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Abstract Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. Methods: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. Results: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusion: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.
Resumen Objetivo: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. Métodos: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. Resultados: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusión: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.
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Objective To analyze the changes of Tpeak-Tend interval (Tp-Te) in patients with type 2 diabetes mellitus (T2DM),and to explore the relationship between the changes of Tp-Te and ventricular arrhythmias. Methods A total of 112 patients with T2DM were selected from the Department of endocrinology of our hospital from June 2014 to May 2016 (T2DM group),and 65 subjects underwent healthy physical examination in our hospital were selected as the normal control group (NC group) during the same period.The general data,fasting plasma glucose (FPG),glycosylated hemoglobin (HbA1c),Tp-Te,Tp-Te dispersion (Tp-Ted) were compared between the two groups.The changes of Tp-Te in patients with or without ventricular arrhythmia in T2DM group were also analyzed. Results The FPG,HbA1c,LDL-C,TC and heart rate were significantly higher in T2DM group than in the NC group (P<0.05).Compared with the control group,V5 lead Tp-Te and Tp-Ted in T2DM group was significantly prolonged (P<0.05).IN T2DM group,V5 lead Tp-Te and Tp-Ted were significantly longer in patients with ventricular arrhythmias than in patients without ventricular arrhythmia (P<0.05).Multiple logistic regression analysis showed that the increase of HbA1c and FPG were independent risk factors for prolonged Tp-Ted,and Tp-Ted was an independent risk factor for ventricular arrhythmia. Conclusion Patients with T2DM are more likely to have prolonged Tp-Ted.The prolonged Tp-Te and Tp-Ted could increase the incidence of ventricular arrhythmias.
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Background: Risk stratification of patients with acute pulmonary embolism (PE) allows assessment of individual prognosis and guides therapeutic decision making. Several electrocardiographic (ECG) markers measuring the arrhythmogenic substrate(s) in ventricular myocardium are used to identify the high-risk patients with acute PE. However studies on Tp-e/QT ratio in patients with acute PE are lacking therefore the present study is aimed to evaluate the in hospital prognostic significance (death and in hospital adverse clinical events [ACE]) of Tp-e/QT ratio at admission in acute PE patients. Materials and methods: This was a retrospective study that included adult patients who had been diagnosed with acute PE and were treated at our hospital between January 2012 and March 2016. After considering inclusion and exclusion criteria, data was collected from eligible patients. All ECG recordings were digitalized and evaluated by a computer based program. Tp-e and QT intervals were measured from all precordial leads and mean value is calculated. Statistical analysis was performed using SPSS 17.0. Receiver operator characteristic (ROC) curves were computed for the Tp-e/QT ratio to assess the optimal cutoff values for predicting mortality and ACE. Univariate logistic regression analysis for the predictors of in hospital events (death and in hospital ACE) in the study population was done. The statistical significance was considered for a p-value <0.05. Results: A total of 48 patients were included in the study with mean age of 37.95 years (±13.86) and male: female ratio of 1.18:1. Patients with pulmonary embolism have mean Tp-e/QT ratio of 0.25 and the range of Tp-e/QT ratio was 0.18 to 0.29. In regression analysis, a Tp-e/QT ratio ≥0.26 increased the risk of death (P = 0.03) and a Tp-e/QT ratio ≥0.25 increased the risk of ACE (P = 0.01) significantly.
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Objective To evaluate the outcome of incomplete revasculariszation by percutaneous coronary intervention (PCI) in elderly patients with coronary artery disease.Methods Data of 48 patients (age≥75 years old) underwent incomplete coronary revascularization during the period from 2008 to 2011 were collected.Their data before PCI and the 6 months follow-up results were comparatively analyzed.Results Six months after incomplete coronary revascularization,the LVEF was higher than that before revascularization ((48.10 ± 7.19)％ vs (39.82 ± 8.23)％) and BNP declined significantly ((575.17 ± 67.27) ng/L vs (793.57 ± 87.53)ng/L).T peak-T end (Tp-Te) √RR and Tp-Te/QT also declined significantly (Tp-Te √RR:(96.38 ± 10.79)ms vs (147.81 ± 17.32)ms;Tp-Te/QT:(0.25 ±0.05) vs (0.30 ±0.07)) (P ＜0.05).Six months after PCI,LVEDV and LVESV were higher than those before surgery,but there was no significant difference(P ＞ 0.05).Conclusion Incomplete coronary revascularization can improve heart function and stability of cardiac electrophysiology in elderly patients with coronary artery disease,but it can not prevent the development of left ventricular remodeling.
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Torsade de pointes (TdP) is a devastating form of polymorphic ventricular arrhythmia associated with corrected QT (QTc) interval prolongation. TdP usually terminates spontaneously but frequently recurs and may degenerate to ventricular fibrillation. The present report describes a case of TdP in a patient being transferred to the postanesthetic care unit following an emergency laparoscopic appendectomy. The patient had undergone open heart surgery 1 week before. Retrospective electrocardiogram analysis revealed the patient had QTc and Tpeak-Tend interval prolongation that had gone unrecognized. We believe TdP may have been induced by accentuation of sympathetic nervous system during emergence from general anesthesia.