The assessment of Tp-e interval and Tp-e/QT ratio in patients with morbid obesity before and after laparoscopic sleeve gastrectomy

Öz

Aim: Tp-e/QT ratio is a novel marker of ventricular repolarisation. Obesity has been associated with various cardiovascular changes and an increased risk of cardiovascular disease. Obesity may be associated with prolongation of the QT interval, which could potentially increase the risk of ventricular arrhythmias. We aimed to research the assessment of Tp-e interval and Tp-e/QT ratio before and after laparoscopic sleeve gastrectomy (LSG) in patients with morbid obesity. Material and Methods: In this study, we enrolled 93 consecutive patients with a BMI >40 kg/m2 or BMI >35kg/m2 with comorbidities who had previously failed to lose weight with conservative methods underwent LSG between January 2012 and December 2016. Results: Heart rate (75.7 ± 4.7 vs. 72.8 ± 11.4; p=0.486), QT interval (358.1 ± 32.0 vs. 362.6 ± 30.4; p=0.399) and QTc interval (399.0 ± 34.3 vs. 396.2 ± 30.9; p=0.621) were similar before and after LSG. Tp-e interval (81.3 ± 11.4 vs. 76.3 ± 10.9; p=0.004), Tp-e/QT ratio (0.23 ± 0.04 vs. 0.21 ± 0.04; p=0.002), Tp-e/QTc ratio (0.20 ± 0.03 vs. 0.19 ± 0.03; p=0.001) were significantly different before and after LSG. Conclusion: Our study showed that morbid obesity may have a negative effect on ventricular repolarization. Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization.

Anahtar Kelimeler

• Laparoscopic sleeve gastrectomy
• morbid obesity
• QT interval
• Tp-e interval
• Tp-e/QT ratio
• ventricular repolarization.

Morbid obezite hastalarında laparoskopik sleeve gastrektomi öncesi ve sonrası Tp-e aralığı ve Tp-e/QT oranının değerlendirilmesi

Öz

Amaç: Tp-e/QT oranı, ventriküler repolarizasyonun yeni bir belirtecidir. Obezite, çeşitli kardiyovasküler değişiklikler ve artan kardiyovasküler hastalık riski ile ilişkilendirilmiştir. Obezite, ventriküler aritmi riskini potansiyel olarak artırabilen QT aralığının uzaması ile ilişkili olabilir. Morbid obezitesi olan hastalarda laparoskopik tüp mide operasyonu (LSG) öncesi ve sonrası Tp-e aralığı ve Tp-e/QT oranının değerlendirilmesini araştırmayı amaçladık. Gereç ve yöntemler: Bu çalışmada, Ocak 2012 ile Aralık 2016 tarihleri arasında BMI >40 kg/m2 veya komorbiditeleri ve BMI >35kg/m2 olan ve daha önce konservatif yöntemlerle kilo vermeyi başaramayan 93 hastaya ardışık olarak LSG uygulandı. Bulgular: Kalp hızı (75,7 ± 4,7 vs 72,8 ± 11,4; p=0,486), QT aralığı (358,1 ± 32,0 vs 362,6 ± 30,4; p=0,399) ve QTc aralığı (399,0 ± 34,3 vs 396,2 ± 30,9; p=0,621) LSG öncesi ve sonrası benzerdi. Tp-e aralığı (81,3 ± 11,4 vs 76,3 ± 10,9; p=0,004), Tp-e/QT oranı (0,23 ± 0,04 vs 0,21 ± 0,04; p=0,002), Tp-e/QTc oranı (0,20 ± 0,03) vs. 0,19 ± 0,03; p=0,001) LSG öncesi ve sonrasında anlamlı olarak farklıydı. Sonuç: Çalışmamız morbid obezitenin ventriküler repolarizasyon üzerinde olumsuz etkisi olabileceğini göstermiştir. Obez hastalarda laparoskopik sleeve gastrektomiyi takiben önemli kilo kaybına, ventriküler repolarizasyonda önemli bir iyileşme eşlik eder.

Anahtar Kelimeler

• Laparoskopik sleeve gastrektomi; morbid obezite
• QT aralığı
• Tp-e aralığı
• Tp-e/QT oranı
• ventriküler repolarizasyon.

Kaynakça

1. Yayla C, Ozcan F, Aras D, et al. Tp-e interval and Tp-e/QT ratio before and after catheter ablation in patients with premature ventricular complexes. Biomark Med 2017;11:339-46.
2. Pathak RK, Mahajan R, Lau DH, Sanders P. The implications of obesity for cardiac arrhythmia mechanisms and management. Can J Cardiol 2015;31:203-10.
3. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 2008;117:1658-67.
4. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008;41:575-80.
5. Zhao X, Xie Z, Chu Y, 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;35:559-64.
6. Gul M, Inci S, Ozkan N, Alsancak Y. Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study. Herz 2021;46:567-74.
7. Kuczmarski RJ, Flegal KM. Criteria for definition of overweight in transition: background and recommendations for the United States. Am J Clin Nutr 2000;72:1074-81.
8. Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts 2008;1:52-9.

9. Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts 2013;6:449-68.
10. Castro Hevia J, Antzelevitch C, Tornes Barzaga F, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006;47:1828-34.
11. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-77.
12. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev 2008;88:389-419.
13. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 2006;47:362-7.
14. Grasser EK, Ernst B, Thurnheer M, Schultes B. QT Interval Shortening After Bariatric Surgery Depends on the Applied Heart Rate Correction Equation. Obes Surg 2017;27:973-82.
15. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021;143:e984-e1010.
16. Adabag S, Huxley RR, Lopez FL, et al. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study. Heart 2015;101:215-21.
17. Pietrasik G, Goldenberg I, McNitt S, Moss AJ, Zareba W. Obesity as a risk factor for sustained ventricular tachyarrhythmias in MADIT II patients. J Cardiovasc Electrophysiol 2007;18:181-4.
18. Russo V, Ammendola E, De Crescenzo I, et al. Effect of weight loss following bariatric surgery on myocardial dispersion of repolarization in morbidly obese patients. Obes Surg 2007;17:857-65.
19. 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;97:467-72.
20. Kors JA, van Herpen G, van Bemmel JH. QT dispersion as an attribute of T-loop morphology. Circulation 1999;99:1458-63.
21. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567-74.
22. Antzelevitch C, Sicouri S, Di Diego JM, et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart rhythm : the official journal of the Heart Rhythm 2007;4:1114-6; author reply 6-9.