Hafif Akut Miyokarditli Genç Hastalarda İnteratriyal Blok ve Ventriküler Repolarizasyon Parametreleri

Yıl 2023, Cilt: 8 Sayı: 1, 96 - 100, 05.03.2023

Yusuf Hoşoğlu , Ayşe Hoşoğlu , Mehmet Göl , Abdulmecit Afşin

https://doi.org/10.26453/otjhs.1182107

Öz

Amaç: Ventrikül fonksiyonları normal olan akut miyokardit tanısı almış genç hastalarda interatriyal blok ve ventriküler repolarizasyon ile ilgili EKG bulgularını ve bazı biyokimyasal parametreleri değerlendirmektir.
Materyal ve Metot: Ocak 2014 ile Ocak 2020 arasında tanısal koroner anjiyografi yapılan 35 yaş altı 405 hastanın verileri geriye dönük olarak incelendi. EKG kayıtlarına ulaşılamayan veya kayıt kalitesi değerlendirmeye uygun olmayan, ani kardiyak ölüm, kardiyomiyopati, ejeksiyon fraksiyonu <%50, diabetes mellitus, hipertansiyon, kronik böbrek ve karaciğer yetmezliği olan hastalar çalışma dışı bırakıldı. Akut miyokardit ayırıcı tanısı için tanısal anjiyografi yapılan hastalar miyokardit grubuna (n: 35) ve yaş ve cinsiyet açısından uyumlu, koroner dolaşımı normal olan ve başka bir sebepten ötürü anjiografi yapılan hastalar kontrol grubuna dahil edildi (n: 35).
Bulgular: Kalp hızı, P dalgası süresi, P dalgası tepe zamanı, PR aralığı, QRS, QT ve Tp–e aralığı, QTc, Tp–e/QT ve Tp–e/QTc oranları gruplar arasında farklılık göstermedi. Troponin (p<0,001), glukoz (p=0,004), LDL (p=0,015), AST (p<0,001), ALT (p<0,026), CRP (p<0,001) düzeyleri ve nötrofil sayısı (p=0,003) miyokardit grubunda belirgin olarak yüksek iken, HDL daha düşüktü (p<0,001).
Sonuç: Biyokimyasal parametreler miyokardit grubunda farklılık göstermsine rağmen, EKG bulguları farklılık göstermedi.

Anahtar Kelimeler

EKG, miyokardit, Tp–e aralığı, troponin, ventriküler repolarizasy

Destekleyen Kurum

Adıyaman Üniversitesi, Tıp Fakültesi

Interatrial Block and Ventricular Repolarization Parameters in Young Patients with Mild Acute Myocarditis

Öz

Objective: To evaluate ECG findings regarding interatrial block and ventricular repolarization and certain biochemical parameters in young patients diagnosed as acute myocarditis with normal ventricular functions.
Materials and Methods: 405 patients under the age of 35 who underwent diagnostic coronary angiography between January 2014 and January 2020 were retrospectively analyzed. Patients whose ECG records could not be accessed or quality were not suitable for evaluation, with sudden cardiac death, cardiomyopathy, ejection fraction <50%, diabetes mellitus, hypertension, chronic kidney and liver failure were excluded. Patients who underwent diagnostic angiography for the differential diagnosis of acute myocarditis were assigned to myocarditis group (n: 35), and age– and sex–matched subjects with normal coronary circulation and underwent coronary angiography for any other reason were assigned to control group (n: 35).
Results: Heart rate, P wave duration, P wave peak time, PR interval, QRS, QT, and Tp–e interval, QTc, Tp–e/QT and Tp–e/QTc ratios did not differ from each other. Whereas troponin (p<0.001), glucose (p=0.004), LDL (p=0.015), AST (p<0.001), ALT (p<0.026), CRP (p<0.001) levels and neutrophil count (p=0.003) were markedly higher in myocarditis group, HDL was lower (p<0.001).
Conclusions: Although biochemical parameters display differences in myocarditis group, ECG findings did not differ.

Anahtar Kelimeler

ECG, myocarditis, Tp–e interval, troponin, ventricular repolarization

Kaynakça

• 1. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636–2648d. doi:10.1093/eurheartj/eht210
• 2. Fung G, Luo H, Qiu Y, et al. Myocarditis. Circ Res. 2016;118(3):496–514. doi:10.1161/CIRCRESAHA.115.306573
• 3. Wu C, Singh A, Collins B, et al. Causes of troponin elevation and associated mortality in young patients. Am J Med. 2018;131(3):284–292.e1. doi:10.1016/j.amjmed.2017.10.026
• 4. Buttà C, Zappia L, Laterra G, et al. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Ann Noninvasive Electrocardiol. 2020;25(3):125-134. doi:10.1111/anec.12726
• 5. Punja M, Mark DG, McCoy JV, et al. Electrocardiographic manifestations of cardiac infectious-inflammatory disorders. Am J Emerg Med. 2010;28(3):364–377. doi:10.1016/j.ajem.2008.12.017
• 6. Henkens MTHM, López Martínez H, Weerts J, et al. Interatrial block predicts life-threatening arrhythmias in dilated cardiomyopathy. J Am Heart Assoc. 2022;11(14):e025473. doi:10.1161/JAHA.121.025473
• 7. Bayés de Luna A, Baranchuk A, Alberto Escobar Robledo L, et al. Diagnosis of interatrial block. J Geriatr Cardiol. 2017;14(3):161–165. doi:10.11909/j.issn.1671-5411.2017.03.007
• 8. McCarthy RE 3rd, Boehmer JP, Hruban RH, et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000;342(10):690–695. doi:10.1056/NEJM200003093421003
• 9. Enriquez A, Conde D, Hopman W, et al. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther. 2014;32(2):52–56. doi:10.1111/1755-5922.12063
• 10. A Reiffel J. Intra-atrial block: Definition and relationship to atrial fibrillation and other adverse outcomes. J Atr Fibrillation. 2019;12(2):2234. doi:10.4022/jafib.2234
• 11. Baranchuk A, Enriquez A, Antiperovitch P, et al. Advanced interatrial block as a key marker for atrial fibrillation recurrence: Bayés' syndrome. J Geriatr Cardiol. 2017;14(3): 169–173. doi:10.11909/j.issn.1671-5411.2017.03.005
• 12. Zhao D, Liang B, Peng J, et al. Tp-e and (Tp-e)/QT ratio as a non–invasive risk factors for malignant ventricular arrhythmia in patients with idiopathic ventricular premature complexes. J Clin Lab Anal. 2021;35(2):e23636. doi:10.1002/jcla.23636
• 13. Uçar FM, Öztürk C, Yılmaztepe MA. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with acute myocarditis. BMC Cardiovasc Disord. 2019;19(1):232. doi:10.1186/s12872-019-1207-z
• 14. Wang X, Zhang L, Gao C, et al. Tpeak-Tend/QT interval predicts ST-segment resolution and major adverse cardiac events in acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Medicine (Baltimore). 2018;97(43):e12943. doi:10.1097/MD.0000000000012943
• 15. Koca H, Koç M. What is the Normal Value of Tpe Interval and Corrected Tpe Interval?. Acta Medica, 2020;51(4), 10-15
• 16. Güneş HM, Babur Güler G, Güler E, et al. Assessment of repolarization abnormalities in baseline electrocardiograms of patients with myocarditis. Turk J Med Sci. 2017; 47(5):1333–1339. doi:10.3906/sag-1612-39
• 17. Liu C, Wang Z, Chen K, et al. The absolute and relative changes in high-sensitivity cardiac troponin I are associated with the in-hospital mortality of patients with fulminant myocarditis. BMC Cardiovasc Disord. 2021;21(1):571. doi:10.1186/s12872-021-02386-8
• 18. Rroku A, Kottwitz J, Heidecker B. Update on myocarditis - what we know so far and where we may be heading. Eur Heart J Acute Cardiovasc Care. 2020;10(4):455-467. doi:10.1177/2048872620910109
• 19. Freitas HF, Barbosa EA, Rosa FH, et al. Association of HDL cholesterol and triglycerides with mortality in patients with heart failure. Braz J Med Biol Res. 2009;42(5):420–425. doi:10.1590/s0100-879x2009000500004
• 20. Chang H, Wang Y, Wu Y, et al. Cardiac apoptosis caused by elevated cholesterol level in experimental autoimmune myocarditis. Exp Cell Res. 2020;395(1):112169. doi:10.1016/j.yexcr.2020.112169
• 21. Lei S, Chen J, Song C, et al. CTRP9 alleviates foam cells apoptosis by enhancing cholesterol efflux. Mol Cell Endocrinol. 2021;522:111138. doi:10.1016/j.mce.2020.111138
• 22. Chattopadhyay A, Kwartler CS, Kaw K, et al. Cholesterol-induced phenotypic modulation of smooth muscle cells to macrophage/fibroblast-like cells is driven by an unfolded protein response. Arterioscler Thromb Vasc Biol. 2021;41(1):302-316. doi:10.1161/ATVBAHA.120.315164
• 23. Sarohi V, Srivastava S, Basak T. A Comprehensive outlook on dilated cardiomyopathy (DCM): State-Of-The-Art Developments with Special Emphasis on OMICS-Based Approaches. J Cardiovasc Dev Dis. 2022;9(6):174. doi:10.3390/jcdd9060174
• 24. İnanır M, Gürler M, Kargın R, et al. Comparison of ECG, laboratory and echocardiographic parameters in patients with acute myocarditis at acute attack and clinical remission. Ortadogu Tıp Derg. 2020;12(2):175-180. doi:10.21601/ortadogutipdergisi.713846