Uğur BOZKURT, Mikail YARLIOĞLU, İbrahim Etem ÇELİK, Mustafa DURAN, Sani Namık MURAT, Sevde Nur FIRAT

Assessment of Tp–e interval, Tp–e/QT, and Tp-e/QTc ratios in patients with acromegaly

Background/aim: Cardiovascular complications, including ventricular arrhythmias associated with abnormalities of ventricular repolarization, are the leading cause of morbidity and mortality in patients with acromegaly. Herein, we aimed to investigate ventricular repolarization using Tp–e interval, Tp-e interval/QT, and Tp-e interval/QTc ratios in acromegalic patients compared to healthy subjects. Materials and methods: A total of 29 patients (aged 51.9 ± 11.2, 65.5% women) with acromegaly and 30 control subjects (aged 47.3 ± 14.4, 63.3% women) were enrolled in the study. Tp–e and QT interval, corrected QT (QTc), Tp–e/QT, and Tp–e/QTc ratios were calculated from the 12-lead electrocardiogram. Results: Tp-e interval (89.28 ± 12.16 vs. 75.97 ± 9.92 ms; p < 0.001), Tp-e/QT ratio (0.237 ± 0.045 vs. 0.212 ± 0.029; p = 0.019), and Tp-e/ QTc ratio (0.218 ± 0.031 vs. 0.195 ± 0.026; p = 0.003) were significantly higher in patients with acromegaly compared to control group. A positive correlation was determined between left atrial volume index (LAVI) and Tp-e interval (r = 0.272, p = 0.039). Conclusion: The current study is the first to have shown significantly increased Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were increased in acromegalic patients. These results may be important for screening malignant arrhythmic events in acromegaly.

PDF

___

1. Kooijman R, Willems M, De Haas CJ, Rijkers GT, Schuurmans AL et al. Expression of type I insulin-like growth factor receptors on human peripheral blood mononuclear cells. Endocrinology 1992; 131 (5): 2244-2250. doi: 10.1210/endo.131.5.1425423
2. Melmed S. Acromegaly. New England Journal of Medicine 2006; 355: 2558–2573. doi: 10.1056/nejmra062453
3. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocrine Reviews 2004; 25 (1): 102–152. doi: 10.1210/er.2002-0022
4. Wolters TLC, Netea MG, Riksen NP, Hermus ARMM, NeteaMaier RT. Acromegaly, inflammation and cardiovascular disease: a review. Reviews in Endocrine and Metabolic Disorders 2020; 21 (4): 547-568. doi: 10.1007/s11154-020- 09560-x
5. Gonzalez B, Vargas G, de Los Monteros ALE, Mendoza V, Mercado M. Persistence of diabetes and hypertension after multimodal treatment of acromegaly. The Journal of Clinical Endocrinology & Metabolism 2018; 103 (6): 2369–2375. doi: 10.1210/jc.2018-00325
6. López-Velasco R, Escobar-Morreale HF, Vega B, Villa E, Sancho JM et al. Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension? The Journal of Clinical Endocrinology & Metabolism 1997; 82 (4): 1047-1053. doi: 10.1210/jcem.82.4.3876
7. Arias MA, Pachón M, Rodríguez-Padial L. Ventricular tachycardia in acromegaly. Revista Portuguesa de Cardiologia 2011; 30 (2): 223-226.
8. Antzelevitch C, Shimizu W, Yan GX, Sicouri S. Cellular basis for QT dispersion. Journal of Electrocardiology 1998; 30 Suppl: 168-175. doi: 10.1016/s0022-0736(98)80070-8
9. Akcay M. The effect of moderate altitude on Tp-e interval, Tp-e/QT, QT, cQT and P-wave dispersion. Journal of Electrocardiology 2018; 51 (6): 929-933. doi: 10.1016/j. jelectrocard.2018.07.016
10. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. Journal of Electrocardiology 2008; 41 (6): 575-580. doi: 10.1016/j. jelectrocard.2008.07.030
11. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 2007; 4 (8): 1114- 1116; author reply 1116-1119. doi: 10.1016/j.hrthm.2007.05.028
12. Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F et al. Tpeak-Tend and TpeakTend dispersion as risk factors for ventricular tachycardia/ ventricular fibrillation in patients with the Brugada syndrome. Journal of the American College of Cardiology 2006; 47 (9): 1828-1834. doi: 10.1016/j.jacc.2005.12.049
13. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B et al. T(p-e)/QT ratio as an index of arrhythmogenesis. Journal of Electrocardiology 2008; 41 (6): 567-574. doi: 10.1016/j. jelectrocard.2008.07.016
14. Yayla Ç, Bilgin M, Akboğa MK, Gayretli Yayla K, Canpolat U et al. Evaluation of Tp-E interval and Tp-E/QT ratio in patients with aortic stenosis. Annals of Noninvasive Electrocardiology 2016; 21 (3): 287-293. doi: 10.1111/anec.12298
15. American College of Cardiology Foundation Appropriate Use Criteria Task Force; American Society of Echocardiography; American Heart Association; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Critical Care Medicine; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American College of Chest Physicians, Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ et al. ACCF/ASE/AHA/ASNC/HFSA/ HRS/ SCAI/SCCM/SCCT/SCMR 2011 Appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. Journal of the American Society of Echocardiography 2011; 24 (3): 229- 267. doi: 10.1016/j.echo.2010.12.008
16. Saccà L, Cittadini A, Fazio S. Growth hormone and the heart. Endocrine Reviews 1994; 15 (5): 555-573. doi: 10.1210/edrv15-5-555
17. Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly. The Quarterly Journal of Medicine 1970; 39 (153): 1-16.
18. Ramos-Leví AM, Marazuela M. Bringing cardiovascular comorbidities in acromegaly to an update. How should we diagnose and manage them? Frontiers in Endocrinology 2019; 10:120. doi: 10.3389/fendo.2019.00120
19. Kahaly G, Olshausen KV, Mohr-Kahaly S, Erbel R, Boor S et al. Arrhythmia profile in acromegaly. European Heart Journal 1992; 13 (1): 51-56. doi: 10.1093/oxfordjournals.eurheartj. a060047
20. Yenerçağ M, Arslan U. Tp-e interval and Tp-e/QT ratio and their association with left ventricular diastolic dysfunction in Fabry disease without left ventricular hypertrophy. Journal of Electrocardiology 2020; 59: 20-24. doi: 10.1016/j. jelectrocard.2019.12.007
21. Ucar FM, Ozturk C, Yılmaztepe MA. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with acute myocarditis. BioMed Central Cardiovascular Disorders 2019; 19 (1): 232. doi: 10.1186/s12872-019-1207-z
22. Alizade E, Yesin M, Yazicioğlu MV, Karaayvaz EB, Atici A et al. Evaluation of Tp-e Interval, Tp-e/QT Ratio, and Tp-e/ QTc Ratio in patients with asymptomatic arrhythmogenic right ventricular cardiomyopathy. Annals of Noninvasive Electrocardiology 2017; 22 (1): e12362. doi: 10.1111/ anec.12362
23. Unubol M, Eryilmaz U, Guney E, Ture M, Akgullu C. QT dispersion in patients with acromegaly. Endocrine 2013; 43 (2): 419-423. doi: 10.1007/s12020-012-9828-3
24. Fatti LM, Scacchi M, Lavezzi E, Pecori Giraldi F, De Martin M et al. Effects of treatment with somatostatin analogues on QT interval duration in acromegalic patients. Clinical Endocrinology (Oxford) 2006; 65 (5): 626-630. doi: 10.1111/j.1365-2265.2006.02639.x
25. Baser H, Akar Bayram N, Polat B, Evranos B, Ersoy R et al. The evaluation of QT intervals during diagnosis and after follow-up in acromegaly patients. Acta Medica Portuguesa 2014; 27(4): 428-432. doi: 10.20344/amp.4966
26. Dural M, Kabakcı G, Cınar N, Erbaş T, Canpolat U et al. Assessment of cardiac autonomic functions by heart rate recovery, heart rate variability and QT dynamicity parameters in patients with acromegaly. Pituitary 2014; 17 (2): 163-170. doi: 10.1007/s11102-013-0482-4
27. Maffei P, Martini C, Milanesi A, Corfini A, Mioni R et al. Late potentials and ventricular arrhythmias in acromegaly. International Journal of Cardiology 2005; 104 (2): 197-203. doi: 10.1016/j.ijcard.2004.12.010
28. Cansu GB, Yılmaz N, Yanıkoğlu A, Özdem S, Yıldırım AB et al. Assessment of diastolic dysfunction, arterial stiffness, and carotid intima-media thickness in patients with acromegaly. Endocrine Practice 2017; 23 (5): 536-545. doi: 10.4158/ EP161637
29. Limongelli G, Fioretti V, Di Maio M, Verrengia M, Rubino M et al. Left atrial volume during stress is associated with increased risk of arrhythmias in patients with hypertrophic cardiomyopathy. Journal of Cardiovascular Echography 2019; 29 (1): 1-6. doi: 10.4103/jcecho.jcecho_45_18