İdyopatik hirşutizm hastalarında QT dispersiyonu

Amaç: Çalışmada idyopatik hirşutizm tanılı hastaların QT dispersiyonu açısından değerlendirilmesi amaçlanmıştır. Metod: 28 İH hastası ve kontrol grubu olarak 35 sağlıklı kadın çalışmaya dahil edildi. Hastaların hormonal incelemeleri ile birlikte elektrokardiyografi (EKG) analizleri yapılarak QT dispersiyonları(QTd) ile düzeltilmiş QT(QTc) değerleri kullanılarak düzeltilmiş QT dispersiyon(QTcd) değerleri elde edilmiştir. Bulgular: İH ve kontrol hastalarının minimum QT (336±30; 337±32 ms), maksimum QT (358±30; 358±34 ms), minimum QTc (391 ± 24; 399 ± 25 ms); maksimum QTc (417 ± 24; 424 ± 26 ms), QTd (22±5; 21±7, P=0.6) ve QTcd (26 ± 6, 25 ± 9 ms, P= 0.7) değerleri arasındaki fark istatistiksel olarak anlamsızdı. Hirşutizm hastalarında açlık insülin, Homeostasis model assessment (HOMA) indeksi ve androjen düzeyleri anlamlı olarak yüksek saptandı. Sonuç: Hormonal ve metabolik bozukluklara rağmen İH hastalarında sağlıklı kadınlara göre anlamlı QT dispersiyonu saptanmamıştır

QT dispertion in patients with idiopathic hirsutism

Objective: Our study purposed to evaluate QT dispertion in idiopathic hirsutism (IH) patients. Method: Study included 28 IH patient and 35 healty women as control group. Patient's hormonal workups and electrocardiograms (ECG) analyzed and QT dispertion (QTd) and corrected QT dispertion (QTcd) values were calculated. Results: Minimum QT (336±30; 337±32 ms), maximum QT (358±30; 358±34 ms), minimum QTc (391 ± 24; 399 ± 25 ms); maximum QTc (417 ± 24; 424 ± 26 ms), QTd (22±5; 21±7, P=0.6) and QTcd (26 ± 6, 25 ± 9 ms, P= 0.7) values were not significantly different between IH and healthy women. Fasting insulin, Homeostasis model assessment (HOMA) index and androgen levels were significantly high in IH patients. Conclusion: Despite differences in hormonal and metabolic pattern, our data demonstrate no significant difference in ECG pattern in IH compared to healthy controls

Kaynakça

Moran C, Tapia MC, Hernandez E, et al. Etiological review of hir- sutism in 250 patients. Arch Med Res 1994;25:311-4.

Azziz R. The evaluation and management of hirsutism. Obstet Gy- necol 2003;101:995-1007.

Unluhizarci K, Karababa Y, Bayram F, et al. The investigation of insulin resistance in patients with idiopathic hirsutism. J Clin En- docrinol Metab 2004;89:2741-4.

Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.

Moss AJ. Measurement of the QT interval and the risk asso- ciated with QTc interval prolongation: a review. Am J Cardiol 1993;72:23B-25B.

Hii JT, Wyse DG, Gillis AM, et al. Precordial QT interval dispersi- on as a marker of torsade de pointes. Disparate effects of class Ia an- tiarrhythmic drugs and amiodarone. Circulation 1992;86:1376-82.

Kuo CS, Reddy CP, Munakata K, et al. Mechanism of ventricular arrhythmias caused by increased dispersion of repolarization. Eur Heart J 1985;6 Suppl D:63-70.

Lehmann MH, Hardy S, Archibald D, et al. Sex difference in risk of torsade de pointes with d,l-sotalol. Circulation 1996;94:2535-41.

Glintborg D, Henriksen JE, Andersen M, et al. Prevalence of en- docrine diseases and abnormal glucose tolerance tests in 340 Cau- casian premenopausal women with hirsutism as the referral diag- nosis. Fertil Steril 2004;82:1570-9.

Budec M, Pjevic M. The insulin response to oral glucose, concent- rations of total cholesterol, triglycerides and uric acid in women with idiopathic hirsutism. Exp Clin Endocrinol 1989;94:300-4.

Paoletti AM, Cagnacci A, Orru M, et al. Treatment with flutamide improves hyperinsulinemia in women with idiopathic hirsutism. Fertil Steril 1999;72:448-53.

Abdel Fattah NS, Darwish YW. Is there a role for insulin resistan- ce in nonobese patients with idiopathic hirsutism? Br J Dermatol 2009;160:1011-5.

Sung KC, Wild SH, Kwag HJ, et al. Fatty Liver, Insulin Resistance, and Features of Metabolic Syndrome: Relationships with coronary artery calcium in 10,153 people. Diabetes Care 2012;35:2359-64.

Bidoggia H, Maciel JP, Capalozza N, et al. Sex differences on the electrocardiographic pattern of cardiac repolarization: possible role of testosterone. Am Heart J 2000;140:678-83.

Glancy JM, Weston PJ, Bhullar HK, et al. Reproducibility and auto- matic measurement of QT dispersion. Eur Heart J 1996;17:1035-9.

Murray A, McLaughlin NB, Campbell RW. Measuring QT disper- sion: man versus machine. Heart 1997;77:539-42.

Bazett H. An analysis of the time-relations of electrocardiograms. Heart 1920;7:353-70.

Bonora E, Targher G, Alberiche M, et al. Homeostasis model as- sessment closely mirrors the glucose clamp technique in the as- sessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000;23:57-63.

Suzuki M, Nishizaki M, Arita M, et al. Increased QT dispersion in patients with vasospastic angina. Circulation 1998;98:435-40.

Tieleman RG, Crijns HJ, Wiesfeld AC, et al. Increased dispersion of refractoriness in the absence of QT prolongation in patients with mitral valve prolapse and ventricular arrhythmias. Br Heart J 1995;73:37-40.

Barr CS, Naas A, Freeman M, et al. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994;343:327-9.

Buja G, Miorelli M, Turrini P, et al. Comparison of QT dispersi- on in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993;72:973-6.

Wei K, Dorian P, Newman D, et al. Association between QT disper- sion and autonomic dysfunction in patients with diabetes mellitus. J Am Coll Cardiol 1995;26:859-63.

Darbar D, Luck J, Davidson N, et al. Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease. BMJ 1996;312:874-8; discussion 78-9.

Clarkson PB, Naas AA, McMahon A, et al. QT dispersion in essen- tial hypertension. QJM 1995;88:327-32.

Arildsen H, May O, Christiansen EH, et al. Increased QT dispersi- on in patients with insulin-dependent diabetes mellitus. Int J Car- diol 1999;71:235-42.

Naas AA, Davidson NC, Thompson C, et al. QT and QTc disper- sion are accurate predictors of cardiac death in newly diagnosed non-insulin dependent diabetes: cohort study. BMJ 1998;316:745- 6.

Fauchier L, Maison-Blanche P, Forhan A, et al. Association betwe- en heart rate-corrected QT interval and coronary risk factors in 2,894 healthy subjects (the DESIR Study). Data from an Epidemi- ological Study on the Insulin Resistance syndrome. Am J Cardiol 2000;86:557-9.

Abi-Gerges N, Philp K, Pollard C, et al. Sex differences in ventri- cular repolarization: from cardiac electrophysiology to Torsades de Pointes. Fundam Clin Pharmacol 2004;18:139-51.

Shin HS, Lee WY, Kim SW, et al. Sex difference in the relationship between insulin resistance and corrected QT interval in non-dia- betic subjects. Circ J 2005;69:409-13.

Borai A, Livingstone C, Kaddam I, et al. Selection of the appropri- ate method for the assessment of insulin resistance. BMC Med Res Methodol 2011;11:158.

Orio F, Palomba S, Cascella T, et al. Lack of electrocardiographic changes in women with polycystic ovary syndrome. Clin Endocri- nol (Oxf) 2007;67:46-50.

Alpaslan M, Onrat E, Yilmazer M, et al. QT dispersion in patients with polycystic ovary syndrome. Jpn Heart J 2002;43:487-93.

Pham TV, Sosunov EA, Gainullin RZ, et al. Impact of sex and gonadal steroids on prolongation of ventricular repolarization and arrhythmias induced by I(K)-blocking drugs. Circulation 2001;103:2207-12.

Shuba YM, Degtiar VE, Osipenko VN, et al. Testosterone-media- ted modulation of HERG blockade by proarrhythmic agents. Bioc- hem Pharmacol 2001;62:41-9.

Kaynak Göster