Yaşlı Hemodiyaliz Hastalarının Elektrokardiyografisinde Tp-e Aralığının ve Elektrolit Bozuklukları ile İlişkisinin Değerlendirilmesi

Year 2021, Volume: 26 Issue: 2, 194 - 200, 29.05.2021

Mustafa Candemir , Mehmet Emin Demir , Burcu Candemir , Serdar Nurkoç

https://doi.org/10.21673/anadoluklin.790495

Abstract

Amaç: Aritmilere bağlı ani kardiyak ölüm (AKÖ), yaşlı hemodiyaliz (HD) hastalarında başlıca ölüm nedenlerindendir. Elektrokardiyografide (EKG) uzamış Tp-e aralığı (Tpe) ve artmış Tpe/QTc oranı ile AKÖ arasında güçlü bir ilişki olduğu bulunmuştur. Bu çalışmada serum elektrolit düzeylerindeki de¬ğişikliklerin HD öncesi ve sonrası EKG parametreleri, özellikle de Tpe üzerindeki etkilerini araştırmak amaçlanmıştır.

Yöntem: Çalışma (QT aralığını etkilediği bilinen bir hastalığı veya ilaç kullanımı olmayan) 160 HD hastası ve normal böbrek fonksiyonlarına sahip, yaş ve cinsiyet uyumlu 80 kontrol içerdi. Tüm katılımcılar 55 yaş ve üzeri idi. HD öncesi ve sonrası serum elektrolit değerleri ve EKG kayıtları elde edildi. Kalp hızı, QRS aralığı, QTc, Tpe ve Tpe/QTc değerleri hesaplandı. HD öncesi veriler, HD sonrası veriler ve kontroller ile karşılaştırıldı.

Bulgular: HD öncesi ve sonrası Tpe (iki karşılaştırma için de p<0,001) ve Tpe/QTc (sırasıyla p=0,024 ve p<0,001) değerleri kontrol grubuna kıyasla HD grubunda anlamlı biçimde daha yüksekti. HD sonrası Tpe ve Tpe/QTc değerleri, HD öncesi değerlere kıyasla anlamlı biçimde artmıştı (her karşı¬laştırma için p<0,001). HD öncesi Tpe, hipokalsemi veya hiperfosfatemili hastalarda normokalsemik ve normofosfatemik hastalara göre daha uzundu (iki veri grubu için de p=0,04). ΔTpe, Δkalsiyum (r=-0,19; p=0,02) ve Δfosfor (r=-0,23; p=0,004) ile anlamlı şekilde koreleydi.

Sonuç: Yaşlı HD hastalarında HD öncesinde uzamış olan Tpe, HD’den sonra daha da uzamıştı. Hipokalsemi ve hiperfosfatemi buna neden olan faktörlerden olabilir.

Keywords

ani kardiyak ölüm, Elektrokardiyografi, hemodiyaliz, Tp-e aralığı, Tp-e / QTc oranı

An Evaluation of Tp-e Interval and its Associations with Electrolyte Imbalances in the Electrocardiography of Elderly Patients on Hemodialysis

Abstract

Aim: Sudden cardiac death (SCD) due to arrhythmias is a major cause of death in elderly patients on hemodialysis (HD). It has been found that prolonged Tp-e interval (Tpe) on electrocardiography (ECG) and increased Tpe/QTc ratio are strongly associated with SCD. In this study, we aimed to inves¬tigate the effects of changes in serum electrolyte levels on the pre- and post-HD ECG parameters, particularly Tpe.

Methods: The study included 160 HD patients (with no disease or medication known to affect the QT interval) and 80 age- and sex-matched controls with normal kidney functions. All participants were aged 55 years or older. Pre- and post-HD serum electrolyte values and ECG re¬cordings were obtained. The heart rate, QRS interval, QTc, Tpe, and Tpe/QTc values were calculated. The pre-HD data were compared with the post-HD data as well as with controls.

Results: The pre- and post-HD Tpe (p<0.001 for both comparisons) and Tpe/QTc (p=0.024 and p<0.001, respectively) values were significantly higher in the HD group than in the control group. The post-HD Tpe and Tpe/QTc values were significantly increased compared to the pre-HD values (p<0.001 for each comparison). The pre-HD Tpe was longer in patients with hypocalcemia or hy¬perphosphatemia than in normocalcemic and normophosphatemic patients (p=0.04 for both data¬sets). ΔTpe was significantly correlated with Δcalcium (r=-0.19, p=0.02) and Δphosphorus (r=-0.23, p=0.004).

Conclusion: In the elderly patients on HD, Tpe, which was prolonged before HD, was even more prolonged after HD. Hypocalcemia and hyperphosphatemia may be among the un¬derlying factors.

Keywords

sudden cardiac death, Electrocardiography, hemodialysis, Tp-e interval, Tp-e/QTc ratio

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