Komplikasyonsuz izole mitral valve prolapsusunda ventriküler aritmilerin QT süresi ve QT değişkenliği ile ilişkileri

Abstract

KOMPLIKASYONSUZ İZOLE MITRAL VALV PROLAPSUSUNDA VENTRHOJLER ARİTMİLERİN QT SÜRESİ VE QT DEĞİŞKENLİĞİ İLE İLİŞKİLERİ Dicle Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı. Diyarbakır / TÜRKİYE Mitral Valve Prolapsusunda(MVP) komplikasyonlar, insidensinin düşük olmasına rağmen hastalığın toplumdaki sıklığı nedeniyle çok sayıda bireyi etkilemektedir. Bunlar arasında özellikle ciddi ventriküler aritmiler ve ani ölüm çok büyük önem taşımaktadır. Bu çalışma komplikasyonsuz izole MVP'de ventriküler aritmilerin insidensini, şiddetine göre dağılımını, QT süresi ve repolarizasyonun değişkenliği ile olan ilişkilerini araştırmak amacıyla planlandı. Çalışmaya ekokardiyografık olarak komplikasyonsuz izole MVP saptanan 58 izole MVP, ventriküler aritmilerle ilişkisini karşılaştırmak amacıyla MVP'na eşlikeden trikuspid valv prolapsusu(TVP) olan 33 hasta ve yaş ve cinsiyet karşılaştırmalı 60 kontrol olgusu dahil edildi. Eşlikeden kardiyak ve/veya sistemik hastalığı olan yada QT süresini etkileyen ilaç kullanan olgular alınmadı. İzole MVP ventriküler aritmi insidensi %48, eşlikeden trikuspid valv prolapsusu(TVP) varlığında ise %64 idi. Bu sonuç isatistiksel olarak anlamlı değildi. QT ve QpeakT ortalamaları hasta ve kontrol istatistiksel olarak anlamlı bir fark göstermedi. Ancak QTd ve QpeakTd ortalamaları( 60±18, 54±14), kontrol grubuna göre (42+10, 38+10) daha yüksekti(p<0.001). Ayrıca kompleks ventriküler aritmilerle( Lown grade> 3) QT ve QpeakT süreleri arasında anlamlı bir ilişki bulunmazken, QTd ve QpeakTd ortalamaları kompleks ventriküler aritmileri olan izole MVP olgularında daha yüksek bulundu(p< 0.001). Bu çalışmanın sonunda; MVP'de eşlikeden TVP'nin ventriküler aritmi insidensini anlamlı olarak artırmadığı; komplikasyonsuz izole MVP olgularında ventriküler aritmilerin QT süresinden ziyade QT değişkenliği ile ilişkili olduğu saptandı. MVP'de ciddi ventriküler aritmi ve ani ölüm açısından yüksek riskli grupların belirlenmesinde QT değişkenliğinin belirlenmesinin oldukça yararlı bir marker olduğu kanaatine varıldı. QT süresinin belirlenmesinde güçlüklerle karşılaşıldığında ( yüksek kalp hızları yada U dalgasının varlığı gibi ) QpeakT değişkenliğinin belirlenmesinin ek bir katkı sağlayabileceği düşünüldü. Anahtar kelimeler: İzole MVP, QT değişkenliği, ventriküler aritmiler. 38RELATIONS BETWEEN QT DISPERSION AND VENTRICULAR ARRHYTMIAS IN UNCOMPLICATED ISOLATED MITRAL VALVE PROLAPSE CASES Dicle University, school of medicine, department of cardiology, Diyarbakir/TURKIYE Complications of Mitral Valve Prolapse (MVP) that serious ventricular arrhytmia and sudden death have major importance among them, despite their low incidence, effect many individuals since high incidence of the disease itself in community. Current study was planned to investigate the incidence and distribution of ventricular arrhytmias according to severity, and relations to QT interval and dispersion of repolarisation in uncomplicated isolated MVP cases. Fifty-eight isolated MVP patients whose echocardiographic exam were uncomplicated. 33 patients with accompanying Tricuspid Valve Prolapse (TVP) to compare relations to ventricular arrhytmia and 60 age and sex matched control subjects were enrolled to the study. Individuals who had accompanying cardiac or systemic disease or had taken drugs potentially would have changed QT characteristics were excluded from the study. Ventricular arrhytmia incidence was 48%in isolated MVP group and 64% in TVP accompanying group that is nonsignificant. QT and QpeakT values were nonsignificant whereas QTd and QpeakTd values were significantly higher in patient group (60±18, 54±14 msec, respectively) versus control group (42+10, 38±10 msec,_respectively ) (p<0.001). Complex ventricular arrhytmia (Lown Grade >III) in isolated MVP had a significant relation to QTd and QpeakTd (p<0.001) but not to QT and QpeakT. At the end of the study it is concluded that TVP accompanying MVP doesn't increase ventricular arrhytmia incidence, ventricular arrhytmia relates to QT dispersion more than QT in isolated MVP so determining QT dispersion is a rather good marker to identify high risk group for serious ventricular arrhytmia and sudden death and QpeakT dispersion measurement could provide an additional high benefit and is an alternative when QT is hard to determine in conditions such as high heart rates or presence of U wave Key Words: Isolated MVP, QT Dispersion, Ventricular arrhythmias 39

RELATIONS BETWEEN QT DISPERSION AND VENTRICULAR ARRHYTMIAS IN UNCOMPLICATED ISOLATED MITRAL VALVE PROLAPSE CASES Dicle University, school of medicine, department of cardiology, Diyarbakir/TURKIYE Complications of Mitral Valve Prolapse (MVP) that serious ventricular arrhytmia and sudden death have major importance among them, despite their low incidence, effect many individuals since high incidence of the disease itself in community. Current study was planned to investigate the incidence and distribution of ventricular arrhytmias according to severity, and relations to QT interval and dispersion of repolarisation in uncomplicated isolated MVP cases. Fifty-eight isolated MVP patients whose echocardiographic exam were uncomplicated. 33 patients with accompanying Tricuspid Valve Prolapse (TVP) to compare relations to ventricular arrhytmia and 60 age and sex matched control subjects were enrolled to the study. Individuals who had accompanying cardiac or systemic disease or had taken drugs potentially would have changed QT characteristics were excluded from the study. Ventricular arrhytmia incidence was 48%in isolated MVP group and 64% in TVP accompanying group that is nonsignificant. QT and QpeakT values were nonsignificant whereas QTd and QpeakTd values were significantly higher in patient group (60±18, 54±14 msec, respectively) versus control group (42+10, 38±10 msec,_respectively ) (p<0.001). Complex ventricular arrhytmia (Lown Grade >III) in isolated MVP had a significant relation to QTd and QpeakTd (p<0.001) but not to QT and QpeakT. At the end of the study it is concluded that TVP accompanying MVP doesn't increase ventricular arrhytmia incidence, ventricular arrhytmia relates to QT dispersion more than QT in isolated MVP so determining QT dispersion is a rather good marker to identify high risk group for serious ventricular arrhytmia and sudden death and QpeakT dispersion measurement could provide an additional high benefit and is an alternative when QT is hard to determine in conditions such as high heart rates or presence of U wave Key Words: Isolated MVP, QT Dispersion, Ventricular arrhythmias 39