Abstract
INTRODUCTION: Although the childhood clinic of COVID-19 is more innocent than adults, its unknown aspects continue to cause concern among pediatricians. One of these unsettling aspects is the cardiovascular system effects. We investigate the role of ventricular repolarization parameters in predicting arrhythmia risk in pediatric COVID-19.
METHODS: Twelve-channel surface electrocardiograms of a total of 166 participants, including children diagnosed with COVID-19 and healthy controls, were analyzed. The QT interval, corrected QT interval, QTc dispersion, Tpeak-Tend, Tp-e dispersion, Tp-e / QT and Tp-e / QTc ratio were calculated. The correlations between ventricular repolarization parameters and laboratory values were examined.
RESULTS: In our study, the COVID-19 patients had a significantly longer Tpeak-Tend (64.51 ± 8.64 and 57.62 ± 7.96; p < 0.001), Tp-e dispersion (21.77 ± 6.4 and 18.01 ± 6.78; p < 0.001), and corrected QT interval (393.18 ± 20.06 and 380 ± 22.3; p < 0.001) duration than the control group. There was a significantly higher Tp-e / QT ratio (0.17 ± 0.02 and 0.15 ± 0.02; p < 0.001), Tp-e / QTc ratio (0.16 ± 0.02 and 0.15 ± 0.02; p < 0.001) in group with COVID-19 than the controls. In addition a positive correlation was found between Tpeak-Tend interval, Tp-e dispersion and white blood cells in the group with SARS CoV2 infection.
DISCUSSION AND CONCLUSION: Evaluating these ventricular repolarization parameters in pediatric SARS CoV2 infection may be useful in predicting the risk of ventricular arrhythmia.
References
- Referans1: Patel NA. Pediatric COVID-19: Systematic review of the literature. Am J Otolaryngol 2020;41:102573.
- Referans2: Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- Referans3: Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-1069.
- Referans4: Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008;41:575-80.
- Referans5: Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green J.T et al. T(p - e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567 –74.
- Referans6: Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Schimizu W et al. Does Tpeak Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 2007;4:1114-1116.
- Referans7: Coşkun FY, Elboğa G, Altunbaş G, Vuruşkan E, Kaya B, Sucu M. Evaluation of ventricular repolarization features with Tp e, Tp e/QTc, JTc and JTd during electroconvulsive therapy. J Electrocardiol 2018;51:440-442.
- Referans8: Fridericia LS. Die systolendauer im elektrokardiogramm bei normalen menschen und bei herzkranken. Acta Med Scand 1920;53:469-86.
- Referans9: Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342–4.
- Referans10: Hevia CJ, Antzelevitch C, Barzaga TF, Sánchez MD, Balea FD, Zayas Molina R 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;47:1828–1834.
- Referans11: Li SS, Cheng C, Fu C, Chan Y, Lee M, Chan WJ et al. Left ventricular performance in patients with severe acute respiratory syndrome: a 30-day echocardiographic follow-up study. Circulation 2003;108:1798–1803.
- Referans12: Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011:4;441–447.
- Referans13: Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342–44.
- Referans14: Das BB, Sharma J. Repolarization Abnormalities in Children with a Structurally Normal Heart and Ventricular Ectopy. Pediatric Cardiology 2004;25:354-6.
- Referans15: Antzelevitch C. Role of spatial dispersion of repolarization in inherited and acquired sudden cardiac death syndromes. American Journal of Physiology. Heart and Circulatory Physiology 2017;93:2024–2038.
- Referans16: Prenner SB, Shah SJ, Goldberger JJ, Sauer A. Repolarization Heterogeneity: Beyond the QT Interval. Journal of the American Heart Association 2016;5:e003607.
- Referans17: Yan GX, Lankipalli RS, Burke JF, Musco S, Kowey PR. Ventricular repolarization components on the electrocardiogram: Cellular basis and clinical significance. Journal of the American College of Cardiology 2003;42:401–409.
- Referans18: Lagrand WK, Visser CA, Hermens WT, Niessen HW, Verheugt FW, Wolbink GJ et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation 1999;100:96–102.
- Referans19: Yenerçağ M, Arslan U, Doğduş M, Günal Ö, Öztürk Ç, Aksan G et al. Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19. Journal of Electrocardiology 2020;62:5-9.
- Referans20: Yamada T, Wakabayashi M, Yamaji T, Chopra N, Mikami T, Miyashita H et al. Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): A systematic review and meta-analysis. Clin Chim Acta 2020;509:235-243.
- Referans21: Yalta T, Yalta K. Systemic Inflammation and Arrhythmogenesis: A Review of Mechanistic and Clinical Perspectives. Angiology 2017;69:288–296.
- Referans22: Okazaki R, Iwasaki YK, Miyauchi Y, Hirayama Y, Kobayashi Y, Katoh T et al. Lipopolysaccharide induces atrial arrhythmogenesis via down-regulation of L-type Ca2þ channel genes in rats. Int Heart J 2009;50:353-363.
- Referans23: Court O, Kumar A, Parrillo JE, Kumar A. Clinical review: myocardial depression in sepsis and septic shock. Crit Care 2002;6:500-508.
- Referans24: Alonso A, Tang W, Agarwal SK, Soliman EZ, Chamberlain AM, Folsom AR. Hemostatic markers are associated with the risk and prognosis of atrial fibrillation: the ARIC study. Int J Cardiol 2012;155:217-222.
Abstract
GİRİŞ ve AMAÇ: COVID-19'un çocukluklardaki kliniği, yetişkinlere kıyasla daha masum seyretse de bilinmeyen yönleri pediatristler arasında endişe yaratmaya devam ediyor. Bu tedirgin edici yönlerinden biri de kardiyovasküler sistem etkileridir. Biz de bu çalışmada pediyatrik COVID-19'da aritmi riskini tahmin etmede ventriküler repolarizasyon parametrelerinin rolünü araştırmayı amaçladık.
YÖNTEM ve GEREÇLER: COVID-19 teşhisi konan çocuklar ve sağlıklı kontroller dahil olmak üzere toplam 166 katılımcının on iki kanallı yüzey elektrokardiyogramı analiz edildi. Tp-e intervali, Tp-e dispersiyonu, Tp-e / QT oranı, Tp-e / QTc oranı, QT intervali, QTc intervali ve QTc dispersiyonu değerleri hesaplandı. Ventriküler repolarizasyon parametreleri ile laboratuvar değerleri arasındaki korelasyonlar incelendi.
BULGULAR: Çalışmamızda, COVID-19 hastalarında kontrol grubuna göre anlamlı derecede uzamış Tpeak-Tend (64.51 ± 8.64 ve 57.62 ± 7.96; p < 0.001), Tp-e dispersionu (21.77 ± 6.4 and 18.01 ± 6.78; p < 0.001), ve corrected QT intervali (393.18 ± 20.06 ve 380 ± 22.3; p < 0.001) saptandı. COVID-19 olan grupta kontrol grubuna göre anlamlı derecede yüksek Tp-e / QT oranı (0.17 ± 0.02'ye ve 0,15 ± 0,02; p <0,001) ve Tp-e / QTc oranı (0,16 ± 0,02'ye ve 0,15 ± 0,02; p <0,001) vardı. Ayrıca SARS CoV2 enfeksiyonu olan grupta Tpeak-Tend aralığı, Tp-e dispersiyonu ve beyaz kan hücreleri arasında pozitif korelasyon bulundu.
TARTIŞMA ve SONUÇ: Pediyatrik COVID-19 hastalarında bu ventriküler repolarizasyon parametrelerinin değerlendirilmesinin ventriküler aritmi riskini tahmin etmede faydalı olabileceğine inanıyoruz.
References
- Referans1: Patel NA. Pediatric COVID-19: Systematic review of the literature. Am J Otolaryngol 2020;41:102573.
- Referans2: Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- Referans3: Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-1069.
- Referans4: Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008;41:575-80.
- Referans5: Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green J.T et al. T(p - e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41:567 –74.
- Referans6: Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Schimizu W et al. Does Tpeak Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 2007;4:1114-1116.
- Referans7: Coşkun FY, Elboğa G, Altunbaş G, Vuruşkan E, Kaya B, Sucu M. Evaluation of ventricular repolarization features with Tp e, Tp e/QTc, JTc and JTd during electroconvulsive therapy. J Electrocardiol 2018;51:440-442.
- Referans8: Fridericia LS. Die systolendauer im elektrokardiogramm bei normalen menschen und bei herzkranken. Acta Med Scand 1920;53:469-86.
- Referans9: Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342–4.
- Referans10: Hevia CJ, Antzelevitch C, Barzaga TF, Sánchez MD, Balea FD, Zayas Molina R 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;47:1828–1834.
- Referans11: Li SS, Cheng C, Fu C, Chan Y, Lee M, Chan WJ et al. Left ventricular performance in patients with severe acute respiratory syndrome: a 30-day echocardiographic follow-up study. Circulation 2003;108:1798–1803.
- Referans12: Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011:4;441–447.
- Referans13: Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342–44.
- Referans14: Das BB, Sharma J. Repolarization Abnormalities in Children with a Structurally Normal Heart and Ventricular Ectopy. Pediatric Cardiology 2004;25:354-6.
- Referans15: Antzelevitch C. Role of spatial dispersion of repolarization in inherited and acquired sudden cardiac death syndromes. American Journal of Physiology. Heart and Circulatory Physiology 2017;93:2024–2038.
- Referans16: Prenner SB, Shah SJ, Goldberger JJ, Sauer A. Repolarization Heterogeneity: Beyond the QT Interval. Journal of the American Heart Association 2016;5:e003607.
- Referans17: Yan GX, Lankipalli RS, Burke JF, Musco S, Kowey PR. Ventricular repolarization components on the electrocardiogram: Cellular basis and clinical significance. Journal of the American College of Cardiology 2003;42:401–409.
- Referans18: Lagrand WK, Visser CA, Hermens WT, Niessen HW, Verheugt FW, Wolbink GJ et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation 1999;100:96–102.
- Referans19: Yenerçağ M, Arslan U, Doğduş M, Günal Ö, Öztürk Ç, Aksan G et al. Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19. Journal of Electrocardiology 2020;62:5-9.
- Referans20: Yamada T, Wakabayashi M, Yamaji T, Chopra N, Mikami T, Miyashita H et al. Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): A systematic review and meta-analysis. Clin Chim Acta 2020;509:235-243.
- Referans21: Yalta T, Yalta K. Systemic Inflammation and Arrhythmogenesis: A Review of Mechanistic and Clinical Perspectives. Angiology 2017;69:288–296.
- Referans22: Okazaki R, Iwasaki YK, Miyauchi Y, Hirayama Y, Kobayashi Y, Katoh T et al. Lipopolysaccharide induces atrial arrhythmogenesis via down-regulation of L-type Ca2þ channel genes in rats. Int Heart J 2009;50:353-363.
- Referans23: Court O, Kumar A, Parrillo JE, Kumar A. Clinical review: myocardial depression in sepsis and septic shock. Crit Care 2002;6:500-508.
- Referans24: Alonso A, Tang W, Agarwal SK, Soliman EZ, Chamberlain AM, Folsom AR. Hemostatic markers are associated with the risk and prognosis of atrial fibrillation: the ARIC study. Int J Cardiol 2012;155:217-222.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | September 22, 2021 |
| Submission Date | May 24, 2021 |
| Published in Issue | Year 2021 Volume: 11 Issue: 3 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.