Düşük ejeksiyon fraksiyonlu kalp yetersizliğinde sakubutril/valsartan'ın Tp-e, QT, QTc, Tp-e/QTc parametreleri üzerine etkisi

Yıl 2024, Cilt: 49 Sayı: 1, 47 - 53, 29.03.2024

Ahmet Genç , Gülsüm Meral Yılmaz Öztekin

https://doi.org/10.17826/cumj.1377925

Öz

yetersizliği (HFrEF) hastalarında Sakubutril/Valsartan-Anjiyotensin reseptör neprilisin inhibitörünün (ARNI) tedavisi öncesi, tedavi sonrası birinci ve altıncı aylarda ventriküler repolarizasyonu değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya anjiyotensin dönüştürücü enzim inhibitörlerinden veya anjiyotensin reseptör blokerlerinden (ACE-I/ARB) ARNI tedavisine geçen 49 HFrEF hastası dahil edildi. ARNI tedavisi öncesinde, birinci ve altıncı aylarda 12 derivasyonlu elektrokardiyografi (EKG) değerlendirildi. Demografik, klinik ve laboratuvar parametrelerinin yanı sıra ilaçlar ve EKG verileri, kalp atış hızı, QT, QTc, Tp-e, hesaplanan Tp-e (Tp-ec), Tp-ec/QTc, Tp-e/QT ve Tp-e/QTc değerlendirildi.
Bulgular: ARNI tedavisi aldıktan sonra ventriküler repolarizasyon indekslerinde tedavi öncesine göre birinci ve altıncı ayda anlamlı azalma görüldü. Spesifik olarak QTc değerleri 457.6 ms'den 443.8 ms'ye, Tp-e/QT oranı ise 0.21±0,03'ten 0.19±0.03'e düştü. Ayrıca QTc değerleri 457.6 ms'den 444.9 ms'ye, Tp-e/QT oranı ise 0.21±0.03'ten 0.18±0.03'e düştü. Ancak ARNI tedavisi altında birinci ve altıncı aylar karşılaştırıldığında anlamlı fark saptanmadı (QTc: 443.8 ms vs. 444.9 ms, Tp-e/QT: 0.19±0.03 vs. 0.18±0.003).
Sonuç: HFrEF'de ARNI tedavisi ile ventriküler repolarizasyonun göstergeleri olan QTc, Tp-e ve Tp-ec aralıklarında ve Tp-e/QT, Tp-e/QTc ve Tp-ec/QTc oranlarında olumlu etkilendi. Üstelik bu etki 1. ayda başlayıp 6. ayda da devam etti.

Anahtar Kelimeler

Ani kardiyak ölüm, Anjiyotensin reseptörü neprilisin inhibitörü, Tp-e; Tp-e/QTc oranı; QTc, Ventriküler repolarizasyon.

Effect of sacubutril/valsartan on Tp-e, QT, QTc, Tp-e/QTc parameters in heart failure with reduced ejection fraction

Öz

Purpose: The purpose of this study is to evaluate ventricular repolarization before, at the first month, and sixth month after Sacubutril/Valsartan, an angiotensin receptor neprilysin inhibitor (ARNI) treatment in heart failure patients with reduced ejection fraction (HFrEF).
Materials and Methods: We included 49 patients with HFrEF who switched to ARNI therapy. The 12-lead electrocardiography (ECG) was evaluated before ARNI therapy and also during the first and sixth months of the therapy. We evaluated demographic, clinical, and laboratory parameters, as well as medications and ECG data, including heart rate. Additionally, we examined QT, QTc, Tp-e, Tp-e calculated (Tp-ec), Tp-ec/QTc, Tp-e/QT, and Tp-e/QTc.
Results: After receiving ARNI treatment, ventricular repolarization indices were significantly reduced in the first and sixth months compared to before treatment. Specifically, the QTc values decreased from 457.6 ms to 443.8 ms, and the Tp-e/QT ratio decreased from 0.21±0.03 to 0.19±0.03. Additionally, the QTc values decreased from 457.6 ms to 444.9 ms, and the Tp-e/QT ratio decreased from 0.21±0.03 to 0.18±0.03. However, when the first and sixth months under ARNI treatment were compared, no significant difference was found (QTc: 443.8 ms vs. 444.9 ms, Tp-e/QT: 0.19±0.03 vs. 0.18±0.003).
Conclusion: ARNI treatment in HFrEF positively affected QTc, Tp-e, and Tp-ec intervals and Tp-e/QT, Tp-e/QTc, and Tp-ec/QTc ratios, which are indicators of ventricular repolarization. Moreover, this effect started in the first month and continued in the sixth month.

Anahtar Kelimeler

Angiotensin receptor neprilysin inhibitor, Tp-e, Tp-e/QTc ratio, QTc, Sudden cardiac death, Ventricular repolarization

Kaynakça

• Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-200.
• Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Colvin MM et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137-e61.
• Kong MH, Fonarow GC, Peterson ED, Curtis AB, Hernandez AF, Sanders GD et al. Systematic review of the incidence of sudden cardiac death in the United States. Journal of the American College of Cardiology. 2011;57:794-801.
• McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993-1004.
• Desai AS, McMurray JJ, Packer M, Swedberg K, Rouleau JL, Chen F et al. Effect of the angiotensin-receptor-neprilysin inhibitor LCZ696 compared with enalapril on mode of death in heart failure patients. Eur Heart J. 2015;36:1990-7.
• de Diego C, Gonzalez-Torres L, Nunez JM, Centurion Inda R, Martin-Langerwerf DA, Sangio AD et al. Effects of angiotensin-neprilysin inhibition compared to angiotensin inhibition on ventricular arrhythmias in reduced ejection fraction patients under continuous remote monitoring of implantable defibrillator devices. Heart Rhythm. 2018;15:395-402.
• Antzelevitch C. Heterogeneity and cardiac arrhythmias: an overview. Heart Rhythm. 2007;4:964-72.
• Martínez JP, Laguna P, Olmos S, Pahlm O, Pettersson J, Sörnmo L. Assessment of QT-measurement accuracy using the 12-lead electrocardiogram derived from EASI leads. J Electrocardiol. 2007;40:172-9.
• Yan GX, Martin J. Electrocardiographic T wave: a symbol of transmural dispersion of repolarization in the ventricles. J Cardiovasc Electrophysiol. 2003;14:639-40.
• 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.
• 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.
• Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4:1114-6; author reply 6-9.
• Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011;4:441-7.
• Moss AJ, Schwartz PJ, Crampton RS, Locati E, Carleen E. The long QT syndrome: a prospective international study. Circulation. 1985;71:17-21.
• Bjerregaard P, Gussak I. Short QT syndrome. Ann Noninvasive Electrocardiol. 2005;10:436-40.
• Zhu TY, Teng SE, Chen YY, Liu SR, Meng SR, Peng J. [Correlation of Tp-e interval and Tp-e/Q-T ratio with malignant ventricular arrhythmia in patients with implantable cardioverter-defibrillator for primary prevention]. Nan Fang Yi Ke Da Xue Xue Bao. 2016;36:401-4.
• Ozgul U, Turan OE, Baskurt AA, Yilancioglu RY, Dogdus M, Inevi UD et al. The predictive value of electrocardiographic polarization parameters on appropriate ICD shock in primary prevention heart failure patients. J Electrocardiol. 2023;77:80-4.
• Yılmaz E, Aydın E, Çamcı S, Kurt D, Aydın E. Effect of sodium-glucose co-transporter-2 inhibitors on ventricular repolarization markers in heart failure with reduced ejection fraction. Cardiovasc Drugs Ther. 2022; doi: 10.1007/s10557-022-07396-y.
• Okutucu S, Sabanoglu C, Yetis Sayin B, Aksoy H, Bursa N, Oto A. Switching from ramipril to sacubitril/valsartan favorably alters electrocardiographic indices of ventricular repolarization in heart failure with reduced ejection fraction. Acta Cardiol. 2020;75:20-5.
• 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 Cardiovasc Imaging. 2015;16:233-71.
• Bazett HC. The time relations of the blood-pressure changes after excision of the adrenal glands, with some observations on blood volume changes. J Physiol. 1920;53:320-39.
• Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006;47:1828-34.
• Morin DP, Saad MN, Shams OF, Owen JS, Xue JQ, Abi-Samra FM et al. Relationships between the T-peak to T-end interval, ventricular tachyarrhythmia, and death in left ventricular systolic dysfunction. Europace. 2012;14:1172-9.
• Yesil E, Uyar H, Orscelik O, Ozkan B, Demir M, Yesildas C et al. The effect of ferric carboxymaltose treatment on the Tp-e interval and the Tp-e/QT and Tp-e/QTc ratios in heart failure patients with iron deficiency. Kardiologiia. 2022;30;62:42-8.
• Sicouri S, Antzelevitch C. A subpopulation of cells with unique electrophysiological properties in the deep subepicardium of the canine ventricle. The M cell. Circ Res. 1991;68:1729-41.
• von Lueder TG, Wang BH, Kompa AR, Huang L, Webb R, Jordaan P et al. Angiotensin receptor neprilysin inhibitor LCZ696 attenuates cardiac remodeling and dysfunction after myocardial infarction by reducing cardiac fibrosis and hypertrophy. Circ Heart Fail. 2015;8:71-8.
• Iborra-Egea O, Gálvez-Montón C, Roura S, Perea-Gil I, Prat-Vidal C, Soler-Botija C et al. Mechanisms of action of sacubitril/valsartan on cardiac remodeling: a systems biology approach. NPJ Syst Biol Appl. 2017;3:12.
• Hubers SA, Brown NJ. Combined angiotensin receptor antagonism and neprilysin inhibition. Circulation. 2016;133:1115-24.
• Martens P, Nuyens D, Rivero-Ayerza M, Van Herendael H, Vercammen J, Ceyssens W et al. Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction. Clin Res Cardiol. 2019;108:1074-82.
• Vaseghi M, Yamakawa K, Sinha A, So EL, Zhou W, Ajijola OA et al. Modulation of regional dispersion of repolarization and T-peak to T-end interval by the right and left stellate ganglia. Am J Physiol Heart Circ Physiol. 2013;305:H1020-30.
• Mullens W, Martens P. Exploiting the Natriuretic Peptide Pathway to Preserve Glomerular Filtration in Heart Failure. JACC Heart Fail. 2018;6:499-502.
• Levine YC, Rosenberg MA, Mittleman M, Samuel M, Methachittiphan N, Link M et al. B-type natriuretic peptide is a major predictor of ventricular tachyarrhythmias. Heart Rhythm. 2014;11:1109-16.
• Landstrom AP, Dobrev D, Wehrens XHT. Calcium signaling and cardiac arrhythmias. Circ Res. 2017;120:1969-93.