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Kaplan O, Kurtoglu E, Nar G, Yasar E, Gozubuyuk G, Dogan C, Boz AU, Hidayet S, Pekdemir H. Evaluation of Electrocardiographic T-peak to T-end Interval in Subjects with Increased Epicardial Fat Tissue Thickness. Arq Bras Cardiol 2015; 105:566-72. [PMID: 26465871 PMCID: PMC4693660 DOI: 10.5935/abc.20150124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The association between periatrial adiposity and atrial arrhythmias has been shown in previous studies. However, there are not enough available data on the association between epicardial fat tissue (EFT) thickness and parameters of ventricular repolarization. Thus, we aimed to evaluate the association of EFT thickness with indices of ventricular repolarization by using T-peak to T-end (Tp-e) interval and Tp-e/QT ratio. METHODS The present study included 50 patients whose EFT thickness ≥ 9 mm (group 1) and 40 control subjects with EFT thickness < 9 mm (group 2). Transthoracic echocardiographic examination was performed in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. RESULTS QTd (41.1 ± 2.5 vs 38.6 ± 3.2, p < 0.001) and corrected QTd (46.7 ± 4.7 vs 43.7 ± 4, p = 0.002) were significantly higher in group 1 when compared to group 2. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, p < 0.001), cTp-e interval (83.1 ± 4.3 vs. 76±4.9, p < 0.001), Tp-e/QT (0.20 ± 0.02 vs. 0.2 ± 0.02, p < 0.001) and Tp-e/QTc ratios (0.2 ± 0.01 vs. 0.18 ± 0.01, p < 0.001) were increased in group 1 in comparison to group 2. Significant positive correlations were found between EFT thickness and Tp-e interval (r = 0.548, p < 0.001), cTp-e interval (r = 0.259, p = 0.01), and Tp-e/QT (r = 0.662, p < 0.001) and Tp-e/QTc ratios (r = 0.560, p < 0.001). CONCLUSION The present study shows that Tp-e and cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in subjects with increased EFT, which may suggest an increased risk of ventricular arrhythmia.
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Affiliation(s)
- Ozgur Kaplan
- Department of Cardiology, School of Medicine, İstanbul Bilim University, İstanbul, Turkey
| | | | - Gokay Nar
- Department of Cardiology, Education And Research Hospital, Ahi Evran University, Kırsehir, Turkey
| | - Erdogan Yasar
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Gokhan Gozubuyuk
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Cem Dogan
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Ahmet Ugur Boz
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Sıho Hidayet
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Hasan Pekdemir
- Department of Cardiology, School of Medicine, İnönü University, Malatya, Turkey
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302
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Jukić A, Carević V, Zekanović D, Stojanović-Stipić S, Runjić F, Ljubković M, Fabijanić D. Impact of Percutaneous Coronary Intervention on Exercise-Induced Repolarization Changes in Patients With Stable Coronary Artery Disease. Am J Cardiol 2015; 116:853-7. [PMID: 26174604 DOI: 10.1016/j.amjcard.2015.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 11/17/2022]
Abstract
Recent reports suggest T peak to T end (Tpe) interval and Tpe/QT ratio as valuable indicators of increased arrhythmogenic risk in patients with coronary artery disease (CAD). We aimed to examine the exercise-induced changes in these indexes in patients with stable CAD, before and after percutaneous coronary intervention (PCI). Forty patients were consecutively included in the interventional group (n = 20), with significant lesions (≥75% luminal narrowing) suitable for PCI and in the control group (n = 20), with no significant coronary artery lesions (<50% luminal narrowing). One day before and 30 days after the coronarography, all patients performed treadmill exercise stress testing, and the electrocardiographic (ECG) indexes of repolarization were assessed during baseline and at peak exercise intensity. In the control group, the QT interval, QTc (QT-corrected) interval, Tpe interval, and Tpe/QT ratio measured at peak exercise significantly decreased from baseline values (p = 0.001, p = 0.004, p <0.001, and p = 0.017, respectively). Conversely, in interventional patients before the PCI, an increase in the Tpe interval and the Tpe/QT ratio was observed at exercise (p = 0.009, and p <0.001, respectively), with only the QT interval exhibiting a significant decrease from baseline (p <0.001). Thirty days after the PCI, all the ECG arrhythmogenic indexes measured at peak exercise significantly decreased from baseline values, thus assuming the same trend as detected in controls. In conclusion, restoration of blood supply normalized exercise-induced repolarization changes, suggesting that revascularization of previously ischemic myocardium lowers the cardiac arrhythmogenic potential in patients with stable CAD.
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Affiliation(s)
- Anita Jukić
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Vedran Carević
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | | | - Sanda Stojanović-Stipić
- Department of Anestesiology, Reanimatology and Intensive Care, University Hospital Centre Split, Split, Croatia
| | - Frane Runjić
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Marko Ljubković
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Damir Fabijanić
- Department of Cardiology, University Hospital Centre Split, Split, Croatia.
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303
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Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015; 3:705-720. [PMID: 26301231 PMCID: PMC4539410 DOI: 10.12998/wjcc.v3.i8.705] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/22/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023] Open
Abstract
Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.
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304
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Yayla Ç, Bilgin M, Akboğa MK, Gayretli Yayla K, Canpolat U, Dinç Asarcikli L, Doğan M, Turak O, Çay S, Özeke Ö, Akyel A, Yeter E, Aydoğdu S. Evaluation of Tp-E Interval and Tp-E/QT Ratio in Patients with Aortic Stenosis. Ann Noninvasive Electrocardiol 2015; 21:287-93. [PMID: 26246339 DOI: 10.1111/anec.12298] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The risk of syncope and sudden cardiac death due to ventricular arrhythmias increased in patients with aortic stenosis (AS). Recently, it was shown that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio can be novel indicators for prediction of ventricular arrhythmias and mortality. We aimed to investigate the association between AS and ventricular repolarization using Tp-e interval and Tp-e/QT ratio. METHODS Totally, 105 patients with AS and 60 control subjects were enrolled to this study. The severity of AS was defined by transthoracic echocardiographic examination. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram. RESULTS Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly increased in parallel to the severity of AS (P < 0.001, P = 0.001, and P = 0.001, respectively). Also, it was shown that Tp-e/QTc ratio had significant positive correlation with mean aortic gradient (r = 0.192, P = 0.049). In multivariate logistic regression analysis, Tp-e/QTc ratio and left ventricular mass were found to be independent predictors of severe AS (P = 0.03 and P = 0.04, respectively). CONCLUSIONS Our study showed that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with severe AS. Tp-e/QTc ratio and left ventricular mass were found as independent predictors of severe AS.
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Affiliation(s)
- Çağrı Yayla
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Murat Bilgin
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboğa
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Uğur Canpolat
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Lale Dinç Asarcikli
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Doğan
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Osman Turak
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Serkan Çay
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Özcan Özeke
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ahmet Akyel
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ekrem Yeter
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sinan Aydoğdu
- Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
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305
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Özcan EE, Szilagyi S, Sallo Z, Molnar L, Zima E, Szeplaki G, Osztheimer I, Öztürk A, Merkely B, Geller L. Comparison of the Effects of Epicardial and Endocardial Cardiac Resynchronization Therapy on Transmural Dispersion of Repolarization. Pacing Clin Electrophysiol 2015; 38:1099-105. [PMID: 26096799 DOI: 10.1111/pace.12678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/22/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite significant improvements in cardiac output and functional capacity with cardiac resynchronization therapy (CRT), incidence of sudden cardiac death still remains high. Reversal of physiological myocardial activation sequence during epicardial pacing increases the transmural dispersion of repolarization (TDR). The aim of this study was to compare the effects of endocardial and epicardial biventricular pacing on repolarization parameters in the same patient group. METHODS Seven patients who had transseptal endocardial left ventricle (LV) lead placement, in whom epicardial CRT had failed due to coronary sinus (CS) lead dislodgement after successful implantation, were admitted to the study. LV endocardial leads were implanted through the interatrial septum in a lateral position. Electrocardiograms (ECGs) were scanned before and after successful epicardial and endocardial biventricular pacing and analyzed using digital calipers. ECG markers of TDR (TpTe and TpTe/QT ratio) were measured and compared. RESULTS Baseline QRS durations (161.7 ± 15.9 ms vs 162.2 ± 17.8 ms, P = 0.95), TpTe values (107.1 ± 20.5 ms vs 108.5 ± 17.6 ms, P = 0.89), and TpTe/QT ratios (0.24 ± 0.05 vs 0.24 ± 0.03, P = 0.88) were similar before epicardial and endocardial CRT. QRS interval reduction was similar (-28.3 ± 11.6 ms vs -29.1 ± 11.4 ms, P = 0.89) in both groups. Compared to transseptal endocardial CRT, epicardial CRT was associated with a significant increase in TpTe (17.1 ± 19.5 ms vs -12.6 ± 18.9 ms, P = 0.01) and TpTe/QT ratio (0.03 ± 0.04 vs -0.02 ± 0.03, P = 0.04). CONCLUSION Transseptal LV endocardial pacing is associated with significant reduction in TDR characteristics compared to epicardial pacing in CRT. Further studies are warranted to determine whether these effects may contribute to reduction of arrhythmias in patients with CRT.
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Affiliation(s)
| | | | - Zoltan Sallo
- Heart Center, Semmelweis University, Budapest, Hungary
| | | | - Endre Zima
- Heart Center, Semmelweis University, Budapest, Hungary
| | | | | | - Ali Öztürk
- Department of Cardiology, Sifa University, Izmir, Turkey
| | - Béla Merkely
- Heart Center, Semmelweis University, Budapest, Hungary
| | - Laszlo Geller
- Heart Center, Semmelweis University, Budapest, Hungary
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306
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Eroglu M, Uz O, Isilak Z, Yalcin M, Yildirim AO, Kardesoglu E. Carbon monoxide poisoning increases Tpeak-Tend dispersion and QTc dispersion. Cardiovasc J Afr 2015; 25:106-9. [PMID: 25000439 PMCID: PMC4120128 DOI: 10.5830/cvja-2014-012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 02/24/2014] [Indexed: 11/13/2022] Open
Abstract
Objective Carbon monoxide (CO) poisoning leads to cardiac dysrhythmia. Increased heterogeneity in ventricular repolarisation on electrocardiogram (ECG) shows an increased risk of arrhythmia. A number of parameters are used to evaluate ventricular repolarisation heterogeneity on ECG. The aim of our study is to investigate the effect of acute CO poisoning on indirect parameters of ventricular repolarisation on ECG. Methods Sixty-seven patients were included in this case–control study. Thirty patients with acute CO poisoning were assigned to group 1 (19 females, mean age: 30.8 ± 11.3 years). A control group was formed with patients without known cardiac disease (group 2, n = 37; 25 females, mean age: 26.0 ± 5.2 years). Twelve-lead ECG and serum electrolyte levels were recorded in all patients. Also, carboxyhaemoglobin (COHb) levels were recorded in group 1. Tpeak–Tend (TpTe) interval, TpTe dispersion, TpTe/QT ratio, QT interval and QTd durations were measured as parameters of ventricular repolarisation. Corrected QT (QTc) and QTc dispersion (QTcd) intervals were determined with the Bazett’s formula. Results The mean COHb level in group 1 was 27.6 ± 7.4% and mean duration of CO exposure was 163.5 ± 110.9 min. No statistically significant difference was found in age, gender, serum electrolytes or blood pressure levels between the groups. QRS, QT, QTc, TpTe interval and TpTe/QT ratio were similar between the groups (p > 0.05). QTcd (65.7 ± 64.4 vs 42.1 ± 14.2 ms, p = 0.003) and TpTe dispersion (40.5 ± 14.8 vs 33.2 ± 4.9 ms, p = 0.006) were significantly longer in group 1 than group 2. COHb level was moderately correlated with TpTe dispersion (r = 0.29; p = 0.01). Conclusion To our knowledge, this is the first study to investigate TpTe interval and dispersion in CO poisoning. Our results showed that TpTe dispersion and QTc dispersion increased after CO poisoning.
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Affiliation(s)
- Murat Eroglu
- Department of Emergency Medicine, Haydarpasa Teaching Hospital, Gulhane Military Medical Academy, Istanbul, Turkey.
| | - Omer Uz
- Department of Cardiology, Haydarpasa Teaching Hospital, Gulhane Military Medical Academy, Istanbul, Turkey
| | - Zafer Isilak
- Department of Cardiology, Haydarpasa Teaching Hospital, Gulhane Military Medical Academy, Istanbul, Turkey
| | - Murat Yalcin
- Department of Cardiology, Haydarpasa Teaching Hospital, Gulhane Military Medical Academy, Istanbul, Turkey
| | - Ali Osman Yildirim
- Department of Emergency Medicine, Haydarpasa Teaching Hospital, Gulhane Military Medical Academy, Istanbul, Turkey
| | - Ejder Kardesoglu
- Department of Cardiology, Haydarpasa Teaching Hospital, Gulhane Military Medical Academy, Istanbul, Turkey
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307
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Aksan G, Nar G, İnci S, Yanık A, Kılıçkesmez KO, Aksoy O, Soylu K. Exercise-Induced Repolarization Changes in Patients with Isolated Myocardial Bridging. Med Sci Monit 2015; 21:2116-24. [PMID: 26198682 PMCID: PMC4515937 DOI: 10.12659/msm.893632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although myocardial bridging (MB) is defined as an angiographic phenomenon with a benign course, it has also been associated with adverse cardiovascular events. The effects of exercise on myocardial repolarization in patients with MB were tested in this study, with Tp-e and Tp-e/QT repolarization indexes. MATERIAL AND METHODS A total of 50 patients in whom isolated MB was diagnosed at coronary angiography (CAG) (Group I) and 48 patients with normal CAG results (Group II) were included in this study. The participants underwent treadmill exercise stress testing according to the Bruce protocol. QT dispersion (QTd) was defined as the minimum QT interval subtracted from the maximum. The Tp-e interval was defined as the difference between the QT and the QT peak time period. QTd and Tp-e intervals were calculated for all patients before and after exercise testing and differences between groups were compared. RESULTS At peak exercise, QTd and cQTd showed a significant increase in comparison to baseline values in the group of patients with myocardial bridges. Significant increases were also found with exercise in the Tp-e, cTp-e durations and Tp-e/QT ratio of the MB patient group in comparison to the baseline values. On the other hand, significant differences in QTd, cQTd, Tp-e, cTp-e intervals, and Tp-e/QT ratio during peak exercise in comparison with baseline values were not detected in the control group (p>0.05). CONCLUSIONS Significant increases in QTd, cQTd, Tp-e and cTp-e intervals and Tp-e/QT ratio were detected in the MB patients during exercise testing.
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Affiliation(s)
- Gökhan Aksan
- Deparment of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Gökay Nar
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Sinan İnci
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Ahmet Yanık
- Department of Cardiology, Samsun Training and Research Hospital, Samsun, Turkey
| | | | - Olcay Aksoy
- Department of Cardiology, University of California, Los Angeles, CA, U.S.A
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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308
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Abstract
BACKGROUND Risk stratification in Brugada syndrome (BS) remains controversial. The time interval between the peak and the end of the T wave (Tpe interval), a marker of transmural dispersion of repolarization, has been linked to malignant ventricular arrhythmias in various settings but leads to discordant results in BS. OBJECTIVE We study the correlation of the Tpe interval with arrhythmic events in a large cohort of patients with BS. METHODS A total of 325 consecutive patients with BS (mean age 47±13 years, 259 men-80%) with spontaneous (n=143, 44%) or drug-induced (n=182, 56%) type 1 electrocardiogram were retrospectively included. 235 were asymptomatic (70%), 80 presented with unexplained syncope (22%), and 10 presented with sudden death (SD) or appropriate implantable cardioverter-defibrillator therapy (AT) (8%) at diagnosis or over a mean follow-up of 48 ± 34 months. The Tpe interval was calculated as the difference between the QT interval and the QT peak interval as measured in each of the precordial leads. RESULTS The Tpe interval from lead V1 to lead V4, maximum value of the Tpe interval (max Tpe), and Tpe dispersion in all precordial leads were significantly higher in patients with SD/AT or in patients with syncope than in asymptomatic patients (P < .001). A max Tpe of ≥100 ms was present in 47 of 226 asymptomatic patients (21%), in 48 of 73 patients with syncope (66%), and in 22 of 26 patients with SD/AT (85%) (P < .0001). In multivariate analysis, a max Tpe of ≥100 ms was independently related to arrhythmic events (odds ratio 9.61; 95% confidence interval 3.13-29.41; P < .0001). CONCLUSION The Tpe interval in the precordial leads is highly related to malignant ventricular arrhythmias in this large cohort of patients with BS. This simple electrocardiographic parameter could be used to refine risk stratification.
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309
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Tenekecioglu E, Karaagac K, Yontar OC, Agca FV, Ozluk OA, Tutuncu A, Arslan B, Yilmaz M. Evaluation of Tp-Te Interval and Tp-Te/QT Ratio in Patients with Coronary Slow Flow Tp-Te/QT Ratio and Coronary Slow Flow. Eurasian J Med 2015; 47:104-8. [PMID: 26180494 DOI: 10.5152/eurasianjmed.2015.72] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Coronary slow flow (CSF) phenomenon is described by angiographically normal coronary arteries with delayed opacification of the distal vasculature. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-Te) may correspond to the transmural dispersion of the repolarization and that increased Tp-Te interval and Tp-Te/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate the ventricular repolarization by using Tp-Te interval and Tp-Te/QT ratio in patients with CSF. MATERIALS AND METHODS This study included 50 CSF patients (40 male, mean age 48.6±12.5 years) and 40 control individuals (23 male, mean age 47.8±12.5 years). Tp-Te interval and Tp-Te/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared in groups. RESULTS Baseline characteristics of the study groups were comparable. In electrocardiographic parameters analysis, QT and corrected QT were similar in CSF patients compared to the controls (357±35.2 vs 362±38.0 milliseconds and 419±25.8 vs 430±44.2 milliseconds, all p value >0.05). Tp-Te interval, Tp-Te/QT and Tp-Te/QTc ratio were significantly higher in CSF patients (85±13.7 vs 74±9.9 milliseconds and 0.24±0.03 vs 0.20±0.02 and 0.20±0.03 vs 0.17±0.02 all p value <0.001). CONCLUSION Our study revealed that QTd, Tp-Te interval and Tp-Te/QT ratio are prolonged in patients with CSF.
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Affiliation(s)
- Erhan Tenekecioglu
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Kemal Karaagac
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Osman Can Yontar
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | | | - Ozlem Arican Ozluk
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ahmet Tutuncu
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Burhan Arslan
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mustafa Yilmaz
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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310
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Tanindi A, Akgun N, Pabuccu EG, Gursoy AY, Yüce E, Tore HF, Duvan CI. 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 2015; 21:169-74. [PMID: 26084968 DOI: 10.1111/anec.12285] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND P-wave duration helps to determine the risk of atrial arrhythmia, especially atrial fibrillation. QT interval, T peak to end interval (Tp-e), and Tp-e/QT ratio are electrocardiographic indices related to ventricular repolarization which are used to determine the risk of ventricular arrhythmias. We search for any alterations in electrocardiographic indices of arrhythmia in the pregnancy period with respect to trimesters. METHODS We enrolled 154 pregnant and 62 nonpregnant, healthy women into this cross-sectional study. Maximum and minimum P-wave durations (Pmax, Pmin), and QT intervals (QTmax, QTmin) were measured from 12 leads. QT measurements were corrected using Fridericia (QTc-Fr) and Bazett's (QTc-Bz) correction. Tp-e interval was obtained from the difference between QT interval, and QT peak interval (QTp) measured from the beginning of the QRS until the peak of the T wave. Tp-e/QT ratio was calculated using these measurements. RESULTS Pmax were 93.0 ± 9.1, 93.9 ± 8.9, 97.9 ± 5.6, 99.0 ± 6.1 in nonpregnant women, first, second, third trimesters of pregnancy, respectively (P = 0.001); whereas Pmin values were not significantly different. QTc-Fr max were 407.4 ± 14.2, 408.5 ± 16.1, 410.1 ± 13.1, 415.1 ± 10.1 (P = 0.007); Tp-e were 72.7 ± 6.2, 73.2 ± 6.5, 77.2 ± 8.9, 87.2 ± 9.6 (P < 0.001); and Tp-e/QT were 0.17 (0.14-0.20), 0.17 (0.14-0.20), 0.18 (0.15-0.23), 0.20 (0.16-0.25) in nonpregnant women, first, second, and third trimesters of pregnancy respectively (P < 0.001). None of the participants experienced any arrhythmic event. CONCLUSIONS P-wave duration is prolonged in the second trimester, and resumes a plateau thereafter. Maximum QTc interval, Tp-e interval and Tp-e/QT ratio are increased in the late pregnancy. Although these indices are altered during the course of pregnancy, they all remain in the normal ranges.
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Affiliation(s)
- Asli Tanindi
- Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Nilufer Akgun
- Department of Obstetrics and Gynecology, Turgut Özal University Faculty of Medicine, Ankara, Turkey
| | - Emre Goksan Pabuccu
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Aslı Yarci Gursoy
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yüce
- Department of Obstetrics and Gynecology, Turgut Özal University Faculty of Medicine, Ankara, Turkey
| | - Hasan Fehmi Tore
- Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Candan Iltemir Duvan
- Department of Obstetrics and Gynecology, Turgut Özal University Faculty of Medicine, Ankara, Turkey
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Tokatli A, Yiginer O, Haholu A, Uzun M. Efficiency of quantification of cardiac electrical heterogeneity: via QT dispersion, transmural dispersion, or both. Biol Sport 2015; 32:175-6. [PMID: 26060343 PMCID: PMC4447765 DOI: 10.5604/20831862.1145079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Tokatli
- Golcuk Military Hospital, Department of Cardiology, Kocaeli-Turkey
| | - O Yiginer
- GATA Haydarpasa Hospital, Department of Cardiology, Istanbul-Turkey
| | - A Haholu
- GATA Haydarpasa Hospital, Department of Pathology, Istanbul-Turkey
| | - M Uzun
- GATA Haydarpasa Hospital, Department of Cardiology, Istanbul-Turkey
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312
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Affiliation(s)
- M Reza Movahed
- Arizona CareMore Regional Cardiology, Director and Profesor of Medicine University of Arizona College of Medicine, Tucson; AZ-USA.
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313
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Joukar S, Asadipour H. Evaluation of Melissa officinalis (Lemon Balm) Effects on Heart Electrical System. Res Cardiovasc Med 2015; 4:e27013. [PMID: 26396973 PMCID: PMC4576163 DOI: 10.5812/cardiovascmed.4(2)2015.27013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/05/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Melissa officinalis, an herbal drug, is well known and frequently applied in traditional and modern medicine. Yet, there is inadequate information regarding its effects on electrical properties of the heart. The present study attempted to elucidate the effects of Melissa officinalis aqueous extract on electrocardiogram (ECG) in rat. Objectives: ECG is an easy, fast and valuable tool to evaluate the safety of used materials and drugs on heart electrical and conductivity properties. Many drugs with no cardiovascular indication or any overt cardiovascular effects of therapeutic dosing become cardiotoxic when overdosed (16). On the other hand, there are numerous substances and drugs that can cause ECG changes, even in patients without a history of cardiac disease. Therefore, this study was conducted to elucidate safety and outcome of one-week administration of M. officinalis aqueous extract on blood pressure and ECG parameters of rats. Materials and Methods: Four animal groups received tap water (control group), aqueous extracts of Melissa officinalis 50 (M50), 100 (M100) and 200 (M200) mg/kg/day, respectively and orally for a week. ECG and blood pressure were recorded on the eighth day of experiment. Results: Consumption of Melissa officinalis extract associated with prolonged QRS interval (P < 0.05 for M50 and M100 groups and P < 0.01 for M200 group versus the control group, respectively), prolonged QTc and JT intervals (P < 0.01 for different M groups versus the control group) and prolonged TpTe interval (P < 0.001 when M groups compared with the control group) of ECG. However, different doses of the extract had no significant effect on RR interval, PR interval, amplitudes of ECG waves, heart rate and blood pressure. Conclusions: For the first time, this study revealed that consumption of Melissa officinalis extract is associated with significant ECG alterations in rat. Future studies are necessary to determine potential clinical outcomes.
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Affiliation(s)
- Siyavash Joukar
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, IR Iran
- Department of Physiology and Pharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran
- Corresponding author: Siyavash Joukar, Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, P. O. Box: 7616914115, Kerman, IR Iran. Tel/Fax: +98-3413220081, E-mail: ,
| | - Haleh Asadipour
- Department of Physiology and Pharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran
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314
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Obeyesekere MN, Antzelevitch C, Krahn AD. Management of ventricular arrhythmias in suspected channelopathies. Circ Arrhythm Electrophysiol 2015; 8:221-31. [PMID: 25691556 DOI: 10.1161/circep.114.002321] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Manoj N Obeyesekere
- From the Department of Cardiology, Northern Healthcare Group, Epping, Victoria, Australia (M.N.O.); Masonic Medical Research Laboratory, Utica, NY (C.A.); and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
| | - Charles Antzelevitch
- From the Department of Cardiology, Northern Healthcare Group, Epping, Victoria, Australia (M.N.O.); Masonic Medical Research Laboratory, Utica, NY (C.A.); and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.)
| | - Andrew D Krahn
- From the Department of Cardiology, Northern Healthcare Group, Epping, Victoria, Australia (M.N.O.); Masonic Medical Research Laboratory, Utica, NY (C.A.); and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.)
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315
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Cho MS, Nam GB, Kim YG, Hwang KW, Kim YR, Choi H, Kim SH, Rhee KS, Kim NJ, Kim JS, Kim J, Choi KJ, Kim YH. Electrocardiographic predictors of bradycardia-induced torsades de pointes in patients with acquired atrioventricular block. Heart Rhythm 2015; 12:498-505. [DOI: 10.1016/j.hrthm.2014.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Indexed: 11/17/2022]
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316
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Shenthar J, Deora S, Rai M, Nanjappa Manjunath C. Prolonged T peak-end and T peak-end /QT ratio as predictors of malignant ventricular arrhythmias in the acute phase of ST-segment elevation myocardial infarction: A prospective case-control study. Heart Rhythm 2015; 12:484-489. [DOI: 10.1016/j.hrthm.2014.11.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 11/16/2022]
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317
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Cakulev I, Waldo AL. Further refinement of torsades de pointes. Heart Rhythm 2015; 12:506-507. [DOI: 10.1016/j.hrthm.2014.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 11/25/2022]
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318
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Sucu M, Ozer O, Davutoglu V, Ercan S, Yuce M, Coskun FY. Relationship between Neurocardiogenic Syncope and Ventricular Repolarization. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:625-9. [PMID: 25645192 DOI: 10.1111/pace.12599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to analyze ventricular repolarization in neurocardiogenic syncope (NCS) patients by using T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio and corrected QT interval (QTc), QT dispersion (QTd), QT index (QTI) and corrected QT interval index (QTcI) comparing with the corrected JT dispersion (JTcd), and corrected JT (JTc) and the corrected JT interval index (JTcI), by inspecting ventricular activation until termination of repolarization. These parameters are used as an index of potential ventricular arrhythmogenesis. METHODS We have studied patients with head-up tilt table test (HUTT) (+) (33 patients; mean age: 28 ± 11 years) and HUTT (-) as control group (33 patients; mean age: 30 ± 11 years). In all patients, T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio, QT, QTd, QTI, QTc, QTcI, JTd, JTc, and JTcI were measured on electrocardiogram. RESULTS The following parameters were statistically significant between groups: QTd (22.72 ± 17.54 msn; 11.21 ± 13.40 msn; P = 0.004), QTc (424.27 ± 33.75 msn; 403.66 ± 38.08 msn; P = 0.023), QTcI (114.09 ± 14, 29%; 106.71 ± 15.33%, P = 0.047), and QTI (100.72 ± 7.19%; 97.14 ± 7.13%, P = 0.046). Furthermore, T-peak-T-end interval was significantly prolonged in the study group (93.78 ± 20.27 msn; 81.21 ± 11.66 msn; P = 0.003). T-peak-T-end/QT ratio was significantly higher in the study group (0.24 ± 0.04 msn; 0.22 ± 0.04 msn; P = 0.030). T-peak-T-end/QTc ratio was significantly higher in the study group (0.22 ± 0.04 msn; 0.20 ± 0.03 msn; P = 0.015). The JTc and JTd were also significantly higher in the study group ([103.00 ± 9, 72%; 95.44 ± 10.26%, P = 0.003], [27.57 ± 16.01 msn; 10.45 ± 16.08 msn; P < 0.001], respectively). CONCLUSIONS Electrocardiographic ventricular repolarization parameters including T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio, QTc, QTd, QTI, QTcI, JTc, JTd, and JTI are prolonged in NCS.
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Affiliation(s)
- Murat Sucu
- Electrophysiology Division, Cardiology Department, Gaziantep University, Gaziantep, Turkey
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319
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Alizade E, Avcı A, Fidan S, Tabakçı M, Bulut M, Zehir R, Simsek Z, Evlice M, Arslantaş U, Çakır H, Emiroglu MY, Akçakoyun M. The Effect of Chronic Anabolic-Androgenic Steroid Use on Tp-E Interval, Tp-E/Qt Ratio, and Tp-E/Qtc Ratio in Male Bodybuilders. Ann Noninvasive Electrocardiol 2015; 20:592-600. [PMID: 25631523 DOI: 10.1111/anec.12256] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The chronic consumption of androgenic anabolic steroids has shown to cause atrial arrhythmias. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate repolarization dispersion measured from the 12-lead surface electrocardiogram (including Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio) in bodybuilders who are using anabolic androgenic steroids (AAS). METHODS We selected a population of 33 competitive bodybuilders, including 15 actively using AAS for ≥ 2 years (users) and 18 who had never used AAS (nonusers), all men. RESULTS QT, cQT, QTd, cQTd, JT, and cJT were significantly increased in AAS users bodybulders compared to the nonusers (all P < 0.001). Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio were also significantly higher in AAS user group compared to the nonuser group (all P < 0.001). QRS duration was not different between the groups. There were negative correlation between E(m) and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = -0.657, P < 0.01; r = -0.607, P = 0.02; r = -0.583, P = 0.02; respectively).There were also negative correlation between S(m) and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = -0.681, P < 0.01; r = -0.549, P = 0.03; r = -0.544, P = 0.023; respectively). CONCLUSION In conclusion, we have presented a strong evidence suggesting that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were increased in AAS users, which suggest that there might be a link between AAS use and ventricular arrthymias and sudden death.
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Affiliation(s)
- Elnur Alizade
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Anıl Avcı
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Serdar Fidan
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Mustafa Tabakçı
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Mustafa Bulut
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Regayip Zehir
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zeki Simsek
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Mert Evlice
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Uğur Arslantaş
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Hakan Çakır
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Mehmet Yunus Emiroglu
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
| | - Mustafa Akçakoyun
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Turkey
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320
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Ni M, Ruan L, Zhang C. Antiarrhythmic Peptide AAP10 Prevents Arrhythmias Induced by Protein Kinase C Activation in Rabbit Left Ventricular Wedges. Int Heart J 2015; 56:234-8. [DOI: 10.1536/ihj.14-234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mingke Ni
- Department of Cardiology, Zhongshan Hospital
| | - Lei Ruan
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Cuntai Zhang
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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321
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Emul M, Kalelioglu T. Etiology of cardiovascular disease in patients with schizophrenia: current perspectives. Neuropsychiatr Dis Treat 2015; 11:2493-503. [PMID: 26491327 PMCID: PMC4599145 DOI: 10.2147/ndt.s50006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular morbidity and mortality are important problems among patients with schizophrenia. A wide spectrum of reasons, ranging from genes to the environment, are held responsible for causing the cardiovascular risk factors that may lead to shortening the life expectancy of patients with schizophrenia. Here, we have summarized the etiologic issues related with the cardiovascular risk factors in schizophrenia. First, we focused on heritable factors associated with cardiovascular disease and schizophrenia by mentioning studies about genetics-epigenetics, in the first-episode or drug-naïve patients. In this context, the association and candidate gene studies about metabolic disturbances in schizophrenia are reviewed, and the lack of the effects of epigenetic/posttranscriptional factors such as microRNAs is mentioned. Increased rates of type 2 diabetes mellitus and disrupted metabolic parameters in schizophrenia are forcing clinicians to struggle with metabolic syndrome parameters and related issues, which are also the underlying causes for the risk of having cardiometabolic and cardiovascular etiology. Second, we summarized the findings of metabolic syndrome-related entities and discussed the influence of the illness itself, antipsychotic drug treatment, and the possible disadvantageous lifestyle on the occurrence of metabolic syndrome (MetS) or diabetes mellitus. Third, we emphasized on the risk factors of sudden cardiac death in patients with schizophrenia. We reviewed the findings on the arrhythmias such as QT prolongation, which is a risk factor for Torsade de Pointes and sudden cardiac death or P-wave prolongation that is a risk factor for atrial fibrillation. For example, the use of antipsychotics is an important reason for the prolongation of QT and some other cardiac autonomic dysfunctions. Additionally, we discussed relatively rare issues such as myocarditis and cardiomyopathy, which are important for prognosis in schizophrenia that may have originated from the use of antipsychotic medication. In conclusion, we considered that the studies and awareness about physical needs of patients with schizophrenia are increasing. It seems logical to increase cooperation and shared care between the different health care professionals to screen and treat cardiovascular disease (CVD)-risk factors, MetS, and diabetes in patients with psychiatric disorders, because some risk factors of MetS or CVD are avoidable or at least modifiable to decrease high mortality in schizophrenia. We suggested that future research should focus on conducting an integrated system of studies based on a holistic biopsychosocial evaluation.
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Affiliation(s)
- Murat Emul
- Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey
| | - Tevfik Kalelioglu
- Department of Psychiatry, Bakırkoy Mental Health Research and Training Hospital, Istanbul, Turkey
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322
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Effect of ramosetron on the QT interval during sevoflurane anaesthesia in children: a prospective observational study. Eur J Anaesthesiol 2014; 32:330-5. [PMID: 25485883 DOI: 10.1097/eja.0000000000000200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated the effects of concomitant administration of sevoflurane and ramosetron on the QT interval, the interval between the peak and end of the T wave (Tpe) and Tpe/QT ratio in children. OBJECTIVES To compare the effects of concomitant administration of ramosetron and sevoflurane on heart rate corrected interval with Bazett's formula (QTc), Tpe interval and Tpe/QT ratio. DESIGN A prospective observational study. SETTING Elective orthopaedic surgery with patient-controlled analgesia. PATIENTS Forty children aged between 3 and 12 years. INTERVENTION ECG recordings were collected before induction (BASE), before sevoflurane administration (SEVO) and after the administration of ramosetron (SEVO and R). MAIN OUTCOME MEASURES The heart rate corrected interval with Bazett's formula (QTc), Tpe interval and Tpe/QT ratio were calculated and the changes were analysed using repeated-measures analysis of variance (ANOVA). RESULTS The QTc interval at BASE was 388.5 ± 29.3 ms. It increased with sevoflurane anaesthesia to 414.9 ± 21.4 ms and did not change with the administration of ramosetron (418.2 ± 23.0 ms). The Tpe interval and Tpe/QT ratio did not differ between measurements. No ventricular arrhythmias occurred during the study. CONCLUSION Ramosetron was not associated with prolongation of the QTc interval when it was given concomitantly with sevoflurane in children. No ventricular arrhythmias or other adverse effects occurred during the study.
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323
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El-safty E, Abdelaziz AA, Khashaba E, Al-Wehedy I, El sheref M, Neamatallah M. QT interval and dispersion among emergency medical responders in Mansoura city. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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324
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Effect of a successful percutaneous coronary intervention for chronic total occlusion on parameters of ventricular repolarization. Coron Artery Dis 2014; 25:705-12. [PMID: 25009975 DOI: 10.1097/mca.0000000000000138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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325
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Schumacher DS, Müller-Mottet S, Hasler ED, Hildenbrand FF, Keusch S, Speich R, Bloch KE, Ulrich S. Effect of Oxygen and Acetazolamide on Nocturnal Cardiac Conduction, Repolarization, and Arrhythmias in Precapillary Pulmonary Hypertension and Sleep-Disturbed Breathing. Chest 2014; 146:1226-1236. [DOI: 10.1378/chest.14-0495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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326
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Cakici M, Dogan A, Cetin M, Suner A, Caner A, Polat M, Kaya H, Abus S, Akturk E. Negative effects of acute sleep deprivation on left ventricular functions and cardiac repolarization in healthy young adults. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:713-22. [PMID: 25353305 DOI: 10.1111/pace.12534] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/21/2014] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep deprivation (SD) is associated with an increased incidence of adverse cardiovascular events, we aimed to determine the impact of acute SD on structural and functional alterations of the left ventricle (LV) and on electrocardiogram (ECG) markers including T wave peak-to-end interval (TpTe), QT interval, and TpTe/QT ratio in healthy subjects after a night of SD. METHODS The study population consisted of 40 healthy young adults (19 males, 21 females; mean age: 28.2 ± 3.86 years). Echocardiographic images and ECGs were obtained from the participants after a night of regular sleep (RS) and SD. The average sleep time of the subjects was 6.67 ± 1.76 hours during RS and 1.25 ± 0.74 hours during a night of SD. RESULTS The myocardial performance index, isovolumic relaxation time, and deceleration time values were significantly higher after SD. In addition, the corrected TpTe interval, corrected QT interval (QTc) max, and TpTe/QT ratio were significantly increased after a night of SD when compared with a night of RS (78.5 ± 6.8 ms vs 70.7 ± 7.6 ms, P < 0.001; 407.5 ± 18.6 ms vs 395.07 ± 21.3 ms, P = 0.001; and 0.189 ± 0.014 ms vs 0. 0.179 ± 0.016 ms, P < 0.001, respectively). However, subjects had similar QTp interval values (defined as beginning of the QRS complex to peak of the T wave) after a night of SD as a night of RS (294.6 ± 19.0 vs 291.9 ± 18.5, P = 233). CONCLUSION Our crossover study revealed the presence of subclinical LV diastolic functional changes and increased QT intervals, TpTe intervals, and TpTe/QT ratios in healthy young adults after one night SD. Therefore, the increased QT interval occurred secondary to the increased TpTe interval in this population.
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Affiliation(s)
- Musa Cakici
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Adnan Dogan
- Department of Cardiology, School of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Mustafa Cetin
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Arif Suner
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Asli Caner
- Department of Biological and Medical Science, Oxford Brookes University, Oxford, UK
| | - Mustafa Polat
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Sabri Abus
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Erdal Akturk
- Department of Cardiology, School of Medicine, Adiyaman University, Adiyaman, Turkey
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327
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Alterations of Blood Pressure and ECG following Two-Week Consumption of Berberis integerrima Fruit Extract. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:209683. [PMID: 27351000 PMCID: PMC4897583 DOI: 10.1155/2014/209683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/26/2014] [Accepted: 10/02/2014] [Indexed: 11/17/2022]
Abstract
In light of the popularity and also the various nutritional and medicinal properties of Berberis integerrima, this study was conducted to assess the influence of its aqueous extract on hemodynamic and electrocardiogram (ECG) indices of rat. Animals were divided to control (CTL), B50, B100, and B200 groups that orally received tap water, aqueous extracts of B. integerrima fruit 50, 100, and 200 mg/kg/day, respectively, for two weeks and on day 15, data were recorded. Different doses of barberry fruit extract had no significant effect on blood pressure, heart rate, RR interval, P duration, and Q wave amplitude of electrocardiogram. Extract administration was associated with an incremental trend in PR interval that was not statistically significant. Higher doses (100 and 200 mg/kg) of extract significantly increased the QRS interval (P < 0.01 versus CTL and B50 groups) but decreased the QTc interval (P < 0.01 versus CTL group and P < 0.001 versus B50 group), the JT interval, and TpTe interval (P < 0.001 versus CTL and B50 groups). The results suggest that high doses of barberry extract definitely prolong the depolarization phase and shorten the repolarization phase of ventricular muscle and hence induce alteration in heart electrical conductivity.
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328
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Acar G, Yorgun H, Inci MF, Akkoyun M, Bakan B, Nacar AB, Dirnak I, Cetin GY, Bozoglan O. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis. Mod Rheumatol 2014; 24:327-30. [PMID: 24593208 DOI: 10.3109/14397595.2013.854072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a chronic multi-systemic inflammatory rheumatic disorder. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with AS, and to assess the relation with inflammation. METHODS Sixty-two patients with AS and 50 controls were included. Tp-e interval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-e interval corrected for heart rate. The plasma level of high sensitive C-reactive protein (hsCRP) was measured. These parameters were compared between groups. RESULTS In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in AS patients compared to the controls (31.7 ± 9.6 vs 28.2 ± 7.4 and 35.8 ± 11.5 vs 30.6 ± 7.9 ms, P = 0.03 and P = 0.007, respectively). cTp-e interval and Tp-e/QT ratio were also significantly higher in AS patients (92.1 ± 10.2 vs 75.8 ± 8.4 and 0.22 ± 0.02 vs 0.19 ± 0.02 ms, all P values <0.001). cTp-e interval and Tp-e/QT ratio were significantly correlated with hsCRP (r = 0.63, P < 0.001 and r = 0.49, P < 0.001, respectively). CONCLUSIONS Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in AS patients. These electrocardiographic ventricular repolarization indexes were significantly correlated with the plasma level of hsCRP.
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Affiliation(s)
- Gurkan Acar
- Kardiyoloji Anabilim Dali, Tıp Fakultesi, Kahramanmaraş Sutcu Imam Universitesi , Kahramanmaras , Turkey
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329
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Fujino M, Hata T, Kuriki M, Horio K, Uchida H, Eryu Y, Boda H, Miyata M, Yoshikawa T. Inflammation aggravates heterogeneity of ventricular repolarization in children with Kawasaki disease. Pediatr Cardiol 2014; 35:1268-72. [PMID: 24823886 DOI: 10.1007/s00246-014-0926-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/25/2014] [Indexed: 02/07/2023]
Abstract
Kawasaki disease complicates with myocarditis and vasculitis. Even if myocarditis is asymptomatic, heterogeneity of ventricular repolarization may be increased in the acute phase. We evaluated whether the change in repolarization characteristics can be used as a predictor for myocarditis and coronary lesions. Enrolled 34 children who were treated with intravenous immunoglobulin therapy. There were no sequelae in the recovery phase in any subjects, including those who had transient coronary artery lesion. QT and the interval from the Tpeak to Tend (Tp-e) were determined. The Tp-e/QT ratios were compared between the acute and recovery phases and correlations with CRP level and body temperature were evaluated. A retrospective evaluation of Tp-e/QT as predictors of coronary dilation was also performed. Tp-e/QT in the acute phase correlated positively with body temperature and CRP level. In a comparison of patients with and without transient coronary artery lesion, Tp-e/QT was significantly higher in those with dilation. In conclusion, Tp-e/QT was strongly related to transient coronary dilation, in comparison with inflammatory indicators including fever and CRP level.
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Affiliation(s)
- Masayuki Fujino
- Department of Pediatrics, Fujita Health University, Toyoake, Japan,
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330
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Taşolar H, Ballı M, Bayramoğlu A, Otlu YÖ, Çetin M, Altun B, Çakıcı M. 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. [PMID: 24746776 DOI: 10.1016/j.hlc.2014.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
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331
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Karaagac K, Emul A, Tenekecioglu E, Agca FV, Ozluk OA, Tutuncu A, Yontar OC, Yilmaz M. The Effects of Metabolic Syndrome on TpTe Interval and TpTe/QT Ratio in Patients with Normal Coronary Arteries. Eurasian J Med 2014; 46:182-6. [PMID: 25610322 DOI: 10.5152/eajm.2014.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE T wave peak to T wave end (TpTe) interval and TpTe/QT have been accepted as predictors of ventricular arrythmia. In this study our aim is to investigate the effect of metabolic syndome on these parameters in patients with angiographically normal coronary arteries. MATERIALS AND METHODS Thirty patients with metabolic syndrome (4 male, mean age 52±7.8 years) and twenty patients without metabolic syndrome as control group (8 male, mean age 54±9.3 years) were included. TpTe interval and TpTe/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between the groups. RESULTS When compared with to the control group the systolic and diastolic blood pressure, pulse pressure, waist circumference, triglyceride and fasting plasma glucose levels were higher and HDL cholesterol level was lower in the metabolic syndrome group. In the analysis of electrocardiography, QT dispersion (QTd) and corrected QTd were significantly increased in metabolic syndrome group as compared to the controls group (44±14 versus 30±12 ms and 433±10 versus 405±4 ms, all p value p=0.01). TpTe interval and TpTe/QT ratio were also significantly higher in patient with metabolic syndrome (112±10 versus 91±10 ms and 0.25±0.02 versus 0.22±0.01, all p value p=0.01). CONCLUSION According to these results, we supposed that TpTe/QT ratio and TpTe interval is prolonged and those patients with metabolic syndrome may be at greater risk of ventricular arrhythmias.
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Affiliation(s)
- Kemal Karaagac
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Ali Emul
- Clinic of Cardiology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Erhan Tenekecioglu
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | | | - Ozlem Arican Ozluk
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Ahmet Tutuncu
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Osman Can Yontar
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Mustafa Yilmaz
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
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332
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Demir C, Demir M. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with chronic hepatitis B. Prague Med Rep 2014; 114:239-45. [PMID: 24485341 DOI: 10.14712/23362936.2014.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic hepatitis B (CHB) is a chronic inflammatory viral disorder. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarisation and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. Impaired autonomic function has been described in patients with CHB. The aim of this study was to evaluate ventricular repolarisation by using Tp-e interval and Tp-e/QT ratio in patients with CHB, and to assess the relation with inflammation. Fifty-five patients with CHB and 50 controls were included. Tp-e interval and Tp-e/QT ratio were measured from the 12-lead electrocardiogram, and Tp-e interval corrected for heart rate. These parameters were compared between groups. In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in CHB patients compared to the controls (38.3 ± 10.9 vs. 28.5 ± 7.3 milliseconds and 39.5 ± 11.2 vs. 29.6 ± 7.6 milliseconds, P=0.01 and P<0.001, respectively). cTp-e interval and Tp-e/QT ratio were also significantly higher in CHB patients (85.3 ± 8.2 vs. 74.5 ± 7.4 milliseconds and 0.24 ± 0.02 vs. 0.18 ± 0.02, all P-value < 0.001). Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in CHB patients.
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Affiliation(s)
- C Demir
- Department of Infectious Disease, Şevket Yılmaz Education and Research Hospital, Bursa, Turkey
| | - M Demir
- Department of Cardiology, Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
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333
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AAGAARD PHILIP, BRAUNSCHWEIG FRIEDER, WECKE LILIANE, SAHLÉN ANDERS, BERGFELDT LENNART. Early Repolarization in Middle-Age Runners. Med Sci Sports Exerc 2014; 46:1285-92. [DOI: 10.1249/mss.0000000000000251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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334
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Avci A, Demir K, Altunkeser BB, Yilmaz S, Yilmaz A, Ersecgin A, Demir T. Assessment of inhomogeneities of repolarization in patients with systemic lupus erythematosus. Ann Noninvasive Electrocardiol 2014; 19:374-82. [PMID: 24597863 PMCID: PMC6932449 DOI: 10.1111/anec.12145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a chronic disease that affects many organ systems and manifests a broad spectrum of laboratory and clinical features. SLE patients have an increased risk of developing cardiovascular disease. The aim of this study was to evaluate inhomogeneities of repolarization by using Tpeak -Tend (Tp-e) interval and Tp-e/QT ratio were measured from the 12-lead surface electrocardiogram (ECG) in patients with SLE. MATERIAL AND METHOD This study included 69 SLE patients (69 females; mean age 35.8 ± 10.2) and 57 control subjects (57 females; mean age 34.5 ± 8.9). Transthoracic echocardiographic examination was done in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead ECG. These parameters were compared between groups. RESULTS No statistically significant difference was found between two groups in terms of basic characteristics. Diastolic function parameters were similar between the two groups (P > 0.05). In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QT dispersion (cQTd) were significantly increased in SLE patients compared the control group (49.5 ± 16.4 ms vs. 32.8±11.7 ms and 56.7 ± 19.5 ms vs. 36.4 ± 13.1 ms, all P value < 0.001). Tp-e interval and Tp-e/QT ratio were also significantly higher in SLE patients (82.8 ± 18.9 vs. 72.4 ± 17.6 and 0.22 ± 0.05 vs. 0.19 ± 0.05, P = 0.002 and P = 0.001, respectively). Tp-e interval and Tp-e/QT were positively correlated with disease duration (r = 0.29, P = 0.01 and r = 0.24, P = 0.04, respectively). CONCLUSION Our study revealed that QTd, cQTd, Tp-e interval and Tp-e/QT ratio increased in patients with SLE. Also, Tp-e interval and Tp-e/QT were positively correlated with disease duration.
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Affiliation(s)
- Ahmet Avci
- Faculty of MedicineCardiology DepartmentSelcuk UniversityKonyaTurkey
| | - Kenan Demir
- Faculty of MedicineCardiology DepartmentSelcuk UniversityKonyaTurkey
| | | | - Sema Yilmaz
- Faculty of MedicineRheumatology DepartmentSelcuk UniversityKonyaTurkey
| | - Ahmet Yilmaz
- Faculty of MedicineCardiology DepartmentSelcuk UniversityKonyaTurkey
| | - Ahmet Ersecgin
- Faculty of MedicineCardiology DepartmentSelcuk UniversityKonyaTurkey
| | - Tarik Demir
- Faculty of Medicine, Internal Medicine DepartmentSelcuk UniversityKonyaTurkey
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335
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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 2014; 20:53-61. [PMID: 24934391 DOI: 10.1111/anec.12173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The clinical utility of the Tp-e interval and Tp-e/QT ratio in the risk stratification of ventricular arrhythmic events is controversial. Therefore, we investigated the impact of CCC on these electrocardiographic indexes in the course of stable CAD. METHODS Two hundred three consecutive patients with stable CAD who underwent coronary angiography and had documented total occlusion of one of the major coronary arteries were enrolled in this prospective cross-sectional study. The Tp-e interval and Tp-e/QT ratio were measured by 12-lead electrocardiogram. RESULTS The Tp-e interval, cTp-e interval, Tp-e/QT ratio, and cTp-e/QT ratio were lower in the grade 3 CCC group compared with the others in all leads. Multivariate linear regression analyses was performed to identify the clinical factors affecting the cTp-e interval and was indicated that age (β = 0.261, P < 0.001), male sex (β = 0.334, P < 0.001), poor Rentrop grade (β = -0.228, P < 0.001), and NLR (β = 0.137, P = 0.027) were independent predictors of a prolonged cTp-e interval. CONCLUSION It could be concluded that the decreased dispersion of ventricular repolarization might contribute to the lower incidence of ventricular arrhythmias and SCD in CAD patients with a good CCC.
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Affiliation(s)
- Hakan Taşolar
- Adiyaman University Training and Research Hospital, Department of Cardiology, Adiyaman, Turkey
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336
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Zehir R, Karabay CY, Kalaycı A, Akgün T, Kılıçgedik A, Kırma C. Evaluation of Tpe interval and Tpe/QT ratio in patients with slow coronary flow. Anatol J Cardiol 2014; 15:463-7. [PMID: 25430412 PMCID: PMC5779137 DOI: 10.5152/akd.2014.5503] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Slow coronary flow (SCF) phenomenon is described as the delayed opacification of the distal vasculature and angiographically normal coronary arteries. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tpe) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. In this study, we intended to evaluate ventricular repolarization in patients with SCF by using the Tpe interval and Tpe/QT ratio. METHODS The study population included 33 patients with angiographically proven SCF and 33 control patients with angiographically proven normal coronary arteries without associated SCF. Coronary flow rates of patients and the control group were documented by TIMI (Thrombolysis in Myocardial Infarction) frame count. From the electrocardiograms, Tpe interval and Tpe/QT ratio were calculated and compared between groups. RESULTS No statistically significant difference was found between the two groups in terms of basic characteristics. Mean Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were prolonged in the study group compared to the control group (p<0.001). CONCLUSION Tpe interval and Tpe/QT ratio were increased in SCF patients.
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Affiliation(s)
- Regayip Zehir
- Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital; İstanbul-Turkey.
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337
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Laboratory markers of ventricular arrhythmia risk in renal failure. BIOMED RESEARCH INTERNATIONAL 2014; 2014:509204. [PMID: 24982887 PMCID: PMC4058221 DOI: 10.1155/2014/509204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 01/01/2023]
Abstract
Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure. Serum phosphates and iron, PTH level, renal function, hemoglobin and hematocrit, pH, inflammatory markers, proteinuria and microalbuminuria, and osmolarity should be monitored, besides standard 12-lead ECG, in order to prevent ventricular arrhythmia and sudden cardiac death.
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338
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Lingman M, Hartford M, Karlsson T, Herlitz J, Rubulis A, Caidahl K, Bergfeldt L. Transient repolarization alterations dominate the initial phase of an acute anterior infarction--a vectorcardiography study. J Electrocardiol 2014; 47:478-85. [PMID: 24891262 DOI: 10.1016/j.jelectrocard.2014.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study effects of ischemia-reperfusion on ventricular electrophysiology in humans by three-dimensional electrocardiography. METHODS Fifty-seven patients with first-time acute anterior ST elevation myocardial infarction were monitored from admission and >24h after symptom onset with continuous vectorcardiography (VCG; modified Frank orthogonal leads). Global ventricular depolarization and repolarization (VR) measures were compared at maximum vs. minimum ST vector magnitude (STVM) (median 208; 111-303 vs. 362; 165-1359min after symptom onset). RESULTS At maximum vs. minimum STVM the Tarea (overall VR dispersion) almost tripled (118 vs. 41μVs; p<0.0001), the T-loop bulginess was 90% greater (Tavplan 0.91 vs 0.48μV; p<0.0001), and Tpeak-end/QT was 39% larger (0.32 vs 0.23; p<0.0001). QRSarea (overall dispersion of depolarization) was 12% larger at maximum STVM, while QRS duration was 10% longer at minimum STVM. CONCLUSIONS Ischemia-reperfusion was accompanied by profound and transient alterations of VR dispersion, while changes in depolarization were modest and delayed.
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Affiliation(s)
- Markus Lingman
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medicine, Halland Hospital, Varberg, Sweden.
| | - Marianne Hartford
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center of Prehospital Research in Western Sweden, University of Borås, Borås, Sweden
| | - Aigars Rubulis
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Bergfeldt
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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339
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Castro-Torres Y. Tpeak-Tend/QT: un nuevo predictor electrocardiográfico de muerte súbita cardíaca. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.carcor.2013.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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340
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Lee JH, Park YH, Kim JT, Kim CS, Kim HS. The effect of sevoflurane and ondansetron on QT interval and transmural dispersion of repolarization in children. Paediatr Anaesth 2014; 24:421-5. [PMID: 24372925 DOI: 10.1111/pan.12339] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study evaluated the prolongation of QT interval by the combination of sevoflurane and ondansetron in pediatric patients. Additionally, transmural dispersion of repolarization as interval between the peak and end of the T wave (Tp-e) and Tp-e/QT ratio was also measured to assess the risk of ventricular arrhythmia. METHODS The 3-lead electrocardiography (ECG) in lead II was sampled at three stages: at preinduction, just before (Sevo alone) and finally, after administration of ondansetron (Sevo+Ondansetron) in 41 children aged from 3 to 12 years. The QT interval was corrected for heart rate using Bazett's formula. And, Tp-e interval was obtained, and Tp-e/QT ratio was calculated. For analysis of the changes of parameters, a repeated-measures analysis of variance was used to identify significant differences in QTc, Tp-e interval and Tp-e/QT ratio at the three epochs. RESULTS The mean QTc at preinduction period was 413.8 (20.8) ms. The mean Sevo alone and Sevo+Ondansetron QTcs were 432.5 (28.1) and 439.2 (27.6) ms, and the differences in QTc prolongation between stages were all significant (P < 0.01). Ondansetron increased Tp-e interval significantly; however, Tp-e/QT ratio was not different among three stages. There were no ECG abnormalities such as atrial or ventricular arrhythmia and T-wave abnormality in any patient. CONCLUSIONS Sevoflurane prolongs the QTc interval and its combination with ondansetron further increased this effect in children. However, the dispersion of ventricular repolarization was not significantly affected, and there were no adverse events such as ventricular arrhythmia in this study. The combination of sevoflurane and ondansetron may be clinically safe, but careful ECG monitoring is still advisable.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul, Korea
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341
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Prognostic value of T peak-to-end interval for risk stratification after acute myocardial infarction. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2014. [DOI: 10.1016/j.ejccm.2014.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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342
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Ruan L, Quan X, Li L, Bai R, Ni M, Xu R, Zhang C. Increasing gap junction coupling suppresses ibutilide-induced torsades de pointes. Exp Ther Med 2014; 7:1279-1284. [PMID: 24940425 PMCID: PMC3991525 DOI: 10.3892/etm.2014.1601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 02/13/2014] [Indexed: 11/24/2022] Open
Abstract
Drug-induced torsades de pointes (TdP) is common with class III antiarrhythmic drugs. Increased transmural dispersion of repolarization (TDR) contributes significantly to the development of TdP. Gap junctions play an important role in maintaining TDR in long QT syndrome. The present study examined the effect of a gap junction enhancer, antiarrhythmic peptide 10 (AAP10), on ibutilide-induced TdP. Coronary-perfused rabbit ventricular wedge preparations were used to evaluate the effect of AAP10 on ibutilide-induced arrhythmia. Transmural electrocardiograms and action potentials were recorded simultaneously. Early afterdepolarizations (EADs), R-on-T extrasystole, TdP and changes in Tpeak-end (Tp-e) and the Tp-e/QT ratio were observed. Changes in the levels of non-phosphorylated connexin 43 (Cx43) were measured by immunoblotting. Compared with those in the control group, the QT interval, Tp-e/QT and incidence rates of EAD and TdP increased with augmented dephosphorylation in the ventricular wedge preparations perfused with ibutilide under conditions of hypokalemia and hypomagnesemia. In the presence of AAP10, the incidence rates of EAD and TdP were reduced and the Tp-e/QT ratio decreased, with a parallel reduction in the level of non-phosphorylated Cx43. The results indicate that AAP10 suppressed ibutilide-induced TdP under conditions of hypokalemia and hypomagnesemia by decreasing TDR. AAP10 reduced TDR, possibly by preventing the dephosphorylation of Cx43 and thereby increasing myocardial cell gap junction coupling.
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Affiliation(s)
- Lei Ruan
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xiaoqing Quan
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Liandong Li
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Mingke Ni
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Rende Xu
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Cuntai Zhang
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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343
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Staikou C, Stamelos M, Stavroulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. Br J Anaesth 2014; 112:217-230. [DOI: 10.1093/bja/aet412] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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344
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Doxapram hydrochloride aggravates adrenaline-induced arrhythmias accompanied by bidirectional ventricular tachycardia. ISRN CARDIOLOGY 2014; 2014:212045. [PMID: 24527224 PMCID: PMC3912761 DOI: 10.1155/2014/212045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/14/2013] [Indexed: 02/05/2023]
Abstract
Objectives. Doxapram hydrochloride is a respiratory stimulant that has an inhibitory effect on myocardial IK1 potassium channels and is thought to increase membrane instability and excitability in myocardial cells. We examined the arrhythmogenic effects of doxapram hydrochloride in a rat model of halothane adrenaline-induced arrhythmia. Methods. Thirteen female Wistar rats (12–14 weeks old) were used in the study. Animals were anesthetized with inhalation of halothane to permit observation of the effects of doxapram hydrochloride on halothane adrenaline-induced arrhythmia. Time-dependent changes in ECG repolarization characteristics (QT, QTc, JTp, JT, and Tp-e intervals) were studied. Results. Doxapram hydrochloride itself did not induce arrhythmia but did induce bidirectional ventricular tachycardia after addition of adrenaline. Conclusion. Drug-induced impairment of intracellular Ca2+ regulation caused BVT in the absence of genetic abnormalities in proteins in the sarcoplasmic reticulum.
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345
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Kim SM, Hwang GS, Park JS, Shin JS, Kim GW, Yang HM, Choi SY, Yoon MH, Shin JH, Tahk SJ. The pattern of Tpeak–Tend and QT interval, and J wave during therapeutic hypothermia. J Electrocardiol 2014; 47:84-92. [DOI: 10.1016/j.jelectrocard.2013.05.139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Indexed: 10/26/2022]
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346
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A new marker for myocardial injury in carbon monoxide poisoning: T peak–T end. Am J Emerg Med 2013; 31:1651-5. [DOI: 10.1016/j.ajem.2013.08.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022] Open
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347
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Korantzopoulos P, Liberopoulos E, Barkas F, Kei A, Goudevenos JA, Elisaf M. No association between high-density lipoprotein levels and ventricular repolarization indexes in subjects with primary hypercholesterolemia. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 74:53-8. [PMID: 24266782 DOI: 10.3109/00365513.2013.857041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Data regarding the effect of lipid parameters on repolarization are sparse. Recent data indicate that reconstituted HDL administration shortens repolarization in cardiomyocytes as well as the corrected QT (QTc) interval in human subjects. We investigated the potential association of high-density lipoprotein cholesterol (HDL-C) levels with conventional and novel electrocardiographic markers of ventricular repolarization in patients with hypercholesterolemia. METHODS Consecutive subjects with primary hypercholesterolemia were recruited. We recorded clinical and laboratory parameters as well as electrocardiographic indexes. With regard to ventricular repolarization, we calculated the QTc interval, the T peak-to-end (Tpe) interval, and the Tpe/QT ratio. RESULTS The study population consisted of 440 patients (199 men) with a median age of 56 [48-65] years. The correlation analysis (Spearman's) failed to show any association between HDL-C and any of the studied electrocardiographic parameter. Moreover, no correlation between other lipid parameters and the electrocardiograhic indexes was evident. Also, a comparison of the ventricular repolarization parameters between different HDL-C quartile groups (HDL-Q1: ≤ 1.11 mmol/L; HDL-Q2: 1.12-1.29 mmol/L; HDL-Q3: 1.30-1.53 mmol/L; HDL-Q4: ≥ 1.54 mmol/L) was performed. Specifically, the differences in QTc (p: 0.372), Tpe in leads II (p: 0.356), V2 (p: 0.372), V5 (p: 0.112), and Tpe/QT in leads II (p: 0.348), V2 (p: 0.162), V5 (p: 0.122) were not significant. CONCLUSION HDL-C levels are not associated with the QTc interval or indexes of repolarization dispersion in patients with primary hypercholesterolemia. The potential antiarrhythmic efficacy of HDL should be further evaluated in the setting of myocardial ischemia where dynamic changes in the heterogeneity of ventricular repolarization ensue.
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348
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Diamant UB, Vahedi F, Winbo A, Rydberg A, Stattin EL, Jensen SM, Bergfeldt L. Electrophysiological phenotype in the LQTS mutations Y111C and R518X in the KCNQ1 gene. J Appl Physiol (1985) 2013; 115:1423-32. [PMID: 24052033 DOI: 10.1152/japplphysiol.00665.2013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Long QT syndrome is the prototypical disorder of ventricular repolarization (VR), and a genotype-phenotype relation is postulated. Furthermore, although increased VR heterogeneity (dispersion) may be important in the arrhythmogenicity in long QT syndrome, this hypothesis has not been evaluated in humans and cannot be tested by conventional electrocardiography. In contrast, vectorcardiography allows assessment of VR heterogeneity and is more sensitive to VR alterations than electrocardiography. Therefore, vectorcardiography was used to compare the electrophysiological phenotypes of two mutations in the LQT1 gene with different in vitro biophysical properties, and with LQT2 mutation carriers and healthy control subjects. We included 99 LQT1 gene mutation carriers (57 Y111C, 42 R518X) and 19 LQT2 gene mutation carriers. Potassium channel function is in vitro most severely impaired in Y111C. The control group consisted of 121 healthy subjects. QRS, QT, and T-peak to T-end (Tp-e) intervals, measures of the QRS vector and T vector and their relationship, and T-loop morphology parameters were compared at rest. Apart from a longer heart rate-corrected QT interval (QT heart rate corrected according to Bazett) in Y111C mutation carriers, there were no significant differences between the two LQT1 mutations. No signs of increased VR heterogeneity were observed among the LQT1 and LQT2 mutation carriers. QT heart rate corrected according to Bazett and Tp-e were longer, and the Tp-e-to-QT ratio greater in LQT2 than in LQT1 and the control group. In conclusion, there was a marked discrepancy between in vitro potassium channel function and in vivo electrophysiological properties in these two LQT1 mutations. Together with previous observations of the relatively low risk for clinical events in Y111C mutation carriers, our results indicate need for cautiousness in predicting in vivo electrophysiological properties and the propensity for clinical events based on in vitro assessment of ion channel function alone.
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Affiliation(s)
- Ulla-Britt Diamant
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
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349
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Amoozgar H, Ahmadipour M, Amirhakimi A. QT Dispersion and T Wave Peak-to-end Interval Dispersion in Children with Kawasaki Disease. Int Cardiovasc Res J 2013; 7:99-103. [PMID: 24757631 PMCID: PMC3987441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/08/2013] [Accepted: 07/13/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The main complication of Kawasaki disease is the Coronary Artery (CA) involvement and long term follow up of patients depends on the severity of coronary arterial aneurysms, ischemia, and thrombosis. Early diagnosis of these complications can lead to a more desirable outcome for patients. Myocardial ischemia can prolong QT dispersion and increase the risk of cardiac arrhythmias as well as sudden cardiac arrests. Also, T wave peak-to-end (Tp-Te) interval dispersion, which provides a valuable index of transmural dispersion of repolarization, can trigger the arrhythmia. MATERIALS AND METHODS We evaluated the non-corrected QT interval dispersion (QTD) and the corrected QT (QTc) dispersion and measured Tp-Te interval dispersion in 49 Iranian children (28 males and 21 females) with the diagnosis of Kawasaki disease (KD) in the acute phase and 49 age-matched controls in a prospective study from 2009 to 2012. Student's t-test and Pearson correlation were used to analyze the data. All the statistical analyses were performed through the SPSS 16. Besides, P<0.05 was considered as statistically significant. RESULTS Patients with KD had significantly longer QTc dispersion (0.099±0.055 s versus. 0.040±0.018 s; P<0.001), non-corrected QT dispersion (0.075±0.046 versus 0.042±0.019; P<0.001), and Tp-Te dispersion (0.047±0.054 versus 0.022±0.011; P=0.015). The patients with elevation in white blood cell count (above 15000) had a statistically significant increased in QTD (P=0.011). No significant correlation was found between coronary involvement and repolarization indexes. CONCLUSIONS In conclusion, the QT interval (corrected or non-corrected) and the Tp-Te dispersion significantly increased in the patients with KD which shows repolarization changes during the acute phase of KD. However, there is no correlation between the QT interval and the coronary involvement.
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Affiliation(s)
- Hamid Amoozgar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Maryam Ahmadipour
- Division of Pediatric Cardiology, Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, IR Iran,Corresponding author: Maryam Ahmadipour, Department of Pediatrics, Nemazee Hospital, Shiraz, IR Iran. Post code: 7193711351, Tel/Fax: +98-7116474298, E-mail:
| | - Anis Amirhakimi
- Division of Pediatric Cardiology, Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Brojmohun A, Lou JY, Zardkoohi O, Funk MC. Protected from Torsades de Pointes? What Psychiatrists Need to Know About Pacemakers and Defibrillators. PSYCHOSOMATICS 2013; 54:407-17. [DOI: 10.1016/j.psym.2013.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/17/2013] [Accepted: 02/19/2013] [Indexed: 10/26/2022]
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