Akut Pankreatitli Hastalarda Tp-e Aralığı, Tp-e/QT Oranı and Tp-e/QTc Oranı’nın Değerlendirilmesi

Year 2020, Volume: 4 Issue: 1, 88 - 94, 02.03.2020

Yilmaz Güler , Can Ramazan Öncel

https://doi.org/10.30565/medalanya.625432

Abstract

Amaç: Akut pankreatit etyoolojisinden bağımsız olarak kardiyovasküler sistemi etkileyebilir. QT aralığı, düzeltilmiş QT aralığı (QTc), Tp-e aralığı ve Tp-e/QT, Tp-e/QTc oranları gibi elektrokardiyografik parametreler myokardiyal repolarizasyonun değerlendirilmesinde kullanılabilir. Çalışmamızda akut pankreatitin kardiyovasküler sistem üzerine olan etkilerini incelemeyi ve hastalığın ağırlığı ile ventriküler repolarizasyon parametreleri arasındaki ilişkiyi ortaya koymayı amaçladık.

Yöntem: Akut pankreatit tanısı alan hastalarda ventriküler repolarizasyon parametreleri (QT aralığı, QTc aralığı, Tp-e/QT, Tp-e/QTc oranı) kontrol grubu hastaları ile karşılaştırıldı. Ayrıca tüm hastalarda bu parametreler yanında Ranson ve APACHE II skorları ile amilaz değerleri hesaplanarak hastalığın şiddeti ile kardiyak parametreler arasındaki ilişki incelendi.

Bulgular: Çalışmada 60 hasta (30 akut pankreatit ve 30 kontrol ) incelendi. Tp-e aralığı, Tp-e/QT ve Tp-e/QTc oranlarının akut pankreatitli hastalarda kontrol grubuna göre istatistiksel olarak anlamlı düzeyde daha yüksek olduğu tespit edildi. Ayrıca Tp-e aralığı, Tp-e/QT ve Tp-e/QTc oranlarının Ranson ve APACHE II skorları ile pozitif korelasyon gösterdiği, Tp-e aralığının amilaz düzeyi ile pozitif korelasyon gösterdiği tespit edildi.

Sonuç: Akut pankreatitli hastalarda Tp-e aralığı, Tp-e/QT ve Tp-e/QTc oranları ventriküler aritmi riskinin tespitinde kullanılabilir ve Tp-e/QT ve Tp-e/QTc oranlarının yükselmesi akut pankreatitin şiddetiyle doğru orantılı olup, Tp-e oranı amilaz düzeyi ile paralel olarak yükselmektedir. Tek başına amilaz düzeyi akut pankreatitli hastalarda ventriküler aritmi riskinin belirleyicisi olarak kullanılabilir.

Keywords

Akut pankreatit, Elektrokardiyografi, Tp-e aralığı, Tp-e/QT oranı, Tp-e/QTc oranı

Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with acute pancreatitis

Abstract

Aim: Acute pancreatitis may affect cardiovascular system regardless of etiology. Electrocardiographic parameters such as QT interval, corrected QT interval (QTc), Tp-e interval and Tp-e/QT, Tp-e/QTc ratio can be used to evaluate myocardial repolarization. We aimed to investigate the effects of acute pancreatitis on the cardiovascular system and the relationship between ventricular repolarization parameters and the severity of the disease.

Methods: Ventricular repolarization parameters (QT interval, QTc interval, Tp-e/QT, Tp-e/QTc ratio) of the patients who were included in the study and diagnosed with acute pancreatitis were compared with the control group patients. In addition, these parameters and Ranson, APACHE II and amylase values were taken into account in all patients in the pancreatitis group and the relationship between the severity of the disease and cardiac parameters was investigated.

Results: 60 patients (30 acute pancreatitis and 30 control) were examined. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were significantly higher in the acute pancreatitis group compared to the control. In addition, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios showed a positive correlation with the Ranson and APACHE II scores and Tp-e interval displayed a positive correlation with amylase levels.

Conclusions: Tp-e interval, Tp-e/QT and Tp-e/QTc ratios can be used as a marker for the detection of ventricular arrhythmia risk in acute pancreatitis patients and Tp-e/QT and Tp-e/QTc ratios increased depending on the severity of AP and Tp-e interval increased in parallel with higher levels of amylase. Amylase level alone could be an indicator for increased risk of ventricular arrhythmia in patients with acute pancreatitis.

Keywords

Acute pancreatitis, Electrocardiography, Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio

References

• 1. Aksoy F, Demiral G, Ekinci Ö Can The timing of laparoscopic cholecystectomy after biliary pancreatitis change the conversion rate to open surgery? Asian J Surg. 2018;41(4):307-312. PMID: 28284749
• 2. Ranson JH. Acute pancreatitis. In: Zinner MJ, Schwartz SI, Ellis H, Ashley SW, McFadden DW, editors. Maingot’s abdominal operations. 10th ed. Stamford: Appleton & Lange. 1997. p. 1899-915.
• 3. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg. 1990;77:1260-4. PMID: 2253005
• 4. Yegneswaran B, Kostis JB, Pitchumoni CS. Cardiovascular manifestations of acute pancreatitis. J Crit Care. 2011;26:225.e11-8. PMID:21185146
• 5. Rubio-Tapia A, García-Leiva J, Asensio-Lafuente E, Robles-Díaz G, Vargas-Vorácková F. Electrocardiographic abnormalities in patients with acute pancreatitis. J Clin Gastroenterol. 2005;39:815-8. PMID:16145345
• 6. Pezzilli R, Barakat B, Billi P, Bertaccini B. Electrocardiographic abnormalities in acute pancreatitis. Eur J Emerg Med. 1999;6:27-9. PMID:10340731
• 7. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41:575-80. PMID:18954608
• 8. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41:567-74. PMID:18790499
• 9. Osvaldt AB, Viero P, Borges da Costa MS, Wendt LR, Bersch VP, Rohde L. Evaluation of Ranson, Glasgow, APACHE-II, and APACHE-O criteria to predict severity in acute biliary pancreatitis. Int Surg. 2001;86:158-61. PMID:11996072
• 10. Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet. 1989;2:201-5. PMID:2568529
• 11. Hodges MS, Salerno D, Erlinen D. Bazett's QT correction reviewed: evidence that a linear QT correction for heart rate is better. J Am Coll Cardiol. 1983;1:694. DOI: https://doi.org/10.1161/JAHA.116.003264
• 12. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-39. PMID:25712077
• 13. Saulea A, Costin S, Rotari V. Heart ultrastructure in experimental acute pancreatitis. Rom J Physiol. 1997;34:35-44. PMID:9653808
• 14. Buch J, Buch A, Scmidt A. Transient ECG changes during acute attacks of pancreatitis. Acta Cardiol. 1980;35:381–90. PMID:6162302
• 15. Prasada R, Dhaka N, Bahl A, Yadav TD, Kochhar R Prevalence of cardiovascular dysfunction and its association with outcome in patients with acute pancreatitis. Indian J Gastroenterol. 2018;37(2):113-119. PMID:29560600
• 16. Yaylaci S, Kocayigit I, Genc AB, Cakar MA, Tamer A, Uslan MI. Electrocardiographic changes in patients with acute pancreatitis. Medical Journal of Dr. D.Y. Patil University. 2015;8(2):196-198. DOI: 10.4103/0975-2870.153159
• 17. Ates F, Kosar F, Aksoy Y, Yildirim B, Sahin I, Hilmioglu F. QT interval analysis in patient with acute biliary pancreatitis. Pancreas. 2005;31(3):238-41. PMID:16163055
• 18. Alizade E, Yesin M, Yazicioğlu MV, Karaayvaz EB, Atici A, Arslan Ş et al. Evaluation of Tp-e Interval, Tp-e/QT Ratio, and Tpe/QTc Ratio in patients with asymptomatic right ventricular cardiomyopathy. Ann Noninvasive Electrocardiol. 2017;22(1). DOI: 10.1111/anec.12362
• 19. 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. 2015;15(6):463-7. DOI: 10.5152/akd.2014.5503 20. James PR, Taggart P, McNally ST, Newman SP, Sproton SC, Hardman SM. Acute psychological stress and the propensity to ventricular arrhythmias. Eur Heart J. 2002;21:1023–1028. PMID:10901515
• 21. Aytemir K, Aksoyek S, Ozer N, Gurlek A, Oto A. QT dispersion and autonomic nervous system function in patients with type 1 diabetes. Int J Cardiol. 1998;65:45–50. PMID:9699930
• 22. Wei K, Dorian P, Newman D, Langer A. Association between QT dispersion and autonomic dysfunction in patients with diabetes mellitus. J Am Coll Cardiol. 1995;26:859–863. PMID:7560609
• 23. Ito K, Ramirez-Schon G, Shah P, Agarwal N, Delguercio LR, Reynolds BM. Myocardial function in acute pancreatitis. Ann Surg. 1981;194:85–8. PMID:7247538
• 24. Beger HG, Bittner R, Buchler M, Hess W, Schmitz JE.. Hemodynamic data pattern in patients with acute pancreatitis. Gastroenterology. 1986;90:74–9. PMID:3940259
• 25. Nadkarni N, Bhasin DK, Rana SS, Bahl A, Sinha SK, Rao C, et al. Diastolic dysfunction, prolonged QTc interval and pericardial effusion as predictors of mortality in acute pancreatitis. J Gastroenterol Hepatol. 2012;27(10):1576-80. PMID:22849657