Akut kolesistitli hastalarda yeni elektrokardiyografik parametrelerin değerlendirilmesi

Yıl 2019, Cilt: 3 Sayı: 3, 236 - 240, 26.10.2019

Can Ramazan Oncel Hasan Calis

https://doi.org/10.30565/medalanya.558816

Öz

Amaç: Akut kolesistit (AC), kardiyovasküler hastalıkları taklit eden elektrokardiyografik değişiklikler gösterebilir. Bu çalışmanın amacı AC'li hastalarda elektrokardiyografik değişiklikleri yeni parametrelerle değerlendirmektir. 

Yöntemler: Çalışmaya AC 'li 34 hasta ve 30 kontrol dahil edildi. Kontrol grubu, herhangi bir kardiyovasküler ve sistemik hastalığı olmayan yaş ve cinsiyet uyumlu bireylerden oluşuyordu. Demografik ve klinik veriler kaydedildi. Elektrokardiyografik ölçümler QT aralığını, düzeltilmiş QT (QTc) aralığını, T dalgasının tepe noktası ve sonu (Tp-e), Tp-e / QT oranını ve p dalga sürelerini hesaplamak için yapıldı. 

Bulgular: Çalışmamızda demografik veriler ve klinik özellikler açısından iki grup arasında anlamlı fark yoktu. QT aralığı, düzeltilmiş QT (QTc) aralığı, T dalgasının tepe noktası ve sonu (Tp-e) ve p dalgası süreleri iki grupta benzerdi. İki grup arasında p dalga dispersiyonu ve Tp-e / QT oranı açısından istatistiksel olarak anlamlı bir fark bulunmadı. 

( 38.0 ± 3.9 vs 37.9 ± 4.4, p: 0.930 ; 0.21 ± 0.07 vs 0.20 ± 0.09 , p: 0.260 sırasıyla ) 

Sonuç: Akut kolesistitli hastalar, sağlıklı kontroller ile karşılaştırıldığında elektrokardiyografide miyokard ve atriyumun benzer elektrofizyolojik özelliklerine sahiptir. 

Anahtar Kelimeler

Kolesistit, elektrokardiyografi, elektrofizyoloji

Evaluation of the novel electrocardiographic parameters in patients with acute cholecystitis

Öz

Aim: Acute cholecystitis (AC) can display electrocardiographic changes mim-icking cardiovascular disorders. The aim of this study is to evaluate electrocardio-graphic changes with novel parameters in patients with AC. Methods: This study included 34 patients with AC and 30 controls. Control group was consisted of age and gender matched individuals without any cardiovascular and systemic disease. Demographic and clinical data were recorded. The electro-cardiographic measurements were done in order to calculate QT interval , corrected QT (QTc) interval, peak and the end of the T wave (Tp-e), Tp-e/QT ratio and p wave durations.

Results: In our study there was no significant difference between two groups in terms of demographic data and clinical features. QT interval , corrected QT (QTc) interval, peak and the end of the T wave (Tp-e), and p wave durations were similiar in the two groups. No statistically significant difference was found between two groups in terms of p wave dispersion and Tp-e/QT ratio. ( 38.0±3.9 vs 37.9±4.4, p:0.93; 0.21±0.07 vs 0.20±0.09, p:0.26 respectively)

Conclusion: Patients with acute cholecystitis have similiar electrophysiological prop-erties of myocardium and atrium on electrocardiography as compared with healthy controls. 

Anahtar Kelimeler

Cholecystitis, electrocardiography, electrophsiology

Kaynakça

• 1. Indar AA, Beckingham IJ. Acute cholecystitis. Br Med J 2002;325(7365):639-43. PMID:12242178
• 2. Ozeki M, Takeda Y, Morita H, Miyamura M, Sohmiya K, Hoshiga M, et al. Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department. BMC Res Notes. 2015;8:805. PMID: 26686987
• 3. Aksay E, Ersel M, Kiyan S, Musalar E, Gungor H. Acute coronary syndrome mimicked by acute cholecystitis. Emerg Med Australas. 2010;22(4):343-46. PMID: 20796011 4. Seewoodhary J, Griffin L. Trifascicular block and a raised Troponin 'T' in acute cholecystitis. QJM. 2010;103(2):121-23. PMID: 19846576
• 5. Soric M, Miletic W, Ziga S, Grabovac V. Intermittent Complete Heart Block in Acute Calculous Cholecystitis. SIGNA VITAE 2015; 10(SUPPL 1): 53-54. DOI:10.22514/SV101.062015.14
• 6. Okutucu S, Aytemir K, Oto A. P-wave dispersion: What we know till now? JRSM Cardiovasc Dis. 2016;5:2048004016639443. PMID:27081484
• 7. Dural M, Mert KU, İskenderov K. Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with mitral valve stenosis before and after balloon valvuloplasty. Anatol J Cardiol. 2017;18(5):353-60. PMID: 29044094
• 8. Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005;38(3):279–84. PMID:16003716
• 9. 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. PMID:18790499
• 10. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54. PMID: 29032636
• 11. Hodges MS, Salerno D, Erlinen D. Bazett's QT correction reviewed: evidence that a linear QT correction for heart rate is better. J Am Coll Cardiol. 1983;1:694.
• 12. R.M. Lang, L.P. Badano, V. Mor-Avi, J. Afilalo, A. Armstrong, L. Ernande, 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. PMID:25559473
• 13. Ryan ET, Pak PH, DeSanctis RW. Myocardial infarction mimicked by acute cholecystitis. Ann Intern Med 1992;116(3):218–20. PMID:1728205
• 14. Franzen D, Jung S, Fatio R, Brunckhorst CB. Complete atrioventricular block in a patient with acute cholecystitis: a case of cardio-biliary reflex? Eur J Emerg Med 2009;16(6):346-47. PMID:19904083
• 15. Durning SJ, Nasir JM, Sweet JM, Cation L. Chest pain and ST segment elevation attributable to cholecystitis: a case report and review of the literature. Mil Med. 2006;171(12):1255-258. PMID:17256696
• 16. Demarchi MS, Regusci L, Fasolini F. Electrocardiographic changes and false-positive troponin I in a patient with acute cholecystitis. Case Rep Gastroenterol. 2012;6(2):410-14. PMID: 23055951
• 17. Grautoff S, Balog M, Winde G. Pseudo-Wellens' syndrome and intermittent left bundle branch block in acute cholecystitis. Am J Emerg Med. 2018;36(7):1323. PMID: 29661666
• 18. Molinari C, Grossini E, Mary DA, Vacca G. Effect of distension of the gallbladder on plasma renin activity in anesthetized pigs. Circulation. 2000;101(21):2539-545. PMID:10831530
• 19. Patel N, Ariyarathenam A, Davies W, Harris A. Acute cholecystits leading to ischemic ECG changes in a patient with no underlying cardiac disease. JSLS. 2011;15(1):105-8. PMID:21902954
• 20. Vacca G, Battaglia A, Grossini E, Mary DA, Molinari C. Reflex coronary vasoconstriction caused by gallbladder distension in anesthetized pigs. Circulation. 1996;94(9):2201-209. PMID:8901672
• 21. Pak M, Lindseth G. Risk Factors for Cholelithiasis. Gastroenterol Nurs. 2016;39(4):297-309. PMID:27467059
• 22. Aytemir K, Özer N, Atalar E, Sade E, Aksöyek S, Övünç K, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23(47):1109-112. PMID: 10914366
• 23. Akin F, Firatli I, Katkat F, Gurmen T, Ayca B, Kalyoncuoglu M et al. P-wave dispersion and its relationship with the severity of the disease in patients with stable coronary artery disease. North Clin Istanb. 2014;1(2):65-70. PMID:28058305
• 24. Turkmen M, Barutcu I, Esen AM, Karakaya O, Esen O, Basaran Y. Effect of slow coronary flow on P-wave duration and dispersion. Angiology. 2007;58(4):408-12. PMID:17652223
• 25. Haarmark C, Hansen PR, Vedel-Larsen E, Pedersen SH, Graff C, Andersen MP et al. The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol. 2009;42(6):555-60. PMID:19643432
• 26. Taşolar H, Ballı M, Çetin M, Otlu YÖ, Altun B, Bayramoğlu A. Effects of the coronary collateral circulation on the Tp-e interval and Tp-e/QT ratio in patients with stable coronary artery disease. Ann Noninvasive Electrocardiol. 2015;20(1):53-61 PMID:24934391
• 27. 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. PMID:12109867
• 28. Lazzerini PE, Capecchi PL, Bertolozzi I, Morozzi G, Lorenzini S, Simpatico A, et al. Marked QTc Prolongation and Torsades de pointes in Patients with Chronic Inflammatory Arthritis. Front Cardiovasc Med. 2016;3:31. PMID: 27703966