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

Yıl 2018, Cilt: 9 Sayı: 4, 331 - 335, 28.12.2018

Hakan Göçer Özlem Kayacık Günday Mustafa Ünal

https://doi.org/10.18663/tjcl.464494

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.

Go to:

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

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