Usefulness of Tp-Te interval and Tp-Te/QT ratio in the prediction of ventricular arrhythmias and mortality in acute STEMI patients undergoing fibrinolytic therapy

Özbek, Sinan Cemgil; Sökmen, Erdoğan

doi:10.1016/j.jelectrocard.2019.07.004

Cited by 10 publications

(6 citation statements)

References 30 publications

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“…In addition to the TpTe interval, the TpTe/QT ratio has emerged as a more accurate marker for ventricular repolarization because of its independence from heart rate and body weight. In a study, Ozbek et al reported that the TpTe/QT ratio is independently associated with ventricular arrhythmia‐related death . Beside these studies, some conflicting results have been demonstrated not only in QTd but also in TpTe interval in patients with MI.…”

mentioning

confidence: 99%

Editorial to “Association of QT dispersion with mortality and arrhythmic events—A meta‐analysis of observational studies”

Karadeniz

2019

Journal of Arrhythmia

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confidence: 99%

Editorial to “Association of QT dispersion with mortality and arrhythmic events—A meta‐analysis of observational studies”

Karadeniz

2019

Journal of Arrhythmia

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“…QTc prolongation is a risk factor for ventricular arrhythmia, particularly Torsades de Pointes (TdP) and associates strongly with mortality in a wide range of conditions, including diabetes mellitus [ 8 ]. The QT interval has been further characterised into the subintervals J-Tpeak and Tpeak-Tend, the latter of which has been shown to be independently predictive of ventricular arrhythmia and death in acute ST-elevated myocardial infarct [ 29 ]. Automated methods for heart-rate correction of J-Tpeak (J-Tpeak c ) have been reported [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of hyperglycaemia in combination with moxifloxacin on cardiac repolarization in male and female patients with type I diabetes

Täubel

Pimenta

Cole³

et al. 2022

Clin Res Cardiol

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Background Patients with Type 1 diabetes mellitus have been shown to be at a two to ten-fold higher risk of sudden cardiac death (SCD) (Svane et al., Curr Cardiol 2020; 22:112) than the general population, but the underlying mechanism is unclear. Hyperglycaemia is a recognised cause of QTc prolongation; a state patients with type 1 diabetes are more prone to, potentially increasing their risk of ventricular arrhythmia. Understanding the QTc prolongation effect of both hyperglycaemia and the concomitant additive risk of commonly prescribed QTc-prolonging drugs such as Moxifloxacin may help to elucidate the mechanism of sudden cardiac death in this cohort. This single-blinded, placebo-controlled study investigated the extent to which hyperglycaemia prolongs the QTc in controlled conditions, and the potential additive risk of QTc-prolonging medications. Methods 21 patients with type 1 diabetes mellitus were enrolled to a placebo-controlled crossover study at a single clinical trials unit. Patients underwent thorough QTc assessment throughout the study. A ‘hyperglycaemic clamp’ of oral and intravenous glucose was administered with a target blood glucose of > 25 mM and maintained for 2 h on day 1 and day 3, alongside placebo on day 1 and moxifloxacin on day 3. Day 2 served as a control day between the two active treatment days. Thorough QTc assessment was conducted at matched time points over 3 days, and regular blood sampling was undertaken at matched time intervals for glucose levels and moxifloxacin exposure. Results Concentration-effect modelling showed that acute hyperglycaemia prolonged the QTc interval in female and male volunteers with type 1 diabetes by a peak mean increase of 13 ms at 2 h. Peak mean QTc intervals after the administration of intravenous Moxifloxacin during the hyperglycaemic state were increased by a further 9 ms at 2 h, to 22 ms across the entire study population. Regression analysis suggested this additional increase was additive, not exponential. Hyperglycaemia was associated with a significantly greater mean QTc-prolonging effect in females, but the mean peak increase with the addition of moxifloxacin was the same for males and females. This apparent sex difference was likely due to the exclusive use of basal insulin in the male patients, which provided a low level of exogenous insulin during the study assessments thereby mitigating the effects of hyperglycaemia on QTc. This effect was partially overcome by Moxifloxacin administration, suggesting both hyperglycaemia and moxifloxacin prolong QTc by different mechanisms, based on subinterval analysis. Conclusions Hyperglycaemia was found to be a significant cause of QTc prolongation and the additional effect of a QTc-prolonging positive control (moxifloxacin) was found to be additive. Given the high risk of sudden cardiac death in type 1 diabetes mellitus, extra caution should be exercised when prescribing any medication in this cohort for QTc effects, and further research needs to be undertaken to elucidate the exact mechanism underlying this finding and explore the potential prescribing risk in diabetes. Trial Registration NCT number: NCT01984827. Graphical abstract

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“…Tp-Te interval has been a relatively new index of ventricular repolarization. Furthermore, prolonged Tp-Te interval is associated with ventricular arrhythmias and cardiac mortality [15,[22][23][24]. More recently, Tp-Te/QTc was suggested as a novel marker of VR and demonstrated to be a more accurate predictor of ventricular arrhythmias [25].…”

Section: Discussionmentioning

confidence: 99%

Tp-Te interval prolongs in hypertension independent of the left ventricular geometry

Özbek¹

2021

Journal of Surgery and Medicine

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Usefulness of Tp-Te interval and Tp-Te/QT ratio in the prediction of ventricular arrhythmias and mortality in acute STEMI patients undergoing fibrinolytic therapy

Cited by 10 publications

References 30 publications

Editorial to “Association of QT dispersion with mortality and arrhythmic events—A meta‐analysis of observational studies”

Editorial to “Association of QT dispersion with mortality and arrhythmic events—A meta‐analysis of observational studies”

Effect of hyperglycaemia in combination with moxifloxacin on cardiac repolarization in male and female patients with type I diabetes

Tp-Te interval prolongs in hypertension independent of the left ventricular geometry

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