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The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure

Year 2018, , 331 - 335, 28.12.2018
https://doi.org/10.18663/tjcl.464494

Abstract

Aim: To evaluate cardiac arrhythmias with surface 12 lead electrocardiography
(ECG) parameters
during pregnancy
in women with mild heart failure.

Material and Cardiovascular
deaths usually occur in older pregnancies and arrhythmia is the third most
common cause. Our study aimed to determine whether the risk of arrhythmia
increases in pregnancy with advanced age.
Go to:Methods:This cross-sectional study was approved by the local
ethics committee of bicard clinic and our hospital 53 consecutive patients were
accepted. All patients were admitted to hospital for cesarean section. Patients
were grouped to heart failure (group 1) and control (group 2) (healthy group). A
12 lead ECG and N-terminal pro
B-type
natriuretic peptide
(NT-pro BNP) plasma levels was
recorded for every woman at 48 hour before cesarean section. They were evaluated
P wave, qt, qtc and Twave peak to end, preoperative NT-pro BNP and compared statistically.

In
total, 280 pregnant women, of whom 98 were of advanced age and 182 were under
35 years of age were included in the study. The risk of arrhythmia was
evaluated by calculating the electrocardiographic P-wave duration, QT interval,
T peak-to-end interval, and the Tp-e/QT ratio.
Go to:Results: There were statistically
significant differences in the Tp–e interval and Tp-e/QTc ratio between the two
groups, the maximum QTc, minimum QTc, and QTc dispersion values, P wave
dispersion were significantly higher in group-1 compared to the group-2. In
addition, preoperative NT-pro BNP plasma levels was greater in the group 1
pregnant women. And there was a positive correlation between ECG parameters and
NT-pro BNP plasma levels in group 1.

Although
there were no differences in the Tp-e interval and Tp-e/QTc ratio between the
groups, the maximum QTc, minimum QTc, and QTc dispersion values were significantly
higher in advanced-age pregnancies compared to the control group. In addition,
the P dispersion was greater in advanced-age pregnancies. In correlation
analysis, the increased dispersion of QTc and P were positively correlated with
maternal age. Multiple linear regression analysis showed that QTc dispersion
was independently associated with maternal age.

Go to:











Conclusion: In conclusion, repolarization
parameters were increased in patients with heart failure with elevated NT-pro
BNP. Pregnancy and heart failure has known risk for pregnant women. But there is
no clear cut atrial and ventricular arrhythmias risk scoring parameters for these
kind patients. We found that ECG parameters which had significantly different
in pregnant women with heart failure than control group and these changes correlated
with NT-pro BNP levels. This is pathological; arrhythmia risk scorings should
be established to reduce mortality and morbidity in heart failure patients with
elevated BNP levels. 

References

  • 1. Astolfi P, Zonta L. Delayed maternity and risk at delivery. Paediatr Perinat Epidemiol 2002; 16: 67–72.
  • 2. Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002; 109: 399–403.
  • 3. Bateman BT, Simpson LL. Higher rate of stillbirth at the extremes of reproductive age:a large nationwide sample of deliveries in the United States. Am J Obstet Gynecol 2006; 194: 840–45.
  • 4. Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries:a systematic review of the literature. Sex Transm Dis 2007; 34: 11–21.
  • 5. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004; 104: 727–33.
  • 6. Briller J, Koch AR, Geller SE. Maternal Cardiovascular Mortality in Illinois, 2002-2011. Obstet Gynecol 2017; 129: 819–26.
  • 7. Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol. 1997; 79: 1061–64.
  • 8. Rosano GM, Leonardo F, Sarrel PM, Beale CM, De Luca F, Collins P. Cyclical variation in paroxysmal supraventricular tachycardia in women. Lancet 1996; 347: 786–68.
  • 9. Kirbas A, Kirbas O, Daglar K et al. Novel indexes of arrhythmogenesis in preeclampsia:QT dispersion, Tp-e interval, and Tp-e/QT ratio. Pregnancy Hypertens 2016; 6: 38–41.
  • 10. Tanindi A, Akgun N, Pabuccu EG et al. Electrocardiographic P-Wave Duration, QT Interval, T Peak to End Interval and Tp-e/QT Ratio in Pregnancy with Respect to Trimesters. Ann Noninvasive Electrocardiol 2016; 21: 169–74.
  • 11. Braschi A, Abrignani MG, Francavilla VC, Abrignani V, Francavilla G. Age- and sex-based reference ranges for non-invasive ventricular repolarisation parameters. Int J Clin Pract 2017; 71
  • 12. Elming H, Holm E, Jun L et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J 1998; 19: 1391–400.
  • 13. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000; 36: 1749–66.
  • 14. Castro Hevia J, Antzelevitch C, Tornes Barzaga F 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.
  • 15. V Madras, N Challa.Electrocardiographic variations during three trimesters of normal pregnancy. Int J Res Med Sci 2015; 3: 2218-22.
  • 16. Hüseyin Altuğ Çakmak , Burcu Dinçgez Çakmak , Gülten Özgen , Mehmet Gül , Ayşe Ender Yumru. P-Wave and QT Dispersion in Pregnant Women with Preeclampsia. Jarem 2016; 6: 170-76.
  • 17. Ozmen N, Cebeci BS, Yiginer O, Muhcu M, Kardesoglu E, Dincturk M. P-wave dispersion is increased in pregnancy due to shortening of minimum duration of P: does this have clinical significance. J Int Med Res 2006; 34: 468-74.
  • 18. Batmaz G, Aksoy AN, Aydın S, Ay NK, Dane B. QT interval changes in term pregnant women living at moderately high altitude. Niger J Clin Pract 2016; 19: 611-15.

Kalp yetersizliği olan hamile kadınlarda yeni elektrokardiyografik parametreler ile aritmi riskinin hesaplanması

Year 2018, , 331 - 335, 28.12.2018
https://doi.org/10.18663/tjcl.464494

Abstract

Amaç: Hafif kalp yetmezliği olan
kadınlarda gebelik sırasında 12 elektrokardiyografi (EKG) parametresi ile
kardiyak aritmi değerlendirmek.

Gereç ve Yöntemler:
Bu kesitsel çalışma, bicard kliniği yerel etik kurul tarafından onaylandı
ve hastanemizdeki ardışık 53 hasta kabul edildi. Tüm hastalar sezaryen için
hastaneye başvurdu. Hastalar kalp yetmezliği (grup 1) ve kontrol (grup 2)
(sağlıklı grup) olarak gruplandırıldı. 12 kanallı EKG ve N-terminal pro B tipi
natriüretik peptid (NT-pro BNP) plazma seviyeleri her kadın için sezaryenden
önce 48 saatte kaydedildi. P dalgası, qt, qtc ve Twave zirve sonu, preoperatif
NT-pro BNP olarak değerlendirildi ve istatistiksel olarak karşılaştırıldı.

Bulgular: İki grup arasında Tp-e
intervali ve Tp-e / QTc oranlarında istatistiksel olarak anlamlı farklılıklar,
maksimum QTc, minimum QTc ve QTc dispersiyon değerleri, P dalgası dispersiyonu grup-1'de
grup-2 ye göre anlamlı olarak yüksek bulundu. . Ek olarak, grup 1 gebelerde
preoperatif NT-pro BNP plazma seviyeleri daha fazlaydı. Ve grup 1'de EKG
parametreleri ve NT-pro BNP plazma seviyeleri arasında pozitif bir korelasyon
vardı.







Sonuç: Sonuç olarak, artmış NT-pro
BNP ile kalp yetmezliği olan hastalarda repolarizasyon parametreleri artmıştır.
Hamilelik ve kalp yetmezliği, hamile kadınlar için bilinen risktir. Ancak bu
tür hastalar için açık atriyal ve ventriküler aritmiler risk skorlama
parametreleri yoktur. Kalp yetmezliği olan gebelerde kontrol grubuna göre
anlamlı derecede farklı olan EKG parametrelerinin, NT-pro BNP düzeyleri ile
korele olduğunu bulduk. Bu patolojik; artmış BNP düzeyi olan kalp yetmezliği
hastalarında mortalite ve morbiditeyi azaltmak için aritmi riski skorlamaları
oluşturulmalıdır.

References

  • 1. Astolfi P, Zonta L. Delayed maternity and risk at delivery. Paediatr Perinat Epidemiol 2002; 16: 67–72.
  • 2. Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002; 109: 399–403.
  • 3. Bateman BT, Simpson LL. Higher rate of stillbirth at the extremes of reproductive age:a large nationwide sample of deliveries in the United States. Am J Obstet Gynecol 2006; 194: 840–45.
  • 4. Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries:a systematic review of the literature. Sex Transm Dis 2007; 34: 11–21.
  • 5. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004; 104: 727–33.
  • 6. Briller J, Koch AR, Geller SE. Maternal Cardiovascular Mortality in Illinois, 2002-2011. Obstet Gynecol 2017; 129: 819–26.
  • 7. Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol. 1997; 79: 1061–64.
  • 8. Rosano GM, Leonardo F, Sarrel PM, Beale CM, De Luca F, Collins P. Cyclical variation in paroxysmal supraventricular tachycardia in women. Lancet 1996; 347: 786–68.
  • 9. Kirbas A, Kirbas O, Daglar K et al. Novel indexes of arrhythmogenesis in preeclampsia:QT dispersion, Tp-e interval, and Tp-e/QT ratio. Pregnancy Hypertens 2016; 6: 38–41.
  • 10. Tanindi A, Akgun N, Pabuccu EG et al. Electrocardiographic P-Wave Duration, QT Interval, T Peak to End Interval and Tp-e/QT Ratio in Pregnancy with Respect to Trimesters. Ann Noninvasive Electrocardiol 2016; 21: 169–74.
  • 11. Braschi A, Abrignani MG, Francavilla VC, Abrignani V, Francavilla G. Age- and sex-based reference ranges for non-invasive ventricular repolarisation parameters. Int J Clin Pract 2017; 71
  • 12. Elming H, Holm E, Jun L et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J 1998; 19: 1391–400.
  • 13. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000; 36: 1749–66.
  • 14. Castro Hevia J, Antzelevitch C, Tornes Barzaga F 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.
  • 15. V Madras, N Challa.Electrocardiographic variations during three trimesters of normal pregnancy. Int J Res Med Sci 2015; 3: 2218-22.
  • 16. Hüseyin Altuğ Çakmak , Burcu Dinçgez Çakmak , Gülten Özgen , Mehmet Gül , Ayşe Ender Yumru. P-Wave and QT Dispersion in Pregnant Women with Preeclampsia. Jarem 2016; 6: 170-76.
  • 17. Ozmen N, Cebeci BS, Yiginer O, Muhcu M, Kardesoglu E, Dincturk M. P-wave dispersion is increased in pregnancy due to shortening of minimum duration of P: does this have clinical significance. J Int Med Res 2006; 34: 468-74.
  • 18. Batmaz G, Aksoy AN, Aydın S, Ay NK, Dane B. QT interval changes in term pregnant women living at moderately high altitude. Niger J Clin Pract 2016; 19: 611-15.
There are 18 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Hakan Göçer

Özlem Kayacık Günday This is me

Mustafa Ünal This is me

Publication Date December 28, 2018
Published in Issue Year 2018

Cite

APA Göçer, H., Kayacık Günday, Ö., & Ünal, M. (2018). The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure. Turkish Journal of Clinics and Laboratory, 9(4), 331-335. https://doi.org/10.18663/tjcl.464494
AMA Göçer H, Kayacık Günday Ö, Ünal M. The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure. TJCL. December 2018;9(4):331-335. doi:10.18663/tjcl.464494
Chicago Göçer, Hakan, Özlem Kayacık Günday, and Mustafa Ünal. “The Risk of Arrhythmia by Calculating With New Electrocardiographic Parameters in Pregnant Women With Heart Failure”. Turkish Journal of Clinics and Laboratory 9, no. 4 (December 2018): 331-35. https://doi.org/10.18663/tjcl.464494.
EndNote Göçer H, Kayacık Günday Ö, Ünal M (December 1, 2018) The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure. Turkish Journal of Clinics and Laboratory 9 4 331–335.
IEEE H. Göçer, Ö. Kayacık Günday, and M. Ünal, “The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure”, TJCL, vol. 9, no. 4, pp. 331–335, 2018, doi: 10.18663/tjcl.464494.
ISNAD Göçer, Hakan et al. “The Risk of Arrhythmia by Calculating With New Electrocardiographic Parameters in Pregnant Women With Heart Failure”. Turkish Journal of Clinics and Laboratory 9/4 (December 2018), 331-335. https://doi.org/10.18663/tjcl.464494.
JAMA Göçer H, Kayacık Günday Ö, Ünal M. The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure. TJCL. 2018;9:331–335.
MLA Göçer, Hakan et al. “The Risk of Arrhythmia by Calculating With New Electrocardiographic Parameters in Pregnant Women With Heart Failure”. Turkish Journal of Clinics and Laboratory, vol. 9, no. 4, 2018, pp. 331-5, doi:10.18663/tjcl.464494.
Vancouver Göçer H, Kayacık Günday Ö, Ünal M. The risk of arrhythmia by calculating with new electrocardiographic parameters in pregnant women with heart failure. TJCL. 2018;9(4):331-5.


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