Lösemi Hastalarında Kemoterapötiklerin Frontal QRS‐T Açısı Üzerine Etkisi

GİRİŞ ve AMAÇ: Bazı kemoterapötikler özelikle de antrasiklinlerin kalbe zararlı etkileri olabilir. Biz bu çalışmamız da lösemi hastalarında kemoterapötiklerin frontal QRS‐T açısı üzerine etkisini değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: Toplam 39 antrasiklin alan lösemi hastası bu retrospektif çalışmada yer aldı. Bütün hastalara antrasiklin öncesi ve sonrası 12 lead elektrokardiografi (EKG) ve ekokardiyografi çekilenler çalışmaya dahil edildi.14 hasta doxorubicin, 25 hasta da idarubicin alıyordu. Bütün hastaların. QT interval, QTc interval, Tp‐e interval, Tp‐e/QT, Tp‐e/QTc ve frontal QRS‐T açıları 12 lead EKG üzerinden hesaplandı BULGULAR: Çalışmamız toplam 39 hastadan (%23 kadın) oluşmaktadır. Hastaların ortalama yaşı 40 ±15 di. QT interval (360 ± 32 vs. 368 ± 27.1, P = 0.161), QTc interval (400 ± 6.4 vs. 404 ± 20, P = 0.276), Tp‐e interval (80.17 ± 14.2 vs. 84.3 ± 13 P = 0.248). Daha da önemlisi frontal QRS‐T angle (17.5 ±17 vs. 16.5 ±14, P = 0.692) değerinin kemoterapi öncesi ve sonrası arasında fark izlenmedi. Ek olarak Tp‐e/QT (0.22 ± 0.04 vs. 0.23 ± 0.04, P = 0.543) and Tp‐e/QTc (0.20 ± 0.03 vs. 0.20 ± 0.04, P = 0.313) değeride kemoterapi sonrası değişmedi. Alt grup analizinde de benzer sonuçlar elde ettik. TARTIŞMA ve SONUÇ: Hem doxorubicin hem de epirubicin temelli kemoterapi erken fazda düşük doz kullanıldığından dolayı EKG parametrelerini değiştirmedi. Antrasiklinleri güvenli bir biçimde lösemi hastalarına kullanabiliriz.

The effect of Chemotherapeutics on Frontal QRS‐T Angle in Patients with Leukemia

INTRODUCTION: Some of the chemotherapeutics can inflictthe cardiac damage, especially anthracyclines. In our study weevaluate to effect of anthracyclines on frontal QRS‐T angle inpatients with leukemia.METHODS: A total of 39 leukemia patients who takeanthracyclines were included in this retrospective study. Allpatients underwent 12‐lead surface electrocardiograms(ECGs) and echocardiography just before and after theanthracyclines. 14 patients were taken doxorubicin and 25patients were taken idarubicin. QT interval, QTc interval, Tp‐einterval, Tp‐e/QT, Tp‐e/QTc and frontal QRS‐T angle werecalculated from 12‐lead ECGs.RESULTS: In all, 39 patients(23% females) were enrolled inour study. Mean age of patients is 40 ±15 years. QT interval(360 ± 32 vs. 368 ± 27.1, P = 0.161), QTc interval (400 ± 6.4vs. 404 ± 20, P = 0.276), Tp‐e interval (80.17 ± 14.2 vs. 84.3 ±13 P = 0.248). More importantly, frontal QRS‐T angle (17.5±17 vs. 16.5 ±14, P = 0.692) was not significantly before andafter chemotherapy. In addition, Tp‐e/QT (0.22 ± 0.04 vs. 0.23± 0.04, P = 0.543) and Tp‐e/QTc (0.20 ± 0.03 vs. 0.20 ± 0.04,P = 0.313) were not significantly changed after chemotherapy.When we made subgroup analysis we found same results.DISCUSSION AND CONCLUSION: Both doxorubicin andepirubicin-based chemotherapy did not change the ECGparameter in early phase because of the lower dose. They canbe used safely in patient with leukemia.

PDF

___

1. Rowinsky, E. K. , McGuire WP, Guarnieri T, Fisherman JS, Christian MC, Donehower RC. et al. Cardiac disturbances during the administration of taxol. J.Clin. Oncol. 9, 1704–1712 (1991).
2. Sorrentino, M. F., Kim, J., Eoderaro, A. E. & Truesdell, A. G. 5-Fluorouracil induced cardiotoxicity: review of the literature. Cardiol. J. 19, 453–458 (2012).
3. Octavia Y, Tocchetti CG, Gabrielson KL, Janssens S, Crijns HJ, Moens AL. Doxorubicininduced cardiomyopathy: from molecular mechanisms to therapeutic strategies. J Mol Cell Cardiol. (2012) 52:1213–25.doi: 10.1016/j.yjmcc.2012.03.006
4. Henriksen PA. Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention. Heart. (2018) 104:971–77. doi: 10.1136/heartjnl2017-312103
5. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990;63(6):342-4.
6. 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.
7. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. Tp-e/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41(6):567-74.
8. Zhao X, Xie Z, Chu Y, Yang L, Xu W, Yang X, 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(9):559-64.
9. Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M, Huber K, et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol. 2011;44(3):301-8.
10. Erikssen G, Liestøl K, Gullestad L, Haugaa KH, Bendz B, Amlie JP. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17(2):85-94.
11. Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM, Group AR. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol. 2007 Sep 1.100:844–9.
12. Lahtinen R, Kuikka J, Nousiainen T, Uusitupa M, Lansimies E. Cardiotoxicity of epirubicin and doxorubicin: a double‐blind randomized study. Eur J Haematol. 1991;46:301–305.
13. Lopez M, Vici P, Carpano S, Natali M, Ganzina F, Conti EM, Di Lauro L. Combination chemotherapy with oral idarubicin and cyclophosphamide for metastatic breast cancer. J Cancer Res Clin Oncol. 1991;117:61–64
14. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W, et al. Does T peak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4(8):1114-6.
15. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990;63(6):342-4.
16. Castro Hevia J, Antzelevitch C, Tornes Barzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R, et al. T peak-Tend and T peak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006;47(9):1828-34.
17. R.A. Jensen, E.M. Acton, J.H. Peters, Doxorubicin cardiotoxicity in the rat: comparison of electrocardiogram, transmembrane potential, and structural effects, J.Cardiovasc. Pharmacol. 6 (1) (1984) 186–200.
18. P. Milberg, D. Fleischer, J. Stypmann, N. Osada, G. Monnig, M.A. Engelen, et al.,Reduced repolarization reserve due to anthracycline therapy facilitates torsade depointes induced by IKr blockers, Basic Res. Cardiol. 102 (1) (2007) 42–51
19. J. Ducroq, H. Moha ou Maati, S. Guilbot, S. Dilly, E. Laemmel, C. Pons-Himbert,et al., Dexrazoxane protects the heart from acute doxorubicin-induced QT prolongation:a key role for I(Ks), Br. J. Pharmacol. 159 (1) (2010) 93–101
20. S. Kharin, V. Krandycheva, A. Tsvetkova, M. Strelkova, D. Shmakov, Remodeling of ventricular repolarization in a chronic doxorubicin cardiotoxicity rat model,Fundam. Clin. Pharmacol. 27 (4) (2013) 364–372
21. C. Agen, N. Bernardini, R. Danesi, P. Della Torre, M. Costa, M. Del Tacca, Reducing doxorubicin cardiotoxicity in the rat using deferred treatment with ADR-529,Cancer Chemother. Pharmacol. 30 (2) (1992) 95–99.
22. Y. Xin, S. Zhang, L. Gu, S. Liu, H. Gao, Z. You, et al., Electrocardiographic and biochemical evidence for the cardioprotective effect of antioxidants in acute doxorubicin- induced cardiotoxicity in the beagle dogs, Biol. Pharm. Bull. 34 (10) (2011) 1523–1526,
23. M.P. Pye, S.M. Cobbe, Arrhythmogenesis in experimental models of heart failure: the role of increased load, Cardiovasc. Res. 32 (2) (1996) 248– 257
24. Bloom MW, Hamo CE, Cardinale D, Ky B, Nohria A, Baer L, et al. Cancer therapy-related cardiac dysfunction and heart failure: part 1: definitions, pathophysiology, risk factors, and imaging. Circ Heart Fail. (2016) 9:e002661.
25. Zamorano JL, Lancellotti P, Rodriguez Munoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC committee for practice guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail. (2017) 19:9–42.
26. Curigliano G, Cardinale D, Dent S, Criscitiello C, Aseyev O, Lenihan D, et al. Cardiotoxicity of anticancer treatments: epidemiology, detection, and management. CA Cancer J Clin. (2016) 66:309–25.
27. Cardinale D, Biasillo G, Cipolla CM. Curing cancer, saving the heart: a challenge that cardioncology should not miss. Curr Cardiol Rep. (2016) 18:51.
28. Kardys I, Kors JA, van der Meer IM, Hofman A, van der Kuip DA, Witteman JC . Spatial QRS-T angle predicts cardiac death in a general population. Eur Heart J. 2003; 24:1357–1364.
29. Yamazaki T, Froelicher VF, Myers J, Chun S, Wang P. Spatial QRS-T angle predicts cardiac death in a clinical population. Heart Rhythm. 2005; 2:73– 78.
30. Aro AL, Huikuri HV, Tikkanen JT, Junttila MJ, Rissanen HA, Reunanen A, et al. QRS-T angle as a predictor of sudden cardiac death in a middleaged general population. Europace. 2012; 14:872– 876.
31. Whang W, Shimbo D, Levitan EB, et al. Relations between QRS|T angle, cardiac risk factors, and mortality in the third National Health and Nutrition Examination Survey (NHANES III). Am J Cardiol. 2012; 109:981–987.