Association Between Index of Cardio‐Electrophysiological Balance and Cardiac Remodeling

Year 2022, Volume: 9 Issue: 2, 228 - 233, 30.06.2022

Mustafa Duran , Mehmet Burak Özen , Zafer Büyükterzi

https://doi.org/10.34087/cbusbed.1025493

Abstract

Objective: Pathophysiological changes in response to myocardial infarction (MI) result in cardiac remodeling. Left untreated this pathologic process contributes to impairment of ventricular function and development of malignant ventricular arrhythmias. Recently introduced ECG‐based marker index of cardio‐electrophysiological balance (iCEB) has been shown to be associated with various cardiac conditions. Herein, we aimed to investigate the association between the iCEB and cardiac remodeling in post-MI patients.
Materials and Methods: Patients aged ≥18 years presenting with acute MI who underwent successful percutaneous coronary intervention between January 2020 and January 2021 were recruited. Regarding the assessment of cardiac remodeling, left ventricular (LV) mass, LV mass index (LVMI), and relative wall thickness (RWT) were measured before the start of treatment and six months after the procedure along with the QT/QRS ratio (iCEB), and QTC/QRS ratio (iCEBc).
Results: According to our study, estimated QT/QRS (iECB) and QTc/QRS (iECBc) ratios were found to be significantly lower at six-month follow-up compared to baseline values (4.73∓0.60 vs 4.62∓0.55 & 4.93∓0.59 vs 4.78∓0.55, p<0.001 respectively). There were significant reductions of estimated LV mass and LVMI at six-month follow-up compared to baseline values (208.85∓40.30 g vs 198.15∓37.18 g & 108.21∓19.84 g/m2 vs 103.49∓19.58 g/m2, p<0.001 respectively). Both LVM and LVMI had a significant correlation with iCEB and iCEBc (p<0.001).
Conclusion: Our results suggest that iCEB may potentially be a useful marker in terms of predicting cardiac remodeling.

Keywords

Cardiac remodeling, left ventricular mass, left ventricular mass index, index of cardio‐electrophysiological balance

Kardiyak Yeniden Şekillenme ile Kardiyo-Elektrofizyolojik Denge İndeksi Arasındaki İlişki

Abstract

Giriş ve Amaç: Miyokart enfarktüsüne yanıt olarak ortaya çıkan patofizyolojik değişiklikler, kardiyak yeniden şekillenme ile sonuçlanır. Tedavi edilmediği takdirde bu patolojik süreç, ventriküler fonksiyonun bozulmasına ve malign ventriküler aritmilerin gelişmesine neden olur. Son zamanlarda kullanılmaya başlanan EKG tabanlı kardiyo-elektrofizyolojik denge indeksinin çeşitli kardiyak durumlarla ilişkili olduğu gösterilmiştir. Bu çalışmada, miyokart enfarktüsü sonrası gelişen kardiyak yeniden şekillenme ile kardiyo-elektrofizyolojik denge indeksi arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntemler: Çalışmaya, Ocak 2020 ile Ocak 2021 arasında hastanemize akut miyokart enfarktüsü ile başvuran ve başarılı perkütan koroner girişim uygulanan 18 yaş ve üzeri hastalar dahil edildi. Kardiyak yeniden şekillenmenin değerlendirilmesi amacıyla; sol ventrikül (SV) kütlesi, sol ventrikül kütle indeksi (SVKİ) ve rölatif duvar kalınlığı (RDK), tedavi başlamadan önce ve işlemden altı ay sonra kardiyo-elektrofizyolojik denge indeksi parametreleri (QT/QRS, QTc/QRS) ile birlikte değerlendirildi.
Bulgular: Çalışmamıza göre, altı aylık takip sonunda QT/QRS ve QTc/QRS değerleri başlangıç değerlerine göre anlamlı derecede düşük bulundu (4.73∓0.60 vs 4.62∓0.55 & 4.93∓0.59 vs 4.78∓0.55, sırasıyla p<0.001). Başlangıç değerlerine kıyasla SV kütle ve SVKİ değerlerinde anlamlı düşüşler tespit edildi (208.85∓40.30 g vs 198.15∓37.18 g & 108.21∓19.84 g/m2 vs 103.49∓19.58 g/m2, sırasıyla p<0.001). Hem SV kütle hem de SVKİ, kardiyo-elektrofizyolojik denge indeksi parametreleri ile anlamlı bir korelasyona sahipti (p<0,001).
Sonuç: Sonuçlarımız, kardiyo-elektrofizyolojik denge indeksi parametrelerinin kardiyak yeniden şekillenmeyi öngörme açısından potansiyel olarak yararlı bir belirteç olabileceğini düşündürmektedir.

Keywords

Kardiyak yeniden şekillenme, Sol ventrikül kütlesi, Sol ventrikül kütle indeksi, Kardiyo-elektrofizyolojik denge indeksi

References

• Cohn, J.N, Ferrari R, Sharpe N, Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling, Behalf of an International Forum on Cardiac Remodeling, Journal of the American College of Cardiology, 2000, 35, 569–582.
• Sacks, C.A, Jarcho, J.A, Curfman, G.D, Paradigm shifts in heart-failure therapy a timeline, New England Journal of Medicine, 2014, 71, 989–991.
• Behfar, A, Crespo-Diaz, R, Terzic, A, Gersh, B.J, Cell therapy for cardiac repair lessons from clinical trials, Nature Reviews Cardiology, 2014, 11, 232–246.
• Yücel, H, Şenarslan, D.A, Relationship Between Progression of Atherosclerosis and Hematological Parameters in Patients with Coronary Artery Bypass Graft (CABG) Surgery, Celal Bayar Üniversitesi-Sağlık Bilimleri Enstitüsi Dergisi, 2020, 7(1), 29-34.
• Lu, H.R, Yan, G.X, Gallacher, D.J, A new biomarker–index of cardiac electrophysiological balance (iCEB)–plays an important role in drug‐induced cardiac arrhythmias: Beyond QT‐prolongation and torsades de pointes (TdPs), Journal of Pharmacological and Toxicological Methods, 2013, 68, 250–259.
• Robyns, T, Lu, H.R, Gallacher, D.J, Garweg, C, Ector, J, Williams, R et al, Evaluation of Index of Cardio‐Electrophysiological Balance (iCEB) as a new biomarker for the Identification of Patients at Increased Arrhythmic Risk, Annals of Noninvasive Electrocardiology, 2016, 21, 294–304.
• Ibanez, B, James, S, Agewall, S, Antunes, M.J, Ducci, C.B, Bueno, H, et al, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST- segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC), European Heart Journal, 2018, 39, 119-77.
• Gibson, C.M, Schomig, A, Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion, Circulation, 2004, 109, 3096–3105.
• Quinones, M.A, Otto, C.M, Stoddard, M, Waggoner, A, Zoghbi, W.A, Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography, Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography, Journal of the American Society of Echocardiography, 2002, 15, 167–84.
• Devereux, R.B, Alonso, D.R, Lutas, E.M, Gottlieb, G.J, Campo, E, Sachs, I, et al., Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy fndings, Journal of the American College of Cardiology, 1986, 57, 450–458.
• Verbraecken, J, Van de Heyning, P, De Backer, W, Van Gaal, L, Body surface area in normal-weight, overweight, and obese adults, A comparison study, Metabolism, 2006, 55, 515-24.
• Kligfield, P, Gettes, S.L, Bailey, J.J, Childers R, Deal, B.J, Hancock, W, et al., Recommendations for the Standardization and Interpretation of the Electrocardiogram, Circulation, 2007, 115, 1306–1324.
• Goldenberg, I, Moss, A.J, Zareba, W, QT interval: how to measure it and what is “normal”, Journal of Cardiovascular Electrophysiology, 2006, 17, 333–6.
• Azevedo, P.S, Polegato, B.F, Minicucci, M.F, Paiva, S.A.R, Zornof, L.A.M, Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment, Arquivos Brasileiros de Cardiologia, 2016, 106, 62–69.
• Anand, I.S, Florea, V.G, Solomon, S.D, Konstam, M.A, Udelson, J.E, Noninvasive assessment of left ventricular remodeling: concepts, techniques and implications for clinical trials, Journal of Cardiac Failure, 2002, 8, S452-64.
• Zornoff LA, Paiva SA, Duarte DR, Spadaro J, Ventricular remodeling after myocardial infarction: concepts and clinical implications, Arquivos Brasileiros de Cardiologia, 2009, 92, 157-64.
• Expert Group on Biomarkers. Biomarkers in cardiology--part 1--in heart failure and specific cardiomyopathies, Arquivos Brasileiros de Cardiologia, 2014, 103, 451-9.
• Heusch, G, Libby P, Gersh, B, Yellon, D, Böhm, M, Lopaschuk, G, et al., Cardiovascular remodelling in coronary artery disease and heart failure, The Lancet, 2014, 383, 1933-43.
• Liu L, Eisen, H.J, Epidemiology of heart failure and scope of the problem, Cardiology Clinics, 2014, 32, 1-8.
• Pimentel, M, Zimerman, L.I, Rohde, L.E, Stratification of the risk of sudden death in nonischemic heart failure, Arquivos Brasileiros de Cardiologia, 2014, 103, 348-57.
• Hernández, D, Left ventricular hypertrophy after renal transplantation: New approach to a deadly disorder, Nephrology Dialysis Transplant, 2004, 19, 1682–86.
• Verma, A, Meris, A, Skali, H, Ghali, J.K, Arnold, J.M, Bourgoun, M, et al, Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study, Journal American College of Cardiology: Cardiovasc Imaging, 2008, 1, 582-91.
• Yumurtacı, O, Kurt, C, Ucar, M.F, Cihan, O, Usefulness Of Electrocardiographic Markers To Predict Ventricular Arrhythmias In Acute Myocarditis Patients, Turkish Medical Student Journal, 2017, 4, 6-10.
• Alsancak, Y, Sahin, A.T, Gurbuz, A.S, Sertdemir, A.L, Icli, A, Akilli H, et al., Index of cardiac-electrophysiological balance and the effects of thrombolytic therapy on the electrocardiogram of patients with pulmonary embolism, Revista da Associação Médica Brasileira (1992), 2020, 66, 1657-1665.