Hayati EREN, Selin GENÇ, Bahri EVREN, İbrahim ŞAHİN

Evaluation of novel ventricular repolarization parameters in patients with acromegaly

Objectives: T wave’s peak and end interval (Tp-e), Tp-e/QT ratio and Tp-e/QTc ratio are novel markers of ventricular repolarization and are associated with ventricular arrhythmias. Increased ventricular arrhythmia incidence is reported in patients with acromegaly. The purpose of this study is to evaluate ventricular repolarization using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with acromegaly. Methods: Thirty-five patients with acromegaly were included in the study. The control group was consisted of forty-one subjects without acromegaly that having similar age, sex ratio and comorbidities. The Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio, and other ventricular repolarization parameters of all patients were evaluated using electrocardiography. Results: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were significantly prolonged in patients with acromegaly compared to the control group. Furthermore, Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio showed a significant correlation with plasma GH levels and LVMI values. Conclusions: Our study revealed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with acromegaly. We believe that the Tp-e interval, Tp-e/QT ratio, and Tpe/QTc ratio can be used in the evaluation of increased cardiovascular risk in patients with acromegaly.

Keywords:

Acromegaly, ventricular repolarization, novel electrocardiographic parameters,

PDF

___

1. Kahaly G, Olshausen KV, Mohr-Kahaly S, Erbel R, Boor S, Beyer J, et al. Arrhythmia profile in acromegaly. Eur Heart J 1992;13:51-6.
2. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004;25:102-52.
3. Matturri L, Varesi C, Nappo A, Cuttin MS, Rossi L. [Sudden cardiac death in acromegaly. Anatomopathological observation of a case]. Minerva Med 1998;89:287-91. [Article in Italian]
4. Arias MA, Pachón M, Rodríguez-Padial L. Ventricular tachycardia in acromegaly. Rev Port Cardiol 2011;30:223-6.
5. Saccà L, Cittadini A, Fazio S. Growth hormone and the heart. Endocr Rev 1994;15:555-73.
6. Colao A, Marzullo P, Di Somma C, Lombardi G. Growth hormone and the heart. Clin Endocrinol (Oxf) 2001;54:137-54.
7. Colao A. Are patients with acromegaly at high risk for dysrhythmias? Clin Endocrinol 2001;55:305-69.
8. Galinier M, Vialette JC, Fourcade J, Cabrol P, Dongay B, Massabuau P, et al. QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology. Eur Heart J 1998;19:1054-62.
9. 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.
10. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W, et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 2007;4:1114-6.
11. Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R, et al. Tpeak-Tend 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. 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;17:85-94.
13. Watanabe N, Kobayashi Y, Tanno K, Miyoshi F, Asano T, Kawamura M, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. J Electrocardiol 2004;37:191-200.
14. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567-74.
15. Baser H, Akar BN, Polat B, Evranos B, Ersoy R, Bozkurt E, et al. The evaluation of QT intervals during diagnosis and after follow-up in acromegaly patients. Acta Med Port 2014;27:428-32.
16. Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol 2018;14:552-56.
17. Devereux RB, de Simone G, Koren MJ, Roman MJ, Laragh JH. Left ventricular mass as a predictor of development of hypertension. Am J Hypertens 1991;4:603S-7S.
18. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. J Am Soc Echocardiogr 2005;18:1440-63.
19. Hinterseer M, Beckmann BM, Thomsen MB, Pfeufer A, Dalla Pozza R, Loeff M, et al. Relation of increased short-term variability of QT interval to congenital long-QT syndrome. Am J Cardiol 2009;103:1244-8.
20. Mohamed AL, Yusoff K, Muttalif AR, Khalid BA. Markers of ventricular tachyarrythmias in patients with acromegaly. Med J Malaysia 1999;54:338-45.
21. Unubol M, Eryilmaz U, Guney E, Ture M, Akgullu C. QT dispersion in patients with acromegaly. Endocrine 2013;43:419-23.
22. Mayet J, Shahi M, McGrath K, Poulter NR, Sever PS, Foale RA, et al. Left ventricular hypertrophy and QT dispersion in hypertension. Hypertension 1996;28:791-6.
23. 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;35:559-64.
24. Yayla Ç, Bilgin M, Akboğa MK, Gayretli Yayla K, Canpolat U, Dinç Asarcikli L, et al. Evaluation of Tp-E interval and Tp-E/QT ratio in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2016;21:287-93.
25. Zhao Z, Yuan Z, Ji Y, Wu Y, Qi Y. Left ventricular hypertrophy amplifies the QT, and Tp-e intervals and the Tp-e/ QT ratio of left chest ECG. J Biomed Res 2010;24:69-72.
26. Ijiri H, Kohno I, Yin D, Iwasaki H, Takusagawa M, Iida T, et al. Cardiac arrhythmias and left ventricular hypertrophy in dipper and nondipper patients with essential hypertension. Jpn Circ J 2000;64:499-504.
27. Ito H, Hiroe M, Hirata Y, Tsujino M, Adachi S, Shichiri M, et al. Insulin-like growth factor-I induces hypertrophy with enhanced expression of muscle specific genes in cultured rat cardiomyocytes. Circulation 1993;87:1715-21.
28. Lie JT. Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients. Am Heart J 1980;100:41-52.