Giriş: Miyokardial bridge (MB) genellikle asemptomatiktir ve iyi huylu olarak bilinir ancak egzersizin indüklediği ventriküler taşikardi, ani ölüm gibi ciddi klinik durumlara neden olabilir. Tp-e intervali elektrokardiyografide T dalgasının tepesi ile sonu arasındaki mesafedir. Tp-e/QT ve Tp-e/QTc oranları ventriküler aritmilerin elektrokardiyografik göstergesi olarak kullanılır. Biz MB'nin koroner anjiyografik özelliklerinin (MB'nin darlık derecesi ve uzunluğu) miyokardiyal repolarizasyon parametreleri üzerindeki etkisini araştırdık. Yöntemler: Bu çalışma izole MB'li 53 ve normal koroner artere sahip 58 hastadan oluşmaktadır.Bulgular:QT intervali ve QTc gruplar arasında benzerdi, Tp-e intervali (92,72±14,72 ve 79,59±12;12, p
Aim: Myocardial bridge (MB) is generally known as an asymptomatic and benign anomaly, however, it can cause serious clinical conditions such as exercise-induced ventricular tachycardia and sudden death. Tp-e interval is the distance between the peak and the end of the T wave in electrocardiography. Tp-e/QT and Tp-e/QTc ratios are used as electrocardiographic indicators of ventricular arrhythmias. We have studied the effect of coronary angiographic features (the degree of stenosis and length of MB) of MB on myocardial repolarization parameters. Methods: The study group consisted of 53 patients with isolated MB and 58 patients with normal coronary arteries. Results: The QT interval and QTc were similar between the groups, however, Tp-e interval (92.72±14.72 and 79.59±12.12, respectively; p <0.001) and Tp-e/QT (0.24±0.041 and 0.21±0.025, respectively; p <0.001) and Tp-e/QTc (0.22±0.037 and 0.19±0.025, respectively; p <0.001) ratios were found to be significantly increased in MB group compared to the control group. In the comparison of the MB patients with critical and those with noncritical stenosis, Tp-e interval (100.69±10.79, 80.57±11.25, respectively; p <0.001) and Tp-e/QT (0.266±0.033, 0.219±0.037, respectively; p <0.001) and Tp-e/QTc (0.244±0.029, 0.196±0.027, respectively; p <0.001) ratios were higher in the MB with critical stenosis group. Conclusion: Our results indicate that these parameters can be practical ECG markers of ventricular arrhythmias in patients with MB.
1. Angelini P, Trivellato M, Donis J, Leachman RD. Myocardial bridges: a review. Prog Cardiovasc Dis 1983;26:75-88.
2. Loukas M, Curry B, Bowers M, et al. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. J Anat 2006;209:43-50.
3. Qian JY, Zhang F, Dong M, et al. Prevalence and characteristics of myocardial bridging in coronary angiogram-data from consecutive 5525 patients. Chin Med J(Engl) 2009;122:632-5.
4. Möhlenkamp S, Hort W, Ge J, Erbel R. Update on myocardial bridging. Circulation 2002;106:2616-22.
5. Morales AR, Romanelli R, Boucek RJ. The mural left anterior descending coronary artery, strenuous exercise and sudden death. Circulation 1980;62:230-7.
6. Bestetti RB, Costa RS, Zucolotto S, Oliveira JS. Fatal outcome associated with autopsy proven myocardial bridging of the left anterior descending coronary artery. Eur Heart J 1989;10:573-6.
7. 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.
8. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567-74.
9. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4.
10. Yontar OC, Karaagac K, Tenekecioglu E, Tutuncu A, Demir M, Melek M. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval. Int J Clin Exp Med 2014;7:2173-8.
11. Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, et al. TpeakTend 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.
12. Zhao X, Xie Z, Chu Y, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol 2012;35:559-64.
13. Topilski I, Rogowski O, Rosso R, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol 2007;49:320-8.
14. Shimizu M, Ino H, Okeie K, et al. T-peak to T-end interval may be beter predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin cardiol 2002;25:335-9.
15. İlgenli TF, Tokatlı A, Akpınar O, Kılıçaslan F. The effects of cigarette smoking on the Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. Adv Cli Exp Med 2015;24:973-8.
16. Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation 1998;98:1928-36.
17. Kilicaslan F, Tokatli A, Ozdag F, et al. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea. Pacing Clin Electrophysiol 2012;35:966-72.
18. Aksan G, Nar G, İnci S, et al. Exercise-induced repolarization changes in patients with isolated myocardial bridging. Med Sci Monit 2015;21:2116-24.
19. Schwarz ER, Klues HG, vom Dahl J, Klein I, Krebs W, Hanrath P. Functional characteristics of myocardial bridging. A combined angiographic and intracoronary doppler flow study. Eur Heart J 1997;18:434-42.
20. Bourassa MG, Butnaru A, Lesperance J, Tardif JC. Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol 2003;41:351-9.
21. Ishii T, Asuwa N, Masuda S, Ishikawa Y. The effects of a myocardial bridge on coronary atherosclerosis and ischemia. J Pathol 1998;185:4-9.
22. Ge J, Eebel R, Görge G, Haude M, Meyer J. High wall shear stres proximal to myocardial bridging and atherosclerosis. İntracoronary ultrasound and pressure measurements. Br Heart 1995;73:462-5.
23. Masuda T, Ishikawa Y, Akasaka Y, Itoh K, Kiguchi H, Ishii T. The effect of myocardial bridging of the coronary artery on vasoactive agents and atherosclerosis localization. J Pathol 2001;193:408-14.
24. Maseri A, Beltrame JF, Shimokawa H. Role of coronary vasoconstriction in ischemic heart disease an search for novel therapeutic targets. Circ J 2009;73:394-403.
25. Ciampricotti R, el Gamal M. Vasospastic coronary occlusion associated with a myocardial bridge. Catheter Cardiovasc Diagn 1988;14:118-20.
26. Brodsky SV, Roh L, Ashar K, Braun A, Ramaswamy G. Myocardial bridging of coronary arteries: a risk factor for myocardial fibrosis? Int J Cardiol 2008;124:391-2.
27. Hostiuc S, Curca GC, Dermangiu D, Dermengiu S, Hostiuc M, Rusu MC. Morphological changes associated with hemodynamically significant myocardial bridges in sudden cardiac death. Thorac Cardiovasc Surg 2011;59:393-8.
28. Xiao WT, Wang XP, Gao CY, et al. Predictive value of corrected QT interval, corrected Tp-e interval and Tp-e/QT ratio on malignant arrhythmia events in acute ST-segment elevation myocardial infarction patients undergoing thrombolysis. Zhonghua Xin Xue Guan Bing Za Zhi 2012;40:473-6.
29. Tatlisu MA, Özcan KS, Güngör B, et al. Can the T-peak to T-end interval be a predictor of mortality in patients with ST-elevation myocardial infarction? Coron Artery Dis 2014;25:399-404.
30. Eslami V, Safi M, Taherkhani M, Adibi A, Movahed MR. Evaluation of QT, QT dispersion, and T-wave peak to end time changes after primary percutaneous coronary intervention in patients presenting with acute ST-elevation myocardial infarction. J Invasive Cardiol 2013;25:232-4.