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QT interval dispersion in patients with Q-wave myocardial infarction
11. Kane D., Pathare S. Early psoriatic arthritis//Rheum. Dis. Clin. North. - 2005. - Vol. 31. - P. 641-657.
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-79-81
Mullabaeva Guzal Uchkunovna, Kurbanov Ravshan Davletovich Republican Specialized Center of Cardiology E-mail: [email protected]
QT interval dispersion in patients with Q-wave myocardial infarction
Abstract: The article provides information on 252 patients with Q-MI (Q-wave myocardial infraction). Evaluation of correlation of QT interval dispersion revealed a significant correlation between its elongation and signs of unfavorable course of disease (anterior localization, left ventricular aneurysm, systolic dysfunction). There were no significant differences of QT interval dispersion in patients with ventricular arrhythmias of high gradations.
Keywords: QT interval dispersion, Q-wave myocardial infarction, ventricular arrhythmias.
Sudden cardiac death (SCD) is one of the most urgent problems in modern cardiology. This is exactly the variant of lethal outcome that occurs most frequently in cases of ischemic heart disease (IHD), especially in patients who endured myocardial infarction (MI). From 6 to 10% of patients die during the first year after MI, and half of them die unexpectedly [1]. A lot of studies have shown that the main electrophysiological cause of SCD is thought to be malignant ventricular arrhythmias (MVA). In the 70s-90s of XX century the studies were published that demonstrated an important prognostic role of VA in SCD [2; 3; 4].
It was suggested that QT dispersion (QTd) may reflect inho-mogeneity of repolarization processes and, thus, a tendency towards development of arrhythmias [4; 5]. A number of studies revealed a connection between the increase of QTd and the emergence of VA in patients with IHD [5, 6]. In general, literature data show that the increased QTd is connected with a higher risk both for sudden death and total mortality [5; 7]. However, some researchers challenge the prognostic significance of QTd [1; 7; 8]. Thus, the duration of QT interval and its dispersion continue to take up an uncertain position in the prediction of outcomes in patients with MI.
The objective of the study: to assess the relationship between predictors of SCD in patients with Q-wave MI and QTd.
Materials and methods: the study included 252 male patients with Q-wave MI (middle age). Exclusion criteria were as follows: female gender, presence of MI in anamnesis, complete block of left bundle branch, patients older than 70 years, presence of congenital
Table 1. - QT interval dispersion in patients with
During the study of QTd on the 10th-14th day in patients with Q-wave MI of different localization we revealed significant dif-
QT abnormalities. The analysis of QTd was performed according to ECG records on the 12th-14th day of the disease. QT-interval was measured from the beginning of Q-wave to the end of T-wave in no less than 3 consecutive ventricular complexes. QTd was calculated as the difference between maximum and minimum values of the interval in 12 deflections. For characterization of VA we used the gradational classification of B. Lown and M. Wolf (1971) and the prognostic classification ofJ. Bigger (1982). Hourly qualitative and quantitative evaluation of VA was conducted in accordance with Lown-Wolf's grading system. According to J. Bigger's classification, after the old MI, potentially dangerous ventricular arrhythmias (PDVA) included VA>10 per hour, paired VA and group VA.
Statistical data analysis was performed using standard statistical methods with the help of the application software package SPSS 12.0. Data evaluation was performed using parametric and non-parametric methods. Data are presented as M±o (M — average value, o — standard deviation) in normal distribution, and as Me (25; 75) (Me — median value, 25th and 75th percentiles) in non-normal distribution. Differences were considered to be significant at p<0.05. Results and their discussion:
On average, this indicator in the group amounted to 82.6±13,2 ms (Me 82,9; IQR 73,3-91,8), i. e. the 25th percentile corresponded to 73.3 ms, the 50th percentile — 82,9 ms and the 75th percentile — 82,9 ms.
We studied the features of QTd in patients depending on the clinical course of Q-wave MI.
Q-wave MI on the 10th-14th day of the disease
ferences of QTd values in anterior and posterior localization of MI, what is explained by more common myocardial damage of
Indicators QT dispersion, ms Reliability
Anterior wall, n=141 92,2±15,3 0,00001
Posterior wall, n=111 70,8±17,4
Ejection fraction <50%, n=136 98,3±30,2 0,00001
Ejection fraction >50%, n=116 78,6±10,1
Presence of aneurysm, n=72 95,1±11,3 0,00001
Absence of aneurysm, n=180 73,5±29,4
Left ventricular diastolic dysfunction, n=137 90,0±30,7 0,00001
Without left ventricular diastolic dysfunction, n=115 78,6±9,8
Heart failure of more than II class according to NYHA, n=100 93,9±25,9 0,00001
Absence of heart failure, n=152 68,7±10,4
Section 8. Medical science
anterior localization. So, in the case of its anterior localization QTd amounted to 92.2±15,3 ms, in the case of posterior localization -70.8±17,4 ms (p=0.00001). We did not detect any significant differences of QTd values in patients with ischemic heart disease (IHD), arterial hypertension (AH) and diabetes mellitus (DM). So, QTd in patients with concomitant arterial hypertension amounted to 69,0±28,6 ms versus 60.4±21,2 ms in the group of patients without arterial hypertension (p>0.05). The QTd value in patients with IHD and in patients without IHD in the anamnesis amounted to 75.6±23,3 ms and 70,3±26,7 ms, respectively (p>0.05). QTd in the case of diabetes mellitus was 86.3±24,3 ms versus 78,9±26,1 ms in the case of its absence (p>0.05).
During comparison of QTd values in patients with different degrees of acute heart failure (AHF) it was found that in patients with heart failure of III-IV class according to Killip there was a tendency towards the increase of this indicator (90,1±19.7 ms), as compared to patients with heart failure of I-II class (80,1±17,5 ms), although it did not reach statistical significance (p=0,07). However, later during evaluation of dependence of QTd from the degree of chronic heart failure (CHF), these differences reach reliable values. So, in patients with heart failure of more than II class according to NYHA classification, QTd amounted to 93.9±25,9 ms (p=0.00001). Moreover, in patients with ejection fraction <50%, QTd value was significantly higher than in patients without systolic dysfunction (98,3±30,2 ms
and 78.6±10,1 ms, respectively, p=0.00001). The presence of left ventricular aneurysm in patients also caused significantly high QTd values (95,1±11,3 ms versus 73,5±29,4 ms, p=0.00001), what does not allow to exclude the dependence of repolarization processes from the degree of structural changes in myocardium.
In patients with left ventricular diastolic dysfunction (LVDD) we revealed significantly higher QTd values, in comparison with patients without LVDD (90,0±30,7 ms versus 78,6±9,8 ms, p=0.00001), which indicates inhomogeneity of myocardium in patients with LVDD.
Despite the fact that QTd values in patients with potentially dangerous ventricular arrhythmias (PDVA) were significantly higher in comparison with patients without PDVA, the differences did not reach reliable values (85,3±28,4 versus 78,6±27,6 ms, respectively, p=0,07).
For more detailed study on distribution of QT dispersion, the patients were divided into percentiles.
Approximately the same number of patients was detected in each percentile. But the structural analysis of patients revealed that the number of patients with PDVA in the 25th percentile constituted 57.1%, while patients without PDVA amounted to 42.8%, patients with PDVA in the 25th-50th percentile made up 70.9%, without PDVA — 29%, patients with PDVA in the 50th-75th percentile constituted 56.2% versus 43.7% without PDVA, 66.7% of patients had PDVA in the 75th percentile versus 33.3% ofpatients without PDVA.
0,0 5,0 10,0 15,0 20,0
□ With PDVA Q Without PDVA □ Tota!
Figure 3.1. Distribution of patients with and without PDVA depending on the percentile values of QTd.
Conclusion: PDVA depending on the percentile values also showed no significant
Thus, maximum elongation of QTd was observed in patients differences, although the group with PDVA included more patients
with anterior localization of MI, which was complicated by devel- with QTd above the 75th percentile (29.1% versus 18.1%; odds ratio
opment of left ventricular aneurysm, marked systolic and diastolic 1.86; 95% confidence interval 0,99-3.48; p=0,07). dysfunction. The study of QTd values in patients with and without
References:
1. Mazur N. A. Sudden cardiac death on patients with ischemic heart desease. -M.: Medicina. - 1986. - 191 p.
2. Kurbanov R. D., Kiyakbayev G. K. Myocardial infarction. Life prognosis. - Tashkent. - 2001. - 199 p.
3. Bigger J. T.Jr., Fleiss. I.L., Rolnitzky L. M. et al. Time course of recovery ofheart period variability after myocardial infarction. J Am Coll Cardiol - 1991. - 18:1643-1649.
4. Osipov A. I., Baytinger V. F., Sotnikov A. A. Vnezapnaya serdechnaya smert' (prichiny i profilaktika) [Sudden cardiac death (causes and prevention)]. - Tomsk, - 2004. - P. 114.
Features immune status changes in children with chronic diseases of lower respiratory
5. Balasubramaniyam N., Palaniswamy C., Aronow W. S. et al. Association of corrected QT interval with long-term mortality in patients with syncope. Arch Med Sci., - 2013, - Vol. 9 (6), - P. 1049-1054.
6. Karpova I. S., Manak N. A., Solovey S. P. The disturbances of longevity and dispersion of QT on patients with ischemic heart disease and ventricular arrhythmias of high gradation. Uzbekistan Cardiology. - 2015. - No 1-2. - P 15-16.
7. Burak T.Ya., The prognostic role of longevity and dispersion of QT on patients with myocardial infarction. St-Petersburg. - 2005. - P. 38.
8. Breidthardt T., Christ M., Matti M. et al. QRS and QTc prolongation in the prediction of long-term mortality of patients with acute destabilized heart failure. Heart - 2007. - 93:1093-1097.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-81-83
Musazhanova Rano Anvarbekovna, Leading Researcher. Republican Specialized Scientific and Practical Medical Center of Pediatrics Ministry of Health of the Republic of Uzbekistan
E-mail: [email protected]
Features immune status changes in children with chronic diseases of lower respiratory
Abstract: Thus, our findings of immunological status in different age groups in patients HBNDP celebrate the suppression of cellular immunity and phagocytes of neutrophils, activation of humoral immunity. It was found that changes in immune status were more pronounced in children aged 7-15 years.
Keywords: Children, immune status, chronic lower respiratory diseases.
Relevance. In the structure of respiratory diseases in children occupy an important place chronic lower respiratory diseases (CLRD) Main place in the structure belongs CLRD chronic bronchitis (CB) and bronchiectasis [1, 2, 6]. Despite advances in the treatment and prevention of chronic diseases caused by bacterial and viral microflora, increasing the number of severe and forms sluggish and torpid course of the inflammatory process, with frequent exacerbations, and low efficiency of the ongoing causal treatment, suggesting that failure of the immune system [3]. Today there is no doubt that immunological mechanisms are somehow involved in the development of almost any pathological conditions or being a cause of, or a consequence, and the main cause chronic disease and its complications [5].
When CLRD often develop secondary immunodeficiency, which can cause the development and chronicity of the pathological process with frequent relapsing little amenable to conventional therapy. In this regard, interest is the identification of the role of the immune system in the formation of CLRD in children [4].
This work is part of research carried out in our clinic, the aim of which is to study the features of the immune status in children with chronic bronchitis and bronchiectasis in exacerbation of the disease.
Material and methods. We observed 305 children with CLRD aged from 3 to 15 years. The patients presented two groups — 263 children with chronic bronchitis (CB), and 42 children with bronchiectasis (Beb) who were hospitalized in the pulmonology department of the Republican Specialized Scientific and Practical Medical Center of Pediatrics Ministry of Health of the Republic of Uzbekistan, and also studied performance of 20 healthy children of the same age. The comparison group consisted of 40 patients with acute bronchitis (OB).
Diagnosis is based on clinical classification of the main forms of bronchopulmonary diseases in children, approved at a special meeting of the XVIII National Congress on Respiratory Diseases (2009).
Immunological parameters were determined by indirect rosetting using monoclonal antibodies: by Garibe FU, [1995]. Determination of serum immunoglobulins A, G, M in the peripheral blood was performed by single radial immunodiffusion in gel G. Manchini et al [1965].
The data were processed by variation statistics using Student's Fisheru — personal computers using the application package.
Results and discussion. The study examined the immune status of patients with varying severity possible to establish the immunodefi-cient state with signs of stress humoral immunity and multi-directional nature of the immunological shifts. Patients with chronic bronchitis in both age groups identified the following deviations in the phase of exacerbation of the disease: a significant reduction in the relative and
absolute number of CD3 +--lymphocytes (45,4±0,8% was in the
group of children aged 3-6 years; 1165,4±22,6 mkl at 61,5±2,2%; 1377,9±44,2 22,6 mkl in healthy children, p<0.001) relative to the comparison group (54,7±1,4%; 1288,1±42 6 mkl p<0.01), in the older age group of 7-15 years-41,6±0,7%; 1100,4±16,622,6 mkl at 61,5±2,2%; 1377,9±44,2 mkl in healthy children, p<0.001, relative to the comparison group (50,2±2,5%; 1245,5±30,6 mkl p<0.01). Patients in Beb disease exacerbation phase as determined by changes in the immune status with the multidirectional nature of immunological changes, as evidenced by a significant decrease in the relative and absolute number of CD3+lymphocytes to 36,8±0,6%; 915,1±22,6 mkl at 61,5±2,2%; 1377,9±44,2 mkl in healthy children, p<0.001, relative to the comparison group (50,2±2,5%; 1245,5±30,6 mkl p<0.001). A more pronounced decrease in CD3+ lymphocytes were observed in patients Beb differed from children with HB 1.1 times and was 1.7 times lower than the normal values. The content of the relative and
absolute number of CD4+--lymphocytes was reduced (33,4±1,1%
was in the group of children aged 3-6 years; 389,2±13,8 mkl at 39,1±2,1%; 538, 7±15,6 mkl in healthy children, p<0.001) relative to the comparison group (38,5±1,2%; 495,9±19,8 mkl p<0.01) in older age group 7-15 years — 28,9±1,0%; 318,0±10,7 mkl at 39,1±2,1%; 538,7±15,6 mkl in healthy children, p<0.001, relative to the comparison group (37,9±1,3%; 472,0±16,2 mkl p <0.01). In the study of the number of CD4 +--lymphocytes in patients Beb content relative and absolute numbers of CD4 +--lymphocytes were
significantly reduced to 25,1±0,9%; 229,7±9,6 mkl at 39,1±2,1%; 538,7±15,6 mkl in healthy children, p<0.001, relative to the comparison group (37,9±1,3%; 472,0±16,2 mkl p<0.001).
