Araştırma Makalesi
Yıl 2022,
Cilt: 9 Sayı: 1, 22 - 27, 29.04.2022
Öz
Kardiyak aritmilere bağlı ani ölüm, kronik hemodiyaliz (HD) hastaları için önemli bir mortalite nedenidir. Çalışmamızda HD hastalarında, aritmi riski ile ilişkili olabilecek elektrokardiyogram (EKG) repolarizasyon parametrelerinin (QT, düzeltilmiş QT (QTc), T peak-end (Tp-e), Tp-e/QT ve Tp-e/QTc) klinik özellikler ile olası ilişkilerini araştırdık. Çalışmaya kronik HD programında olan 131 erişkin hasta ve 49 sağlıklı birey alındı. Bütün katılımcıların EKG repolarizasyon parametreleri kaydedildi. HD grubunda klinik özellikler kaydedilirken, kan örnekleri ve EKG kayıtları hafta ortası rutin bir HD seansından önce alındı. HD grubunda QT ve QTc daha uzun bulundu (p=0.001, p<0.001). Gruplar arasında TP-e değerleri farklı bulunmadı. Diyabetes mellitus (DM) olan HD hastalarında, QT ve QTc aralıkları daha uzun bulundu (p<0.001, p=0.001). Bu ilişkiler yaş, cinsiyet ve komorbiditelerle yapılan regresyonlardan sonra anlamlılığını korudu. Kardiyovasküler hastalığı olan HD hastalarında QT mesafesi daha uzundu (p=0.033). HD hastalarında; QT ve QTc ölçümlerinin uzadığı görüldü. Bu durum artmış aritmi riskinin bir işareti olabilir. DM tanısı olanlarda çoklu değişkenlerle yapılan regresyonlardan sonra bile QT ve QTc değerleri anlamlı düzeyde uzundu. Kronik HD programındaki hastalarımızı EKG parametreleri açısından değerlendirmek, repolarizasyon ölçümlerinde uzama ve DM gibi komorbid durumları olanları takipte tutmak akılcı olabilir.
Anahtar Kelimeler
Diyabetes Mellitus Hemodiyaliz Kardiyak Repolarizasyon QTc Tp-e İntervali
Destekleyen Kurum
Proje desteği alınmadı.
Proje Numarası
Proje desteği alınmadı.
Teşekkür
.
Kaynakça
- 1. Herzog CA, Mangrum M, Passman R. Sudden cardiac death in dialysis patients. Semin Dial. 2008;21(4):300-7.
- 2. Alsheikh-Ali AA, Trikalinos TA, Ruthazer R, et al. Risk of arrhythmic and nonarrhythmic death in patients with heart failure and chronic kidney disease. Am Heart J. 2011;161(1):204-9.
- 3. Di Lullo L, Rivera R, Barbera V, et al. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol. 2016;15;217:16-27.
- 4. Secemsky EA, Verrier RL, Cooke G, et al. High prevalence of cardiac autonomic dysfunction and T-wave alternans in dialysis patients. Heart Rhythm. 2011;8(4):592–8.
- 5. Di Iorio B, Bellasi A. QT interval in CKD and haemodialysis patients. Clin Kidney J. 2013;6(2):137-43.
- 6. Wu VC, Lin LY, Wu KD. QT interval dispersion in dialysis patients. Nephrology (Carlton). 2005;10(2):109-12.
- 7. Monfared A, Assadian Rad M, Feizkhah M, et al. Comparison of tpe changing on ECG, in pre and post dialysis and post transplantation. Nephrourol Mon. 2016;8(3):e35864. 8. Hansen S, Rasmussen V, Torp-Pedersen C, et al. QT intervals and QT dispersion determined from a 12-lead 24-hour Holter recording in patients with coronary artery disease and patients with heart failure. Ann Noninvasive Electrocardiol. 2008;13(1):22-30.
- 9. Erken E, Altunoren O, Yildiz YS, et al. Evaluation of Cardiac Repolarization and Serum Electrolytes in Pre-Dialytic Stages of Chronic Kidney Disease. Turk Neph Dial Transpl. 2018;27(2):189-95.
- 10. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41(6):575-80.
- 11. National Kidney Foundation Hemodialysis Adequecy 2015 Work Group. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930.
- 12. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
- 13. Kestenbaum B, Rudser KD, Shlipak MG, et al. Kidney function, electrocardiographic findings, and cardiovascular events among older adults. Clin J Am Soc Nephrol. 2007;2(3):501-8.
- 14. Dobre M, Brateanu A, Rashidi A, et al. Electrocardiogram abnormalities and cardiovascular mortality in elderly patients with CKD. Clin J Am Soc Nephrol. 2012;7(6):949-56.
- 15. Hage FG, de Mattos AM, Khamash H, et al. QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol. 2010;33(6):361-66.
- 16. Antzelevitch C. T peak-Tend interval as an index of transmural dispersion of repolarization. European journal of clinical investigation. 2001;31(7):555-7.
- 17. Watanabe N, Kobayashi Y, Tanno K, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. J Electrocardiol. 2004;37(3):191-200.
- 18. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. Journal of electrocardiology. 2008;41(6):567-74.
- 19. Kollu K, Altintepe L, Duran C, et al. The assessment of P-wave dispersion and myocardial repolarization parameters in patients with chronic kidney disease. Ren Fail. 2018;40(1):1-7.
- 20. Sivri S, Çelik M. Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease. J Electrocardiol. 2019;54:72-5.
- 21. Kalantzi K, Gouva C, Letsas KP, et al. The impact of hemodialysis on the dispersion of ventricular repolarization. Pacing Clin Electrophysiol. 2013;36(3):322-7.
- 22. Sherif KA, Abo-Salem E, Panikkath R, et al. Cardiac repolarization abnormalities among patients with various stages of chronic kidney disease. Clin Cardiol. 2014;37(7):417-21.
- 23. Kobayashi S, Nagao M, Asai A, et al. Severity and multiplicity of microvascular complications are associated with QT interval prolongation in patients with type 2 diabetes. J Diabetes Investig. 2018;9(4):946-51.
- 24. Wu CC, Lu YC, Yu TH, et al. Serum albumin level and abnormal corrected QT interval in patients with coronary artery disease and chronic kidney disease. Intern Med J. 2018;48(10):1242-51.
- 25. Kim E, Joo S, Kim J, et al. Association between C-reactive protein and QTc interval in middle-aged men and women. Eur J Epidemiol. 2006;21(9):653-9.
- 26. Zhang Y, Post WS, Dalal D, et al. Serum 25-hydroxyvitamin D, calcium, phosphorus, and electrocardiographic QT interval duration: findings from NHANES III and ARIC. J Clin Endocrinol Metab. 2011;96(6):1873-82.
Yıl 2022,
Cilt: 9 Sayı: 1, 22 - 27, 29.04.2022
Öz
Sudden cardiac death from arrhythmias is an important cause of mortality in chronic hemodialysis (HD) patients. In this study, we aimed to investigate ventricular repolarization parameters on electrocardiogram (ECG) (QT, corrected QT (QTc), T peak-end (Tp-e), Tp-e/QT and Tp-e/QTc) and their possible relationships with clinical features in HD patients. The study included 131 adult patients on maintenance HD, and 49 healthy individuals. ECG repolarization parameters were recorded. In the HD group, clinical features were recorded along with blood samples and ECG recordings before a midweek HD session. QT and QTc were longer in the HD group (p=0.001, p<0.001). Tp-e values were not different among groups. HD patients with diabetes mellitus (DM), had longer QT and QTc intervals (p<0.001, p=0.001). These associations were still significant after regressions for age, sex, and comorbidities. HD patients with cardiovascular disease had longer QT intervals (p=0.033). QT and QTc were longer in HD patients. This might be an indicator of increased arrhythmia risk. The diagnosis of DM was associated with longer QT and QTc, adjusted for multiple confouners. It is feasible to evaluate HD patients for ECG parameters and follow up those with prolonged repolarizations and comorbidities, especially DM.
Anahtar Kelimeler
Diabetes Mellitus Hemodialysis Cardiac Repolarization QTc tp-e Interval
Proje Numarası
Proje desteği alınmadı.
Kaynakça
- 1. Herzog CA, Mangrum M, Passman R. Sudden cardiac death in dialysis patients. Semin Dial. 2008;21(4):300-7.
- 2. Alsheikh-Ali AA, Trikalinos TA, Ruthazer R, et al. Risk of arrhythmic and nonarrhythmic death in patients with heart failure and chronic kidney disease. Am Heart J. 2011;161(1):204-9.
- 3. Di Lullo L, Rivera R, Barbera V, et al. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol. 2016;15;217:16-27.
- 4. Secemsky EA, Verrier RL, Cooke G, et al. High prevalence of cardiac autonomic dysfunction and T-wave alternans in dialysis patients. Heart Rhythm. 2011;8(4):592–8.
- 5. Di Iorio B, Bellasi A. QT interval in CKD and haemodialysis patients. Clin Kidney J. 2013;6(2):137-43.
- 6. Wu VC, Lin LY, Wu KD. QT interval dispersion in dialysis patients. Nephrology (Carlton). 2005;10(2):109-12.
- 7. Monfared A, Assadian Rad M, Feizkhah M, et al. Comparison of tpe changing on ECG, in pre and post dialysis and post transplantation. Nephrourol Mon. 2016;8(3):e35864. 8. Hansen S, Rasmussen V, Torp-Pedersen C, et al. QT intervals and QT dispersion determined from a 12-lead 24-hour Holter recording in patients with coronary artery disease and patients with heart failure. Ann Noninvasive Electrocardiol. 2008;13(1):22-30.
- 9. Erken E, Altunoren O, Yildiz YS, et al. Evaluation of Cardiac Repolarization and Serum Electrolytes in Pre-Dialytic Stages of Chronic Kidney Disease. Turk Neph Dial Transpl. 2018;27(2):189-95.
- 10. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol. 2008;41(6):575-80.
- 11. National Kidney Foundation Hemodialysis Adequecy 2015 Work Group. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930.
- 12. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
- 13. Kestenbaum B, Rudser KD, Shlipak MG, et al. Kidney function, electrocardiographic findings, and cardiovascular events among older adults. Clin J Am Soc Nephrol. 2007;2(3):501-8.
- 14. Dobre M, Brateanu A, Rashidi A, et al. Electrocardiogram abnormalities and cardiovascular mortality in elderly patients with CKD. Clin J Am Soc Nephrol. 2012;7(6):949-56.
- 15. Hage FG, de Mattos AM, Khamash H, et al. QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol. 2010;33(6):361-66.
- 16. Antzelevitch C. T peak-Tend interval as an index of transmural dispersion of repolarization. European journal of clinical investigation. 2001;31(7):555-7.
- 17. Watanabe N, Kobayashi Y, Tanno K, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. J Electrocardiol. 2004;37(3):191-200.
- 18. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. Journal of electrocardiology. 2008;41(6):567-74.
- 19. Kollu K, Altintepe L, Duran C, et al. The assessment of P-wave dispersion and myocardial repolarization parameters in patients with chronic kidney disease. Ren Fail. 2018;40(1):1-7.
- 20. Sivri S, Çelik M. Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease. J Electrocardiol. 2019;54:72-5.
- 21. Kalantzi K, Gouva C, Letsas KP, et al. The impact of hemodialysis on the dispersion of ventricular repolarization. Pacing Clin Electrophysiol. 2013;36(3):322-7.
- 22. Sherif KA, Abo-Salem E, Panikkath R, et al. Cardiac repolarization abnormalities among patients with various stages of chronic kidney disease. Clin Cardiol. 2014;37(7):417-21.
- 23. Kobayashi S, Nagao M, Asai A, et al. Severity and multiplicity of microvascular complications are associated with QT interval prolongation in patients with type 2 diabetes. J Diabetes Investig. 2018;9(4):946-51.
- 24. Wu CC, Lu YC, Yu TH, et al. Serum albumin level and abnormal corrected QT interval in patients with coronary artery disease and chronic kidney disease. Intern Med J. 2018;48(10):1242-51.
- 25. Kim E, Joo S, Kim J, et al. Association between C-reactive protein and QTc interval in middle-aged men and women. Eur J Epidemiol. 2006;21(9):653-9.
- 26. Zhang Y, Post WS, Dalal D, et al. Serum 25-hydroxyvitamin D, calcium, phosphorus, and electrocardiographic QT interval duration: findings from NHANES III and ARIC. J Clin Endocrinol Metab. 2011;96(6):1873-82.
Toplam 25 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | Proje desteği alınmadı. |
| Yayımlanma Tarihi | 29 Nisan 2022 |
| Gönderilme Tarihi | 3 Eylül 2020 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 9 Sayı: 1 |
