ACMJ
Anatolian Current Medical Journal

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

eISSN: 2718-0115
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Evaluation of Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio in primary hyperparathyroidism before and after parathyroidectomy
Abstract
Aims: This study aimed to evaluate Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratios, which are new ventricular repolarization (VR) parameters in primary hyperparathyroidism (PHPT) patients, and also investigate the potential effect of parathyroidectomy (PTx) on these parameters. Methods: In total, 27 patients with PHPT who underwent PTx and 25 control subjects were selected for our study. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratios of patients planned for PTx were compared to healthy matched controls. Electrocardiographic parameters measured 6 months after the surgery were also compared with preoperative values for each patient. Results: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were significantly higher in PHPT patients compared to the control group (p<0.001, for all).It was observed that the parameters mentioned after surgery decreased significantly, and there was no statistical difference when compared to the control group.The correlation analysis revealed a significant and positive correlation between corrected calcium (CCa) and PTH levels with Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio (for Ca; r=0.515, p=0.006; r=0.398, p=0.040; r=0.797, p<0.001 respectively vs. for PTH; r=538, p=0.04; r=0.422, p=0.028; r=0.812, p<0.001 respectively). Conclusions: This study showed that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were prolonged in PHPT.These values, which are accepted as an indicator of sudden cardiac death after PTx, decreased significantly. In addition, both high PTH and high calcium(Ca) levels appear to have the potential to cause arrhythmogenic effects separately.

Keywords : Primary hyperparathyroidism, ventricular repolarization, parathyroidectomy, ventricular arrhythmia

Download Article


1. Pallan S, Rahman MO, Khan AA. Diagnosis and management ofprimary hyperparathyroidism. BMJ. 2012;344:e1013.
2. Walker MD, Silverberg SJ. Cardiovascular aspects of primaryhyperparathyroidism. J Endocrinol Invest. 2008;31(10):925-931.
3. Insogna KL. Primary hyperparathyroidism. N Engl J Med. 2018;379(11):1050-1059.
4. Elming H, Holm E, Jun L, et al. The prognostic value of the QTinterval and QT interval dispersion in all-cause and cardiacmortality and morbidity in a population of Danish citizens. EurHeart J. 1998;19(9):1391-1400.
5. Tse G, Yan BP. Traditional and novel electrocardiographicconduction and repolarization markers of sudden cardiac death.Europace. 2017;19(5):712-721.
6. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning ofthe Tp-Te interval and its diagnostic value. J Electrocardiol.2008;41(6):575-580.
7. Castro Hevia J, Antzelevitch C, Torn&eacute;sB&aacute;rzaga F, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventriculartachycardia/ventricular fibrillation in patients with the Brugadasyndrome. J Am Coll Cardiol. 2006;47(9):1828-1834.
8. Li W, Liu W, Li H. Electrocardiography is useful to predictpostoperative ventricular arrhythmia in patients undergoing cardiacsurgery: a retrospective study. Front Physiol. 2022;13:873821.
9. Piepoli MF, Hoes AW, Agewall S, et al; ESC Scientific DocumentGroup. 2016 European Guidelines on cardiovascular diseaseprevention in clinical practice: The Sixth Joint Task Forceof the European Society of Cardiology and Other Societieson Cardiovascular Disease Prevention in Clinical Practice(constituted by representatives of 10 societies and by invitedexperts)Developed with the special contribution of the EuropeanAssociation for Cardiovascular Prevention &amp; Rehabilitation(EACPR). Eur Heart J. 2016;37(29):2315-2381.
10. Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index ofarrhythmogenesis. J Electrocardiol. 2008;41(6):567-574.
11. Kors JA, van Herpen G, van Bemmel JH. QT dispersion as anattribute of T-loop morphology. Circulation. 1999;99(11):1458-1463.
12. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations forcardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography andthe European Association of Cardiovascular Imaging. Eur HeartJ Cardiovasc Imaging. 2015;16(3):233-271. doi.org/10.1093/ehjci/jev014
13. Ozdemir D, Kalkan GY, Bayram NA, et al. Evaluation of leftventricle functions by tissue Doppler, strain, and strain rateechocardiography in patients with primary hyperparathyroidism.Endocrine. 2014;47(2):609-617.
14. Soares AA, Freitas WM, Japiass&uacute; AV, et al. Enhanced parathyroidhormone levels are associated with left ventricle hypertrophy in veryelderly men and women. J Am SocHypertens. 2015;9(9):697-704.
15. Walker MD, Rundek T, Homma S, et al. Effect ofparathyroidectomy on subclinical cardiovascular disease in mildprimary hyperparathyroidism. Eur J Endocrinol. 2012;167(2):277-285.
16. Bosworth C, Sachs MC, Duprez D, et al. Parathyroid hormone andarterial dysfunction in the multi-ethnic study of atherosclerosis.Clin Endocrinol. 2013;79(3):429-436.
17. Ekmekci A, Abaci N, Colak Ozbey N, et al. Endothelial functionand endothelial nitric oxide synthase intron 4a/b polymorphismin primary hyperparathyroidism. J Endocrinol Invest. 2009;32(7):611-616.
18. Lind L, Ljunghall S. Serum calcium and the ECG in patients withprimary hyperparathyroidism. J Electrocardiol. 1994;27(2):99-103.
19. Surawicz B. Role of electrolytes in etiology and management ofcardiac arrhythmias. Prog Cardiovasc Dis. 1966;8(4):364-386.
20. Rosenqvist M, Nordenstr&ouml;m J, Andersson M, Edhag OK. Cardiacconduction in patients with hypercalcaemia due to primaryhyperparathyroidism. Clin Endocrinol. 1992;37(1):29-33.
21. Celik M, Emiroglu MY, Bayram Z, et al. Electrophysiologicchanges and their effects on ventricular arrhythmias in patientswith continuous-flow left ventricular assist devices. ASAIO J.2022;68(3):341-348.
22. Barr CS, Naas A, Freeman M, et al. QT dispersion andsudden unexpected death in chronic heart failure. Lancet.1994;343(8893):327-329.
23. Yamaguchi M, Shimizu M, Ino H, et al. T wave peak-to-endinterval and QT dispersion in acquired long QT syndrome: a newindex for arrhythmogenicity. Clin Sci. 2003;05(6):671-676.
24. Yan GX, Antzelevitch C. Cellular basis for the normal T waveand the electrocardiographic manifestations of the long-QTsyndrome. Circulation. 1998;98(18):1928-1936.
25. Antzelevitch C, Shimizu W, Yan GX, et al. The M cell: itscontribution to the ECG and to normal and abnormalelectrical function of the heart. J Cardiovasc Electrophysiol.1999;10(8):1124-1152.
26. Emori T, Antzelevitch C. Cellular basis for complex T waves andarrhythmic activity following combined I(Kr) and I(Ks) block. JCardiovasc Electrophysiol. 2001;12(12):1369-1378.
27. Watanabe N, Kobayashi Y, Tanno K, et al. Transmuraldispersion of repolarization and ventricular tachyarrhythmias. JElectrocardiol. 2004;37(3):191-200.
28. Milberg P, Reinsch N, Wasmer K, et al. Transmural dispersionof repolarization as a key factor of arrhythmogenicity in a novelintact heart model of LQT3. Cardiovasc Res. 2005;65(2):397-404.
29. Pepe J, Cipriani C, Curione M, et al. Reduction of arrhythmias inprimary hyperparathyroidism, by parathyroidectomy, evaluatedwith 24-h ECG monitoring. Eur J Endocrinol. 2018;179(2):117-124.
30. Curione M, Letizia C, Amato S, et al. Increased risk of cardiacdeath in primary hyperparathyroidism: what is a role of electricalinstability? Int J Cardiol. 2007;121(2):200-202.
31. Curione M, Amato S, Di Bona S, et al. Parathyroidectomy eraseincreased myocardial electrical vulnerability in patients withprimary hyperparathyroidism. Int J Cardiol. 2010;141(2):201-202.
32. Yılmaz Y, Keleşoğlu Ş, G&ouml;kay F. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios in patients with primary hyperparathyroidism andtheir relationship with cardiac arrhythmic events. Turk J Med Sci.2022;52(2):397-404.
33. Yan H, Liu H, Wang G, et al. The Tp-e/QT ratio as a predictor ofnocturnal premature ventricular contraction events in patientswith obstructive sleep apnea. Sleep Breath. 2023;27(2):469-476.
34. Tashiro N, Muneuchi J, Ezaki H, et al. Ventricular repolarizationdispersion is a potential risk for the development of life-threatening arrhythmia in children with hypertrophiccardiomyopathy. Pediatr Cardiol. 2022;43(7):1455-1461.
35. Shimizu M, Ino H, Okeie K, et al. T-peak to T-end interval maybe a better predictor of high-risk patients with hypertrophiccardiomyopathy associated with a cardiac troponin I mutationthan QT dispersion. Clin Cardiol. 2002;25(7):335-339.
36. Nilsson IL, Aberg J, Rastad J, Lind L. Maintained normalizationof cardiovascular dysfunction 5 years after parathyroidectomy inprimary hyperparathyroidism. Surg. 2005;137(6):632-638.
37. DiPette DJ, Christenson W, Nickols MA, Nickols GA.Cardiovascular responsiveness to parathyroid hormone (PTH)and PTH-related protein in genetic hypertension. Endocrinol.1992;130(4):2045-2051.
38. Schl&uuml;ter KD, Piper HM. Cardiovascular actions of parathyroidhormone and parathyroid hormone-related peptide. CardiovascRes. 1998;37(1):34-41.
39. Zhang YB, Smogorzewski M, Ni Z, Massry SG. Altered cytosoliccalcium homeostasis in rat cardiac myocytes in CRF. Kidney Int.1994;45(4):1113-1119.
40. Wald DA. ECG manifestations of selected metabolic andendocrine disorders. Emerg Med Clin North Am. 2006;24(1):145-157.
Article available in :
Volume 6, Issue 1, 2024
Page : 73-79
https://doi.org/10.38053/acmj.1382439
Article Information
Received : 28 Eki 2023
Accepted : 25 Ara 2023
Published : 15 Oca 2024
Corresponding Author :

Zeki Çetinkaya: Department of Cardiology, Elazığ Fethi Sekin City Hospital, Elazığ, Turkiye

[email protected]
Citation : Çetinkaya Z, Keleşoğlu Ş, Gökay F, Yılmaz Y. Evaluation of Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio in primary hyperparathyroidism before and after parathyroidectomy. Anatolian Curr Med J. 2024;6(1):73-79.

Read: 49
Cited: 0
Download : 100
_Footer