Talasemi Major Hastalarında Tp-E Intervali Ve Tp-E/Qt, Tp-E/Qtc Oranlarının Değerlendirilmesi

Year 2022, Volume: 6 Issue: 1, 42 - 48, 27.03.2022

Zehra Erkal

https://doi.org/10.30565/medalanya.955688

Abstract

Amaç: Talasemi majör (TM), kronik hemolitik anemiye sebep olan genetik bir hemoglobinopatidir. Tedavisinde tekrarlayan kan transfüzyonları gereklidir. Transfüzyonlara bağlı miyokardda biriken demir, kardiyomiyopati ve ventriküler aritmi gelişimine neden olur. Özellikle hayatı tehdit edebilecek ventriküler aritmi gelişme riskini öngörmek klinik açıdan çok önemlidir ve bu amaçla birçok parametre kullanılmıştır. Biz ventriküler repolarizasyonu gösteren, yeni ve güvenilir prediktörler olan Tp-e intervali, Tp-e/QT ve Tp-e/QTc oranını TM hastalarında ve sağlıklı kontrol grubunda karşılaştırmak amacıyla bu çalışmayı planladık.

Yöntem: Çalışmamıza Mart 2019- Haziran 2020 yılları arasında polikliniğimize rutin kardiyak kontrol amacıyla gelen 97 TM hastası ve 90 tane sağlıklı gönüllü kontrol grubu dahil edildi. Demografik ve ekokardiyografik bulgularına ek olarak retrospektif olarak hastaların elektrokardiyografileri (EKG) incelendi. Serum ferritin, C reaktif protein (CRP)düzeyleri ve nötrofil lenfosit oranları kaydedildi ve karşılaştırıldı. Yine hastalar aldıkları şelasyon tedavilerine göre sınıflandırılarak EKG parametreleri arasındaki fark açısından karşılaştırıldı.

Bulgular: Talasemi majör hasta grubunda Tp-e intervali 80 msn (60.0-80.0) iken kontrol grubunda 60 msn (50.0-70.0) (p<0.001), Tp-e/QT oranı TM grubunda 0.200 (0.160-0.225) iken kontrol grubunda 0.175(0.150-0.210) (p:0.014), Tp-e/QTc oranı TM grubunda 0.180 (0.130-0.190) iken kontrol grubunda 0.150 (0.130-0.180) (p:0.035) tespit edildi. Serum ferritin düzeyi ile EKG parametreleri arasında korelasyon izlenmedi.

Sonuç: Talasemi majör hastalarında EKG de artmış Tp-e intervali, Tp-e/QT ve Tp-e/QTc oranları, artmış kardiyak demir depolanmasına bağlı oluşan ventriküler repolarizasyon bozuklukları ve ventriküler aritmiler ile ilişkilidir. Aritmi gelişme riskini öngörmede bu basit ama güvenilir parametreler kullanılabilir.

Keywords

Aritmi, elektrokardiyografi, talesemi

Assessment Of Tp-E Interval, Tp-E/Qt, Tp-E/Qtc Ratıos In Thalassemıa Major Patıents

Abstract

Aim: Thalassemia major (TM) is a genetic hemoglobinopathy that causes chronic hemolytic anemia. Repeated blood transfusions are needed for treatment. Iron accumulation is used to predict the risk of ventricular arrhythmia. We designed this study to compare the Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio, which are the novel and reliable predictors that show ventricular repolarization, between the TM patients and healthy control group.

Method: We included 97 TM patients who presented to our outpatient clinic for routine cardiac check-up from March 2019 to June 2020 and 90 healthy volunteers. In addition to the demographic and echocardiographic findings, patients’ electrocardiograms (ECG) were retrospectively analyzed. Their serum ferritin, C reactive protein (CRP) levels and neutrophil to lymphocyte ratios were recorded and compared.

Result: The Tp-e interval was 80 msn (60.0-80.0) in the group of thalassemia major patients whereas it was 60 msn (50.0-70.0) (p<0.001) in the control group. The Tp-e/QT ratio was 0.200 (0.160-0.225) in the TM group while it was 0.175(0.150-0.210) in the control group (p=0.014). The Tp-e/QTc ratio was 0.180 (0.130-0.190) in the TM group while it was 0.150 (0.130-0.180) in the control group (p=0.035). No correlation was found between their serum ferritin levels and ECG parameters.

Conclusion: Prolonged Tp-e interval, Tp-e/QT ve Tp-e/QTc ratios on the ECG in TM patients are associated with impaired ventricular repolarization due to excessive cardiac iron deposition and ventricular arrhythmias. These simple but reliable parameters can be used to predict the risk of arrhythmia.

Keywords

arrhythmia, electrocardiography, thalassemia

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