Nonalkolik yağlı karaciğer hastalığı olan bireylerde Tp-e intervali ve Tp-e/qt oranı

Yıl 2019, Cilt: 10 Sayı: 3, 358 - 363, 30.09.2019

Bahar Tekin Tak Serkan Çay Mahmut Yüksel Firdevs Ayşenur Ekizler Meral Akdoğan Ayhan Habibe Kafes Çağrı Yayla Ertuğrul Kayaçetin

https://doi.org/10.18663/tjcl.555313

Öz

Giriş:
Elektrokardiyografide (EKG) ventriküler repolarizasyon Tp-e
intervali ve kalp hızına göre düzeltilmiş QT (QTc) aralığı
kullanılarak değerlendirilir. Uzamış Tp-e/QTc oranı aritmiler ve
kardiyak mortalite riskinde artışla ilişkilidir. NASH
(nonalkolik steatohepatit)’
in ventriküler repolarizasyon üzerine etkileriyle ilgili az sayıda
çalışma olduğu için, NASH
hastalarında Tp-e
interval ölçümlerini ve Tp-e/QT oranını değerlendirmeyi
amaçladık.

Gereç
ve Yöntemler:
Çalışmamıza toplam
97 NASH
hastası ile 77 kişilik kontrol grubu dahil edildi. Tp-e intervali,
Tp-e/QT ve Tp-e/QTc oranları 12-lead elektrokardiyogram ile
ölçüldü.

Bulgular:
Kalp hızı her iki grupta da benzerdi (74.8
± 10.1 vs.
75.7
± 11.7;
p=0.598). QT interval (396.0
± 34.2 vs.
384.6
± 30.7;
p=0.023) ve QTc interval (403.6
± 34.8 vs.
399.9
± 36.3;
p=0.027), Tp-e interval (100.4
± 13.6 vs.
91.4
± 13.4;
p<0.001) , Tp-e/QT oranı (0.25
± 0.03 vs.
0.23
± 0.03;
p=0.003) ve Tp-e/QTc oranı (0.23
± 0.03 vs.
0.21
± 0.03;
p=0.002), gruplararası anlamlı olarak farklı saptandı. Tp-e
interval (r= 0.328, p<0.001) ve Tp-e/QTc oranı ile hepatik
steatoz derecesi (r=
0.237, p=0.002) arasında anlamlı bir ilişki mevcuttu.

Sonuç:
NASH

hastalarında Tp-e
interval, QT
interval, QTc interval,
Tp-e/QT ve Tp-e/QTc
oranları uzamıştı.
NASH
‘in artmış Tp-e/QT oranı için bağımsız bir faktör olduğu
bulundu. Bu çalışma NASH
hastalarında Tp-e
intervali ve Tp-e/QT parametrelerinin araştırıldığı ilk
çalışmadır.

Anahtar Kelimeler

Tp-e intervali, Tp-e/QTc oranı, ventirküler repolarizasyon, NASH

Tp-e interval and Tp-e/qt ratio in patients with non alcoholic fatty liver disease

Öz

Aim:   Ventricular repolarization is assessed using
the Tp-e interval and QT interval corrected by the heart rate (QTc) via an
electrocardiogram (ECG). Prolonged Tp-e/QTc is related with an increased risk
of arrhythmias and cardiac mortality. As there have been few reports regarding
the effects of NAFLD on ventricular repolarization, we aimed
to appraise the assessment of Tp-e
interval and Tp-e/QT ratio in patients with NAFLD.

 

Material
and Methods: Totally 97 patients with NAFLD and 77 control subjects were enrolled in our study. Tp-e interval, Tp-e/QT and Tp-e/QTc
ratios were measured from the 12-lead electrocardiogram.

 

Results:
Heart rate was similar between groups (74.8 ± 10.1 vs. 75.7 ± 11.7; p=0.598). QT interval
(396.0 ± 34.2 vs.
384.6 ± 30.7;
p=0.023) and QTc interval  (403.6 ± 34.8 vs. 399.9 ± 36.3; p=0.027), Tp-e
interval (100.4 ± 13.6 vs.
91.4 ± 13.4;
p<0.001) , Tp-e/QT ratio (0.25
± 0.03 vs.
0.23 ± 0.03;
p=0.003) and Tp-e/QTc ratio (0.23
± 0.03 vs.
0.21 ± 0.03;
p=0.002) were significantly different between groups. There was significant
correlation between Tp-e interval  (r=
0.328, p<0.001) and Tp-e/QTc ratio and hepatic steatosis grade (r= 0.237,
p=0.002).

Conclusion:
Tp-e interval, QT
interval, QTc interval, Tp-e/QT and Tp-e/QTc ratios were prolonged in patients
with NAFLD.
NAFLD
is found an independent factor for increased Tp-e/QT ratio. This is the first study that investigated the Tp-e
interval  and Tp-e/QT parameters in patients with NAFLD.

Anahtar Kelimeler

NAFLD, Tp-e interval, Tp-e/QTc ratio, ventricular repolarization

Kaynakça

• 1. Mantovani A. Nonalcoholic Fatty Liver Disease (NAFLD) and Risk of Cardiac Arrhythmias: A New Aspect of the Liver-heart Axis. J Clin Transl Hepatol 2017; 5: 134-41.
• 2. Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363: 1341-50.
• 3. Mantovani A, Ballestri S, Lonardo A, Targher G. Cardiovascular Disease and Myocardial Abnormalities in Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2016; 61: 1246-67.
• 4. Gurdal A, Eroglu H, Helvaci F et al. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with subclinical hypothyroidism. Ther Adv Endocrinol Metab 2017; 8: 25-32.
• 5. Bakiner O, Ertorer ME, Haydardedeoglu FE, Bozkirli E, Tutuncu NB, Demirag NG. Subclinical hypothyroidism is characterized by increased QT interval dispersion among women. Med Princ Pract 2008; 17: 390-94.
• 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: 575-80.
• 7. 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.
• 8. Gupta P, Patel C, Patel H et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41: 567-74.
• 9. Tasolar H, Balli M, Bayramoglu A et al. Effect of smoking on Tp-e interval, Tp-e/QT and Tp-e/QTc ratios as indices of ventricular arrhythmogenesis. Heart Lung Circ 2014; 23: 827-32.
• 10. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-104.
• 11. Needleman L, Kurtz AB, Rifkin MD, Cooper HS, Pasto ME, Goldberg BB. Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading. AJR Am J Roentgenol 1986; 146: 1011-15.
• 12. 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.
• 13. Hung CS, Tseng PH, Tu CH et al. Nonalcoholic Fatty Liver Disease Is Associated With QT Prolongation in the General Population. J Am Heart Assoc 2015; 4.
• 14. Targher G, Valbusa F, Bonapace S et al. Association of nonalcoholic fatty liver disease with QTc interval in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2014; 24: 663-69.
• 15. Mantovani A, Rigamonti A, Bonapace S et al. Nonalcoholic Fatty Liver Disease Is Associated With Ventricular Arrhythmias in Patients With Type 2 Diabetes Referred for Clinically Indicated 24-Hour Holter Monitoring. Diabetes Care 2016; 39: 1416-23.
• 16. 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.
• 17. Yayla C, Bilgin M, Akboga MK et al. Evaluation of Tp-E Interval and Tp-E/QT Ratio in Patients with Aortic Stenosis. Ann Noninvasive Electrocardiol 2016: 21; 287-93.
• 18. Antzelevitch C, Sicouri S, Di Diego JM et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 2007; 4: 1114-16; author reply 6-9.
• 19. Lonardo A, Ballestri S, Targher G, Loria P. Diagnosis and management of cardiovascular risk in nonalcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol 2015; 9: 629-50.
• 20. Byrne CD, Targher G. Ectopic fat, insulin resistance, and nonalcoholic fatty liver disease: implications for cardiovascular disease. Arterioscler Thromb Vasc Biol 2014; 34: 1155-61.
• 21. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013; 10: 330-44.
• 22. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015; 62: 47-64.