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Ragavan N, Thavalam R, Moorthy S. The Effect of Glycemic Status on P Wave Dispersion. Cureus 2024; 16:e58233. [PMID: 38745813 PMCID: PMC11092425 DOI: 10.7759/cureus.58233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
Background and aim The growing number of people with diabetes mellitus (DM) across the world is a public health concern. The diabetes epidemic involves enormous health costs to the patients, their careers, and society at large. Cardiovascular diseases such as atrial fibrillation (AF) often develop in the diabetic population. An increase in the P wave dispersion (PWD) has been established as an independent risk factor for the occurrence of AF, hence the present study was conducted to establish a possible relationship between PWD and the glycemic status of the individual to predict the occurrence of AF ahead of clinical symptomology. Methodology A comparative cross-sectional study was conducted at a tertiary care hospital after obtaining approval from the institutional ethics committee and written consent of each study subject. The main steps included the selection and categorization of the study population based on their glycemic status, collection of demographic data, performing ECGs calculating PWD using digital calipers, and recording the data systematically for evaluation. Results In this study, 234 patients with a mean age of 53.3 ± 13.1 years were studied, of which 121 (51.7%) were male and 113 (48.29%) were female. The 234 patients were divided into four groups based on their glycemic status - 74 uncontrolled DM patients (31.62%), 51 type 2 DM (T2DM) patients (21.78%), 56 prediabetes patients (23.93%), and 53 patients in the control group (22.64%; not a known case of diabetes with normal HbA1c and fasting blood sugar (FBS) levels). Minimal correlation was observed between FBS with PWD (r value 0.175) and age with PWD (r value 0.161), but statistical significance was observed only between age and PWD (p-value 0.014). The difference in means between the four different study groups was found to be not statistically significant (p-value- 0.104); hence, no intergroup variation was noted. Conclusion Advancing age and higher fasting blood sugars have shown minimal correlation with widening P-wave dispersion. With further studies involving larger populations, this can be a promising aid in identifying PWD as a probable early predictor of atrial arrhythmias among diabetic patients.
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Affiliation(s)
- Niranjan Ragavan
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Rida Thavalam
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Swathy Moorthy
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Nussinovitch U, Livneh A. Late ventricular potentials in familial Mediterranean fever with and without AA amyloidosis. Eur J Rheumatol 2017; 4:184-188. [PMID: 29164000 DOI: 10.5152/eurjrheum.2017.16113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/21/2017] [Indexed: 01/13/2023] Open
Abstract
Objective Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by episodic and chronic inflammation that may lead to both accelerated coronary atherosclerosis and cardiac AA amyloidosis. We hypothesized that late ventricular potentials (LPs), an established electrocardiographic susceptibility marker of ventricular arrhythmias, will be more common in FMF than in the adjusted normal population due to these two types of inflammation-associated cardiac effects. Therefore, we aimed to evaluate the occurrence of LPs in FMF patients with and without amyloidosis. Material and Methods Signal-averaged electrocardiography was performed in consecutive patients with FMF using the Frank corrected orthogonal lead system. At least 200 consecutive beats were digitally recorded and averaged, and the presence of LPs was determined according to acceptable thresholds. Results There were 54 patients with colchicine-treated FMF, of whom 14 had biopsy-proven AA amyloidosis. None of the uncomplicated FMF patients and 2 of the 14 FMF amyloidosis patients had abnormal or borderline LPs. Conclusion Based on LPs as a susceptibility marker for arrhythmia, FMF patients, including the large majority of FMF patients with amyloidosis, are seemingly not at an increased risk to develop arrhythmias.
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Affiliation(s)
- Udi Nussinovitch
- Medicine A, Rambam Health Care Campus, Haalia Hashnia, Haifa, Israel
| | - Avi Livneh
- The Heller Institute of Medical Research and Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Cardiovascular disease in patients with autoinflammatory syndromes. Rheumatol Int 2017; 38:37-50. [DOI: 10.1007/s00296-017-3854-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022]
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4
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Cardiac disease in familial Mediterranean fever. Rheumatol Int 2017; 38:51-58. [DOI: 10.1007/s00296-017-3853-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023]
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5
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Giese A, Örnek A, Kurucay M, Kara K, Wittkowski H, Gohar F, Menge BA, Schmidt WE, Zeidler C. P wave dispersion and QT dispersion in adult Turkish migrants with familial mediterranean fever living in Germany. Int J Med Sci 2014; 11:1140-6. [PMID: 25170297 PMCID: PMC4147640 DOI: 10.7150/ijms.9444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/21/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease associated with subclinical inflammation, which includes atherosclerosis arising from endothelial inflammation, which in turn increases the risk of atrial or ventricular arrhythmias. Conduction abnormalities can be detected using the electrocardiographic (ECG) indices P and QT dispersion (Pdisp and QTdisp). Currently, it is unknown whether patients with FMF are more likely to have abnormalities of these ECG indices. Moreover, existing studies were conducted in countries with higher FMF prevalence. We therefore perform the first prospective study assessing Pdisp and QTdisp in adult FMF patients in Germany, where prevalence of FMF is low. METHOD Asymptomatic FMF patients (n=30) of Turkish ancestry living in Germany and age-matched healthy controls (n=37) were prospectively assessed using 12-lead ECG. RESULTS Patients and controls were comparable in gender and body mass index, and patients had higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum amyloid A (SAA) compared to controls (ESR: 23.7±14.3 vs. 16.1±13,3 mm/1(st)h, p=0.03, CRP: 0.73±0.9 vs. 0.26±0.4 g/dl, p=0.01, SAA: 3.14±4,8 vs. 0.37±0.3 mg/dl, p<0.01). No statistically significant difference between patients and controls respectively, for Pdisp (43.7±11.9 vs. 47.1±11.2ms, p=0.23), QTdisp (65.9±12.3 vs. 67.6±12.7 ms, p=0.58) or corrected QTdisp (cQTdisp: 73.9±15.0 vs. 76.0±13.3 ms, p=0.55) was found. No correlation could be found between Pdisp or QTdisp or cQTdisp and any of the biochemical markers of inflammation. CONCLUSION FMF patients living in Germany show a Pdisp and QTdisp comparable to healthy controls, with no increased risk of atrial or ventricular arrhythmias indicated.
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Affiliation(s)
- Arnd Giese
- 1. Department of Internal Medicine I, St. Josef-Hospital, Medical Centre of the Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
- 2. Department of Internal Medicine I, Marienhospital Herne, Medical Centre of the Ruhr-University Bochum, Herne, Germany
| | - Ahmet Örnek
- 2. Department of Internal Medicine I, Marienhospital Herne, Medical Centre of the Ruhr-University Bochum, Herne, Germany
- 3. Institute for Radiologic Diagnostics, Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Mustafa Kurucay
- 2. Department of Internal Medicine I, Marienhospital Herne, Medical Centre of the Ruhr-University Bochum, Herne, Germany
| | - Kaffer Kara
- 4. Department of Internal Medicine II, St. Josef-Hospital, Medical Centre of the Ruhr-University Bochum, Bochum, Germany
| | - Helmut Wittkowski
- 5. Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Germany
- 6. AID-NET Autoinflammatory disorders (AID) in children: Genetics, disease mechanisms, diagnostic markers and therapeutic targets, Essen and Muenster, Germany
| | - Faekah Gohar
- 5. Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Germany
- 6. AID-NET Autoinflammatory disorders (AID) in children: Genetics, disease mechanisms, diagnostic markers and therapeutic targets, Essen and Muenster, Germany
| | - Bjoern A. Menge
- 1. Department of Internal Medicine I, St. Josef-Hospital, Medical Centre of the Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
| | - Wolfgang E. Schmidt
- 1. Department of Internal Medicine I, St. Josef-Hospital, Medical Centre of the Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
| | - Christoph Zeidler
- 1. Department of Internal Medicine I, St. Josef-Hospital, Medical Centre of the Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
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Sarı İ, Birlik M, Kasifoğlu T. Familial Mediterranean fever: An updated review. Eur J Rheumatol 2014; 1:21-33. [PMID: 27708867 DOI: 10.5152/eurjrheum.2014.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/05/2014] [Indexed: 12/21/2022] Open
Abstract
Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disorder characterised by acute attacks of fever and serosal inflammation. FMF primarily affects Jewish, Armenian, Turkish, and Arab populations. The disease is accompanied by a marked decrease in quality of life due to the effects of attacks and subclinical inflammation in the attack-free periods. Untreated or inadequately treated patients run the risk of amyloidosis, which is an important cause of morbidity and mortality. In this review, the current information available on FMF is summarised.
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Affiliation(s)
- İsmail Sarı
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Merih Birlik
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Timuçin Kasifoğlu
- Department of Internal Medicine, Division of Rheumatology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Salah A, Zhou S, Liu Q, Yan H. P wave indices to predict atrial fibrillation recurrences post pulmonary vein isolation. Arq Bras Cardiol 2013; 101:519-27. [PMID: 24173135 PMCID: PMC4106810 DOI: 10.5935/abc.20130214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 08/05/2013] [Indexed: 12/21/2022] Open
Abstract
Background P-wave indices are appealing markers for predicting atrial fibrillation (AF)
recurrences post ablation. Objective This study evaluates the value of P wave indices to predict recurrences post
pulmonary vein isolation (PVI) in patients with paroxysmal AF. Methods We selected 198 patients (57 ± 8 years, 150 males) with symptomatic
drug-refractory paroxysmal AF undergoing PVI in our hospital. A 12-lead
electrocardiogram was used to measure P wave duration in lead II, P wave terminal
force (PWTF) in lead V1, P wave axis and dispersion. Results During a follow-up of 9 ± 3 months, recurrences occurred in 60 (30.3%) patients.
The patients that had AF recurrence had longer mean P wave duration (122.9 ± 10.3
vs 104.3 ± 14.2 ms, p < 0.001), larger P wave dispersion (40.7 ± 1.7 ms vs 36.6
± 3.2 ms, p < 0.001). P wave duration ≥ 125 ms has 60% sensitivity, 90%
specificity, positive predictive value (PPV) of 72% and negative predictive value
(NPV) of 83.7%, whereas P wave dispersion ≥ 40 ms has 78% sensitivity, 67%
specificity, PPV of 51% and NPV of 87.6% 48/66 (72.7%) patients with PWTF ≤ - 0.04
mm/second vs 12/132(9%) with PWTF > -0.04 mm/second showed recurrence of AF (p
< 0.001). P wave axis was not different between two groups. On multivariate
analysis, P wave indices were not independent from left atrial size and age. Conclusions P wave duration ≥ 125 ms, P wave dispersion ≥ 40 ms and PWTF in V1 ≤ - 0.04 mm/sec
are good clinical predictors of AF recurrences post PVI in patients with
paroxysmal atrial fibrillation; however they were not independent from left atrial
size and age.
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Affiliation(s)
| | - Shenghua Zhou
- Mailing Address: Shenghua Zhou, Department of Cardiology, The Second
Xiangya Hospital of Central South University, middle Ren-Min road, 139, Changsha.
Postal Code 410011, Hunan, China. E-mail:
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Nussinovitch U. Meta-analysis of p-wave dispersion values in healthy individuals: the influence of clinical characteristics. Ann Noninvasive Electrocardiol 2012; 17:28-35. [PMID: 22276626 DOI: 10.1111/j.1542-474x.2011.00478.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND P-wave dispersion (Pd) is an appealing marker for predicting the risk of developing atrial fibrillation. At present, no definitive cutoff value has been determined as to the diagnosis of high-risk patients. Our aims were to evaluate P-wave parameters of healthy subjects published in the literature, determine normal range and weighted means of Pd and P-wave parameters, and investigate the influences of gender, age, and BMI on the weighted results. METHODS A systematic search of studies published in PubMed was conducted. Only studies which included control groups of healthy individuals were included. RESULTS Of the 657 studies initially identified, 80 were eligible for inclusion. The total number of participants was 6,827. The highest reported Pd values were 58.56 ± 16.24 ms; the lowest were 7 ± 2.7 ms. The weighted mean was 33.46 ± 9.65 ms; weighted median was 32.2 ms. Gender and age were not found to be associated with significant influences on P-wave parameter values. High-normal BMI was not found to be associated with increased P-wave parameter values. CONCLUSIONS Pd, Pmax, and Pmin span a wide range of values in healthy individuals. Seemingly, abnormal values were often reported in healthy adults. The high variability of P-wave parameters in healthy individuals, and overlapping of the results with those reported for patients with increased risk for atrial fibrillation, might suggest that this technique has limited sensitivity and specificity. The variability between studies may stem from methodological issues and, therefore, there is a definite need for methodological standardization of Pd measurements.
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Affiliation(s)
- Udi Nussinovitch
- Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel.
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Nussinovitch U, Livneh A, Volovitz B, Nussinovitch M, Ben-Zvi I, Lidar M, Nussinovitch N. Normal QT dispersion in colchicine-resistant familial Mediterranean fever (FMF). Clin Rheumatol 2012; 31:1093-6. [DOI: 10.1007/s10067-012-1982-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 03/18/2012] [Accepted: 03/26/2012] [Indexed: 11/29/2022]
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10
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Nussinovitch U, Kaminer K, Nussinovitch M, Volovitz B, Lidar M, Nussinovitch N, Livneh A. QT interval variability in familial Mediterranean fever: a study in colchicine-responsive and colchicine-resistant patients. Clin Rheumatol 2012; 31:795-9. [PMID: 22271228 DOI: 10.1007/s10067-011-1926-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 12/06/2011] [Accepted: 12/20/2011] [Indexed: 02/02/2023]
Abstract
The association between familial Mediterranean fever (FMF), early atherosclerosis, and electrocardiographic markers for arrhythmias remains controversial. There are conflicting results as to the occurrence of high QT dispersion in FMF. The aim of the present study was to further investigate repolarization dynamics and other repolarization-associated pro-arrhythmogenic markers in FMF patients. To explore repolarization in FMF, patients who responded well to colchicine and patients who had not responded to colchicine, yet were amyloidosis-free, were included. We aimed to evaluate whether increased inflammatory burden, a characteristic of non-responsive patients, was specifically associated with abnormal repolarization. Included in the study were 53 FMF patients (27 colchicine non-responders) and 53 age- and sex-matched control subjects. Electrocardiograms were performed under strict standards. QT variability parameters were computed with custom-made computer software. No significant difference in any of the QT dynamic parameters was found in either FMF group compared with the healthy controls. Mean values of QT variability index, regardless of colchicine response, were similar to previously published results for healthy persons. In conclusion, patients with FMF who are continuously treated with colchicine and have not developed amyloidosis, regardless of their clinical response, have normal QT variability parameters, indicating normal repolarization dynamics and suggesting no increased risk of repolarization-associated cardiac arrhythmias.
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Affiliation(s)
- Udi Nussinovitch
- Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel 31080.
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Topal F, Tanindi A, Kurtoglu HG, Akbulut S, Kucukazman M, Topal FE. QT Dispersion is Not Increased in Familial Mediterranean Fever. J Int Med Res 2011; 39:2006-11. [DOI: 10.1177/147323001103900547] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Familial Mediterranean fever (FMF) is an autoimmune disease inherited as an autosomal recessive trait and is characterized by recurrent attacks of fever and sterile polyserositis. This study examined electrocardiographic ventricular repolarization parameters (QT interval and QT dispersion) in 38 FMF patients and 35 healthy controls. The QT interval was measured manually from the onset of QRS to the end of the T wave (return to the TP baseline). QT dispersion was defined as the difference between the maximum and minimum QT values, and corrected QT was calculated according to the Bazett formula. There were no significant differences between FMF patients and healthy control subjects in any parameter of ventricular repolarization; hence QT dispersion was not affected by FMF. Electrocardiographic assessment of QT interval and QT dispersion are, therefore, of little value for the evaluation of cardiac impairment and risk of arrhythmia in FMF patients.
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Affiliation(s)
- F Topal
- Department of Gastroenterology, Cankiri State Hospital, Cankiri, Turkey
| | - A Tanindi
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - HG Kurtoglu
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - S Akbulut
- Department of Gastroenterology, Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital, Istanbul, Turkey
| | - M Kucukazman
- Department of Gastroenterology, Kecioren Education and Research Hospital, Ankara, Turkey
| | - FE Topal
- Department of Emergency Medicine, Cankiri State Hospital, Cankiri, Turkey
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Nussinovitch U, Livneh A, Nussinovitch M, Volovitz B, Ben-Zvi I, Lidar M, Nussinovitch N. P-wave dispersion in systemic AA amyloidosis of familial Mediterranean fever. Clin Rheumatol 2011; 30:1295-8. [DOI: 10.1007/s10067-011-1745-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/26/2011] [Accepted: 03/25/2011] [Indexed: 01/12/2023]
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Nussinovitch U, Nussinovitch N, Nussinovitch M, Volovitz B, Feld O, Ben-Zvi I, Livneh A. QT dispersion in amyloidosis due to familial Mediterranean fever. Rheumatol Int 2011; 32:1945-8. [DOI: 10.1007/s00296-011-1896-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 03/13/2011] [Indexed: 02/05/2023]
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