduğunu tespit ettik.

Sonuç: Çalışmamız hipertansiyon hastalarında sol ventriküler hipertrofi varlığının Tp-e aralığı, Tp-e/QT ve Tp-e/QTc oranlarını arttırdığını ortaya çıkarmıştır. Sonuçlarımız hipertansiyon hastalarında aritmi gelişimi için ana risk faktörlerinden birisinin sol ventriküler hipertrofi varlığı olduğunu göstermektedir.

Anahtar Kelimeler

Hipertansiyon, Sol ventrikül hipertrofisi, Ventriküler repolarizasyon

Destekleyen Kurum

yok

Proje Numarası

yok

The Effect of Hypertensive Left Ventricular Hypertrophy on Ventricular Repolarization

Öz

Objective: The peak and end interval of the T wave (Tp-e), the Tp-e/QT ratio and the Tp-e/QTc ratio are new indices of ventricular repolarization and have been associated with ventricular arrhythmias. It is known that the presence of both hypertension and left ventricular hypertrophy is a risk factor for the development of ventricular arrhythmia and sudden cardiac death. In this study, we aimed to determine the effect of the presence of left ventricular hypertrophy on Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with hypertension.

Material and Methods: Three hundred and forty-six newly diagnosed hypertension patients were included in the study. Hypertension patients were divided into two groups according to the presence of echocardiographic left ventricular hypertrophy. Then, 175 age and gender adjusted patients were determined as a control group. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios, QT and QTc values of all patients were measured by 12-lead electrocardiography and compared between the groups.

Results: There was no statistically significant difference in baseline characteristics among three groups. Tp-e interval, Tp-e/QT and Tp-e/QTc ratio were found to be longer in the hypertension group with left ventricular hypertrophy compared to both the control group and the group without left ventricular hypertrophy. Similarly, we observed that the QT and QTc values which are known as conventional parameters of ventricular repolarization were longer in the left ventricular hypertrophy group compared to the other two groups.

Conclusion: Our study revealed that the presence of left ventricular hypertrophy in hypertension patients increased the Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Our results show that the presence of left ventricular hypertrophy in patients with hypertension is one of the main risk factors for the development of arrhythmia.

Anahtar Kelimeler

Hypertension, Left ventricular hypertrophy, Ventricular Repolarization.

Proje Numarası

yok

Kaynakça

• 1. Dahlöf B, Devereux R, de Faire U, Fyhrquist F, Hedner T, Ibsen H et al. The Losartan Intervention for Endpoint reduction (LIFE) in hypertension study: rationale, design, and methods. The LIFE Study Group. Am J Hypertens. 1997;10(7 Pt 1):705-13.
• 2. Dahlöf B, Devereux RB, Julius S, Kjeldsen SE, Beevers G, de Faire U et al. Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. Losartan intervention for endpoint reduction in hypertension. Hypertension. 1998;32(6):989-97.
• 3. Passino C, Magagna A, Conforti F, Buralli S, Kozáková M, Palombo C et al. Ventricular repolarization is prolonged in nondipper hypertensive patients: role of left ventricular hypertrophy and autonomic dysfunction. J Hypertens. 2003;21(2):445-51.
• 4. Antzelevitch C, Shimizu W, Yan GX, Sicouri S. Cellular basis for QT dispersion. J Electrocardiol. 1998;30 Suppl:168-75.
• 5. de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study. Circulation. 1998;97(5):467-72.
• 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):575-80.
• 7. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4(8):1114-9.
• 8. 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):567-74.
• 9. Zhao X, Xie Z, Chu Y, Yang L, Xu W, Yang X et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol. 2012;35(9):559-64.
• 10. Luo X, Lin H, Pan Z, Xiao J, Zhang Y, Lu Y et al. Down-regulation of miR-1/miR-133 contributes to re-expression of pacemaker channel genes HCN2 and HCN4 in hypertrophic heart. J Biol Chem. 2008;283(29):20045-52.
• 11. Marionneau C, Brunet S, Flagg TP, Pilgram TK, Demolombe S, Nerbonne JM. Distinct cellular and molecular mechanisms underlie functional remodeling of repolarizing K+ currents with left ventricular hypertrophy. Circ Res. 2008;102(11):1406-15.
• 12. Wang JF, Shan QJ, Yang B, Chen ML, Zou JG, Xu DJ et al. Tpeak-Tend interval as a new risk factor for arrhythmic event in patient with Brugada syndrome. JNMU. 2007;21(4):213-7.
• 13. Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation. 1998;98(18):1928-36.
• 14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.
• 15. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57(6):450-8.
• 16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14.
• 17. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart.1920;(7):353-70.
• 18. Guo D, Young L, Patel C, Jiao Z, Wu Y, Liu T et al. Calcium-activated chloride current contributes to action potential alternations in left ventricular hypertrophy rabbit. Am J Physiol Heart Circ Physiol. 2008;295(1):H97-H104.
• 19. Salles GF, Cardoso CR, Leocadio SM, Muxfeldt ES. Recent ventricular repolarization markers in resistant hypertension: are they different from the traditional QT interval? Am J Hypertens. 2008;21(1):47-53.
• 20. Hlaing T, Guo D, Zhao X, DiMino T, Greenspon L, Kowey PR et al. The QT and Tp-e intervals in left and right chest leads: comparison between patients with systemic and pulmonary hypertension. J Electrocardiol. 2005;38(4 Suppl):154-8.
• 21. Watanabe N, Kobayashi Y, Tanno K, Miyoshi F, Asano T, Kawamura M et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. J Electrocardiol. 2004;37(3):191-200.
• 22. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990;63(6):342-4.
• 23. Saenen JB, Vrints CJ. Molecular aspects of the congenital and acquired Long QT Syndrome: clinical implications. J Mol Cell Cardiol. 2008;44(4):633-46.