Index of cardiac-electrophysiological balance and the effects of thrombolytic therapy on the electrocardiogram of patients with pulmonary embolism.

OBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT. First, the high-risk APE patients' ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups' ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group ( P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group ( P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio ( P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P -value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT ( P -value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT. It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period.

Index of cardiac-electrophysiological balance and the effects of thrombolytic therapy on the electrocardiogram of patients with pulmonary embolism

SUMMARY OBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT. First, the high-risk APE patients' ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups' ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group ( P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group ( P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio ( P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P -value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT ( P -value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT. It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period.

RESUMO OBJETIVO: Diferentes parâmetros de eletrocardiograma (ECG) têm sido investigados para predizer mortalidade e arritmia em pacientes com embolia pulmonar aguda (EPA). O efeito agudo da terapia trombolítica (TT) nesses parâmetros ainda não foi investigado. MÉTODOS: Examinamos os dados de 83 pacientes avaliados com EPA de alto risco e que receberam alta hospitalar após TT. Primeiramente, comparamos os ECGs dos pacientes com EPA de alto risco com os de indivíduos saudáveis (n = 55). Os ECGs dos pacientes com EPA foram comparados logo após a internação e 24 horas mais tarde. A frequência cardíaca, a morfologia da onda P, a duração do QRS, o intervalo QT, Tp-e e o índice de equilíbrio eletrofisiológico cardíaco (iCEB) foram analisados. RESULTADOS: Embora o valor máximo de P não tenha sido diferente entre os grupos no ECG, a frequência cardíaca, QT, intervalo QTc (QT corrigido), intervalos Tpe, razão TP-e/QT e dispersão da onda P foram significativamente mais elevados no grupo de EPA (valores de P < 0,031). Os valores do iCEB ou iCEBc (iCEB corrigido) foram inferiores no grupo de APE (P < 0,001). Após a TT, observamos uma diminuição da frequência cardíaca, do intervalo TP-e e da razão TP-e/QT ( P < 0,001). Apesar de termos observado uma diminuição do intervalo QT e QTc e da dispersão do QT (QTd), o valor de QTd não apresentou uma diferença estatisticamente significativa (respectivamente, valor de P 0,013, 0,029 e 0,096). Os níveis do iCEB e iCEBc foram menores após a TT (valor de P 0,035 e 0,044, respectivamente). CONCLUSÃO: Os valores de QT, QTc, intervalo Tp-e, razão Tp-e/QTc, iCEB e iCEBc diminuíram significativamente após TT. Pode-se concluir que a TT eficaz causa uma melhora parcial da repolarização ventricular no período inicial.