The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure

Öz

Aim: To evaluate cardiac arrhythmias with surface 12 lead electrocardiography (ECG) parameters during pregnancy in women with mild heart failure.

Material and Cardiovascular deaths usually occur in older pregnancies and arrhythmia is the third most common cause. Our study aimed to determine whether the risk of arrhythmia increases in pregnancy with advanced age.Go to:Methods:This cross-sectional study was approved by the local ethics committee of bicard clinic and our hospital 53 consecutive patients were accepted. All patients were admitted to hospital for cesarean section. Patients were grouped to heart failure (group 1) and control (group 2) (healthy group). A 12 lead ECG and N-terminal pro B-type natriuretic peptide (NT-pro BNP) plasma levels was recorded for every woman at 48 hour before cesarean section. They were evaluated P wave, qt, qtc and Twave peak to end, preoperative NT-pro BNP and compared statistically.

In total, 280 pregnant women, of whom 98 were of advanced age and 182 were under 35 years of age were included in the study. The risk of arrhythmia was evaluated by calculating the electrocardiographic P-wave duration, QT interval, T peak-to-end interval, and the Tp-e/QT ratio.Go to:Results: There were statistically significant differences in the Tp–e interval and Tp-e/QTc ratio between the two groups, the maximum QTc, minimum QTc, and QTc dispersion values, P wave dispersion were significantly higher in group-1 compared to the group-2. In addition, preoperative NT-pro BNP plasma levels was greater in the group 1 pregnant women. And there was a positive correlation between ECG parameters and NT-pro BNP plasma levels in group 1.

Although there were no differences in the Tp-e interval and Tp-e/QTc ratio between the groups, the maximum QTc, minimum QTc, and QTc dispersion values were significantly higher in advanced-age pregnancies compared to the control group. In addition, the P dispersion was greater in advanced-age pregnancies. In correlation analysis, the increased dispersion of QTc and P were positively correlated with maternal age. Multiple linear regression analysis showed that QTc dispersion was independently associated with maternal age.

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Conclusion: In conclusion, repolarization parameters were increased in patients with heart failure with elevated NT-pro BNP. Pregnancy and heart failure has known risk for pregnant women. But there is no clear cut atrial and ventricular arrhythmias risk scoring parameters for these kind patients. We found that ECG parameters which had significantly different in pregnant women with heart failure than control group and these changes correlated with NT-pro BNP levels. This is pathological; arrhythmia risk scorings should be established to reduce mortality and morbidity in heart failure patients with elevated BNP levels. 

Anahtar Kelimeler

• Cardiac arrhythmias,repolarization parameters,pregnancy,heart failure,NT-pro BNP,electrocardiography

Kalp yetersizliği olan hamile kadınlarda yeni elektrokardiyografik parametreler ile aritmi riskinin hesaplanması

Öz

Amaç: Hafif kalp yetmezliği olan kadınlarda gebelik sırasında 12 elektrokardiyografi (EKG) parametresi ile kardiyak aritmi değerlendirmek.

Gereç ve Yöntemler: Bu kesitsel çalışma, bicard kliniği yerel etik kurul tarafından onaylandı ve hastanemizdeki ardışık 53 hasta kabul edildi. Tüm hastalar sezaryen için hastaneye başvurdu. Hastalar kalp yetmezliği (grup 1) ve kontrol (grup 2) (sağlıklı grup) olarak gruplandırıldı. 12 kanallı EKG ve N-terminal pro B tipi natriüretik peptid (NT-pro BNP) plazma seviyeleri her kadın için sezaryenden önce 48 saatte kaydedildi. P dalgası, qt, qtc ve Twave zirve sonu, preoperatif NT-pro BNP olarak değerlendirildi ve istatistiksel olarak karşılaştırıldı.

Bulgular: İki grup arasında Tp-e intervali ve Tp-e / QTc oranlarında istatistiksel olarak anlamlı farklılıklar, maksimum QTc, minimum QTc ve QTc dispersiyon değerleri, P dalgası dispersiyonu grup-1'de grup-2 ye göre anlamlı olarak yüksek bulundu. . Ek olarak, grup 1 gebelerde preoperatif NT-pro BNP plazma seviyeleri daha fazlaydı. Ve grup 1'de EKG parametreleri ve NT-pro BNP plazma seviyeleri arasında pozitif bir korelasyon vardı.

Sonuç: Sonuç olarak, artmış NT-pro BNP ile kalp yetmezliği olan hastalarda repolarizasyon parametreleri artmıştır. Hamilelik ve kalp yetmezliği, hamile kadınlar için bilinen risktir. Ancak bu tür hastalar için açık atriyal ve ventriküler aritmiler risk skorlama parametreleri yoktur. Kalp yetmezliği olan gebelerde kontrol grubuna göre anlamlı derecede farklı olan EKG parametrelerinin, NT-pro BNP düzeyleri ile korele olduğunu bulduk. Bu patolojik; artmış BNP düzeyi olan kalp yetmezliği hastalarında mortalite ve morbiditeyi azaltmak için aritmi riski skorlamaları oluşturulmalıdır.

Anahtar Kelimeler

• Cardiac arrhythmias,repolarization parameters,pregnancy,heart failure,electrocardiography

Kaynakça

1. 1. Astolfi P, Zonta L. Delayed maternity and risk at delivery. Paediatr Perinat Epidemiol 2002; 16: 67–72.
2. 2. Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002; 109: 399–403.
3. 3. Bateman BT, Simpson LL. Higher rate of stillbirth at the extremes of reproductive age:a large nationwide sample of deliveries in the United States. Am J Obstet Gynecol 2006; 194: 840–45.
4. 4. Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries:a systematic review of the literature. Sex Transm Dis 2007; 34: 11–21.
5. 5. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004; 104: 727–33.
6. 6. Briller J, Koch AR, Geller SE. Maternal Cardiovascular Mortality in Illinois, 2002-2011. Obstet Gynecol 2017; 129: 819–26.
7. 7. Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol. 1997; 79: 1061–64.
8. 8. Rosano GM, Leonardo F, Sarrel PM, Beale CM, De Luca F, Collins P. Cyclical variation in paroxysmal supraventricular tachycardia in women. Lancet 1996; 347: 786–68.

9. 9. Kirbas A, Kirbas O, Daglar K et al. Novel indexes of arrhythmogenesis in preeclampsia:QT dispersion, Tp-e interval, and Tp-e/QT ratio. Pregnancy Hypertens 2016; 6: 38–41.
10. 10. Tanindi A, Akgun N, Pabuccu EG et al. Electrocardiographic P-Wave Duration, QT Interval, T Peak to End Interval and Tp-e/QT Ratio in Pregnancy with Respect to Trimesters. Ann Noninvasive Electrocardiol 2016; 21: 169–74.
11. 11. Braschi A, Abrignani MG, Francavilla VC, Abrignani V, Francavilla G. Age- and sex-based reference ranges for non-invasive ventricular repolarisation parameters. Int J Clin Pract 2017; 71
12. 12. Elming H, Holm E, Jun L et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J 1998; 19: 1391–400.
13. 13. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000; 36: 1749–66.
14. 14. 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.
15. 15. V Madras, N Challa.Electrocardiographic variations during three trimesters of normal pregnancy. Int J Res Med Sci 2015; 3: 2218-22.
16. 16. Hüseyin Altuğ Çakmak , Burcu Dinçgez Çakmak , Gülten Özgen , Mehmet Gül , Ayşe Ender Yumru. P-Wave and QT Dispersion in Pregnant Women with Preeclampsia. Jarem 2016; 6: 170-76.
17. 17. Ozmen N, Cebeci BS, Yiginer O, Muhcu M, Kardesoglu E, Dincturk M. P-wave dispersion is increased in pregnancy due to shortening of minimum duration of P: does this have clinical significance. J Int Med Res 2006; 34: 468-74.
18. 18. Batmaz G, Aksoy AN, Aydın S, Ay NK, Dane B. QT interval changes in term pregnant women living at moderately high altitude. Niger J Clin Pract 2016; 19: 611-15.