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Künt göğüs travmalı hastalarda Tp-e aralığı, Tp-e/QT oranı ve Tp-e/QTc oranının Klinik Önemi

Yıl 2023, Cilt: 33 Sayı: 6, 689 - 693, 31.12.2023

Günay Yıldız Cihan Bedel Fatih Selvi Ökkeş Zortuk Mustafa Korkut Görkem Kuş Muharrem Özkaya

https://doi.org/10.54005/geneltip.1262217

Öz

Amaç: Künt göğüs travması sonrası birçok komplikasyon gelişebilir. Künt göğüs travmasından sonra potansiyel ölümcül olabilcek aritmi gelişebileceği gösterilmiştir. Biz bu çalışmada künt göğüs travmalı hastalarda kardiyak aritmi riskini Tp-e aralığı, tp-e/QT oranı ve Tp-e/QTc oranını kullanarak potansiyel kardiyak aritmi belirteci olarak kullanılabilirliğini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmamız tek merkezli prospektif olgu-kontrol şeklinde 15.01.2022 -15.06.2022 tarihleri arasında acil servise künt göğüs travması ile başvuran tüm hastalar hastalardan oluşmaktadır. Tüm katılımcılardan kâğıt hızı 50 mm/sn hızda 12 derivasyonlu EKG kaydı alınmış olup Tp-e interval, QT aralığı ve bunların birbirine oranlanmasından elde edilen (tp-e/QT, Tp-e/QTc) parametreler gruplar arasında karşılaştırıldı. Hastalar travma şiddetine göre gruplandırılıp parametreler karşılaştırılmıştır.
Bulgular: Travma hastalarındaki Tpe/QT oranı kontrol grubuna göre anlamlı yüksek saptanmıştır (0,23±0.03 vs. 0.19±0.03, p<0.001). Ayrıca Travma hastalarındaki Tpe/QTc oranı kontrol grubuna göre anlamlı yüksek saptanmıştır (0.21±0.02 vs. 0.17±0.02, p<0.001). Ayrıca travma şiddetine etki eden faktörlerin analizi yapıldığında yaş,cinsiyet, BMI, QT interval, Tp-e/QT ve Tp-e/QTc açısından anlamlı farklılık saptanmadı.
Sonuç: Çalışmamızdaki sonuçlara dayanarak acil servise künt toraks travması ile başvuran hastalarda EKG'de Tp-e aralığı, Tp-e/QT oranı ve Tp-e/QTc oranının oluşabilecek aritminin bir göstergesi olabileceğini ve bunun travma şiddeti ile ilişkisiz olduğunu saptadık.

Anahtar Kelimeler

Tp-e aralığı Tp-e/QT oranı Tp-e/QTc oranı göğüs travması

Kaynakça

  • Emircan Ş, Özgüç H, Aydın Ş, Özdemir A, Cesur EE, Bildik N, et al. Factors Affecting Mortality in Patients With Thorax Trauma. Ulus Travma Acil Cerrahi Derg. 2011;17:329-33.
  • Eghbalzadeh K, Sabashnikov A, Zeriouh M, Choi YH, Bunck AC, Mader N, et al. Blunt chest trauma: a clinical chameleon. Heart. 2018;104(9):719-724.
  • Çaltekin İ. Hidayet Ş. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in blunt chest trauma patients. Ulus Travma Acil Cerrahi Derg 2020;26:526-530.
  • Mergan İliklerden D, Çobanoğlu U, Sayır F, İliklerden ÜH. Late complications due to thoracic traumas. Ulus Travma Acil Cerrahi Derg. 2022;28(3):328-335.
  • Hadjizacharia P, O'Keeffe T, Brown CV, Inaba K, Salim A, Chan LS, et al. Incidence, risk factors, and outcomes for atrial arrhythmias in trauma patients. Am Surg. 2011;77:634-639
  • De Veld L, van der Lely N, Hermans BJM, van Hoof JJ, Wong L, Vink AS. QTc prolongation in adolescents with acute alcohol intoxication. Eur J Pediatr. 2022;181:2757-2770.
  • 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.
  • Tokatli A, Kiliçaslan F, Alis M, Yiginer O, Uzun M. Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus. Endocrinol Metab (Seoul). 2016;31:105-112.
  • 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;21:287-293.
  • Briet JP, Houwert RM, Smeeing DPJ, Dijkgraaf MGW, Verleisdonk EJ, Leenen LPH, et al. Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study. J Foot Ankle Surg. 2017;56:793-796.
  • Scalea TM. Caring for vascular injuries: Training more vascular specialists may not be the answer. J Trauma Acute Care Surg. 2022;92:760-761.
  • Kalogerakos PD, Lazopoulos G, Palioudakis S, Drositis I, Chionidou K, Chalkiadakis G. Pneumorachis associated with persistent tachycardia after blunt thoracic trauma. Asian Cardiovasc Thorac Ann. 2017;25:463-465.
  • Ismailov RM. Trauma associated with cardiac conduction abnormalities: population-based perspective, mechanism and review of literature. European Journal of Trauma and Emergency Surgery. 2010;36:227-232.
  • Ismailov RM, Ness RB, Redmond CK, Talbott EO, Weiss HB. Trauma associated with cardiac dysrhythmias: results from a large matched case-control study. J Trauma. 2007;62:1186-1191.
  • Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management. J Cardiothorac Vasc Anesth. 2022;36:2707-2718.
  • Kilicaslan F, Tokatli A, Ozdag F, Uzun M, Uz O, Isilak Z, et al. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea. Pacing Clin Electrophysiol. 2012;35:966-972.
  • Yamaguchi M, Shimizu M, Ino H, Terai H, Uchiyama K, Oe K, et al. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clin Sci (Lond). 2003;105:671-676.
  • Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, et al. Repolarization abnormalities in patients with subarachnoid and intracerebral hemorrhage: predisposing factors and association with outcome. Anesth Analg. 2013;116:190-197.
  • Ozturk U, Ozturk O. Relation between index of cardioelectrophysiological balance and stroke severity in patients with acute ischemic stroke. Niger J Clin Pract. 2020;23:768-774.
  • Demirtas D, Sumbul HE, Bulut A, Demirtas AO, Gulumsek E, Koca H, et al. Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in hypertensive patients with primary aldosteronism. Clin Exp Hypertens. 2020;42:93-98.
  • Tokatli A, Kiliçaslan F, Alis M, Yiginer O, Uzun M. Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus. Endocrinol Metab (Seoul). 2016;31:105-112.
  • Avci A, Acehan S, Avci BS, Gulen M, Bulut A, Satar S. QTc, Tp-e interval and Tp-e/QTc ratio in patients with nontraumatic subarachnoid hemorrhage. Am J Emerg Med. 2020;38:2458-2459.
  • Karaagac K, Yildiz A, Tenekecioglu E, Ozluk OA, Kanat S, Yilmaz M. Tp-e Interval and Tp-e/QT Ratio in Chronic Renal Failure Patients Requiring Hemodialysis. J Clin Anal Med 2016;7: 222-225.
  • 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. BMC Cardiovasc Disord. 2019;19:232.
  • 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;35:559-564.
  • Hidayet Ş, Demir V, Turan Y, Gürel G, Taşolar MH. Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with Behçet's disease. Anatol J Cardiol. 2019;22:85-90.

Clinical Importance of Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Blunt Trauma Patients

Yıl 2023, Cilt: 33 Sayı: 6, 689 - 693, 31.12.2023

Günay Yıldız Cihan Bedel Fatih Selvi Ökkeş Zortuk Mustafa Korkut Görkem Kuş Muharrem Özkaya

https://doi.org/10.54005/geneltip.1262217

Öz

Objective: Diffirents complications can develop after blunt chest trauma. It has been shown that potentially dectructive arrhythmias may develop after blunt chest trauma. In this study, our main objective is to evaluate the risk of cardiac arrhythmia in patients with blunt chest trauma, using the Tp-e interval, tp-e/QT ratio, and Tp-e/QTc ratio as a potential marker of cardiac arrhythmia.
Materials and Methods: Our study consists of all patients who applied to the emergency department with blunt chest trauma between 15.01.2022 and 15.06.2022 in the form of a single-center, prospective case-control. 12-lead ECG documented on were taken from all participants at a paper speed of 50 mm/sec, and Tp-e interval, QT interval and the parameters obtained by their ratio to each other (tp-e/QT, Tp-e/QTc) were compared between the groups. Patients were shared according to trauma severity and parameters were compared.
Results: Tpe/QT ratio in trauma patients was found to be statistically significantly higher than the control group (0.23±0.03 vs. 0.19±0.03, p<0.001). In addition, the Tpe/QTc ratio in trauma patients was found to be statistically significantly higher than the control group (0.21±0.02 vs. 0.17±0.02, p<0.001). In addition, when the analysis of age, gender and BMI, which are the factors affecting trauma severity, was performed, no significant difference was found in terms of QT interval, Tp-e/QT and Tp-e/QTc.
Conclusıon: Based on the results of our study, we verified that the Tp-e interval in the ECG, Tp-e/QT ratio, and Tp-e/QTc ratio might indicate possible arrhythmia in patients who presented to the emergency department with blunt thoracic trauma, and this was unrelated to the severity of the trauma.

Anahtar Kelimeler

Tp-e interval Tp-e/QT ratio Tp-e/QTc ratio chest trauma

Kaynakça

  • Emircan Ş, Özgüç H, Aydın Ş, Özdemir A, Cesur EE, Bildik N, et al. Factors Affecting Mortality in Patients With Thorax Trauma. Ulus Travma Acil Cerrahi Derg. 2011;17:329-33.
  • Eghbalzadeh K, Sabashnikov A, Zeriouh M, Choi YH, Bunck AC, Mader N, et al. Blunt chest trauma: a clinical chameleon. Heart. 2018;104(9):719-724.
  • Çaltekin İ. Hidayet Ş. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in blunt chest trauma patients. Ulus Travma Acil Cerrahi Derg 2020;26:526-530.
  • Mergan İliklerden D, Çobanoğlu U, Sayır F, İliklerden ÜH. Late complications due to thoracic traumas. Ulus Travma Acil Cerrahi Derg. 2022;28(3):328-335.
  • Hadjizacharia P, O'Keeffe T, Brown CV, Inaba K, Salim A, Chan LS, et al. Incidence, risk factors, and outcomes for atrial arrhythmias in trauma patients. Am Surg. 2011;77:634-639
  • De Veld L, van der Lely N, Hermans BJM, van Hoof JJ, Wong L, Vink AS. QTc prolongation in adolescents with acute alcohol intoxication. Eur J Pediatr. 2022;181:2757-2770.
  • 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.
  • Tokatli A, Kiliçaslan F, Alis M, Yiginer O, Uzun M. Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus. Endocrinol Metab (Seoul). 2016;31:105-112.
  • 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;21:287-293.
  • Briet JP, Houwert RM, Smeeing DPJ, Dijkgraaf MGW, Verleisdonk EJ, Leenen LPH, et al. Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study. J Foot Ankle Surg. 2017;56:793-796.
  • Scalea TM. Caring for vascular injuries: Training more vascular specialists may not be the answer. J Trauma Acute Care Surg. 2022;92:760-761.
  • Kalogerakos PD, Lazopoulos G, Palioudakis S, Drositis I, Chionidou K, Chalkiadakis G. Pneumorachis associated with persistent tachycardia after blunt thoracic trauma. Asian Cardiovasc Thorac Ann. 2017;25:463-465.
  • Ismailov RM. Trauma associated with cardiac conduction abnormalities: population-based perspective, mechanism and review of literature. European Journal of Trauma and Emergency Surgery. 2010;36:227-232.
  • Ismailov RM, Ness RB, Redmond CK, Talbott EO, Weiss HB. Trauma associated with cardiac dysrhythmias: results from a large matched case-control study. J Trauma. 2007;62:1186-1191.
  • Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management. J Cardiothorac Vasc Anesth. 2022;36:2707-2718.
  • Kilicaslan F, Tokatli A, Ozdag F, Uzun M, Uz O, Isilak Z, et al. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea. Pacing Clin Electrophysiol. 2012;35:966-972.
  • Yamaguchi M, Shimizu M, Ino H, Terai H, Uchiyama K, Oe K, et al. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clin Sci (Lond). 2003;105:671-676.
  • Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, et al. Repolarization abnormalities in patients with subarachnoid and intracerebral hemorrhage: predisposing factors and association with outcome. Anesth Analg. 2013;116:190-197.
  • Ozturk U, Ozturk O. Relation between index of cardioelectrophysiological balance and stroke severity in patients with acute ischemic stroke. Niger J Clin Pract. 2020;23:768-774.
  • Demirtas D, Sumbul HE, Bulut A, Demirtas AO, Gulumsek E, Koca H, et al. Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in hypertensive patients with primary aldosteronism. Clin Exp Hypertens. 2020;42:93-98.
  • Tokatli A, Kiliçaslan F, Alis M, Yiginer O, Uzun M. Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus. Endocrinol Metab (Seoul). 2016;31:105-112.
  • Avci A, Acehan S, Avci BS, Gulen M, Bulut A, Satar S. QTc, Tp-e interval and Tp-e/QTc ratio in patients with nontraumatic subarachnoid hemorrhage. Am J Emerg Med. 2020;38:2458-2459.
  • Karaagac K, Yildiz A, Tenekecioglu E, Ozluk OA, Kanat S, Yilmaz M. Tp-e Interval and Tp-e/QT Ratio in Chronic Renal Failure Patients Requiring Hemodialysis. J Clin Anal Med 2016;7: 222-225.
  • 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. BMC Cardiovasc Disord. 2019;19:232.
  • 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;35:559-564.
  • Hidayet Ş, Demir V, Turan Y, Gürel G, Taşolar MH. Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with Behçet's disease. Anatol J Cardiol. 2019;22:85-90.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Günay Yıldız 0000-0002-2722-0674

Cihan Bedel 0000-0002-3823-2929

Fatih Selvi 0000-0002-9701-9714

Ökkeş Zortuk 0000-0001-6776-2702

Mustafa Korkut 0000-0003-1665-1601

Görkem Kuş 0000-0002-6058-5501

Muharrem Özkaya 0000-0002-3507-1349

Erken Görünüm Tarihi 29 Aralık 2023
Yayımlanma Tarihi 31 Aralık 2023
Gönderilme Tarihi 8 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 33 Sayı: 6

Kaynak Göster

Vancouver Yıldız G, Bedel C, Selvi F, Zortuk Ö, Korkut M, Kuş G, Özkaya M. Clinical Importance of Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Blunt Trauma Patients. Genel Tıp Derg. 2023;33(6):689-93.

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.