Skip to main content

Advertisement

Log in

QT and JT dispersion and cardiac performance in children with neonatal Bartter syndrome: a pilot study

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

QT dispersion and JT dispersion are simple noninvasive arrhythmogenic markers that can be used to assess the homogeneity of cardiac repolarization. The aim of this study was to assess QT and JT dispersion and their relation with left ventricular systolic and diastolic functions in children with Bartter syndrome (BS).

Methods

Nine neonatal patients with BS (median age 9.7 years) and 20 controls (median age 8 years) were investigated at rest. Both study and control subjects underwent electrocardiography (ECG) in which the interval between two R waves and QT intervals, corrected QT, QT dispersion, corrected QT dispersion, JT, corrected JT, JT dispersion and corrected JT dispersion were measured with 12-lead ECG. Two-dimensional, Doppler echocardiographic examinations were performed.

Results

Patients and controls did not differ for gender and for serum levels of potassium, magnesium, and calcium (p > 0.05). Both study and control subjects had normal echocardiographic examination and baseline myocardial performance indexes. The QT dispersion and JT dispersion were significantly prolonged in patients with BS compared to those of the controls {37.5 ms [interquartile range (IQR) 32.5–40] vs. 25.5 ms (IQR 20–30), respectively, p = 0.014 and 37.5 ms (IQR 27.5–40) vs. 22.5 ms (IQR 20–30), respectively, p = 0.003}.

Conclusions

Elevated QT and JT dispersion during asymptomatic and normokalemic periods may be risk factors for the development of cardiac complications and arrhythmias in children with BS. In these patients the need for systematic cardiac screening and management protocol is extremely important for effective prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Seyberth HW, Schlingmann KP (2011) Bartter- and Gitelman-like syndromes: salt-losing tubulopathies with loop or DCT defects. Pediatr Nephrol 26:1789–1802

    Article  PubMed  Google Scholar 

  2. Yang T, Park JM, Arend L, Huang Y, Topaloglu R, Pasumarthy A, Praetorius H, Spring K, Briggs JP, Schnermann J (2000) Low chloride stimulation of prostaglandin E2 release and cyclooxygenase-2 expression in a mouse macula densa cell line. J Biol Chem 275(48):37922–37929

    Article  PubMed  CAS  Google Scholar 

  3. Geary DF, Schaefer F (2008) Comprehensive pediatric nephrology, 1st edn. Mosby Elsevier, Philadephia, pp 451–459

    Google Scholar 

  4. Brochard K, Boyer O, Blanchard A, Loirat C, Niaudet P, Macher MA, Deschenes G, Bensman A, Decramer S, Cochat P, Morin D, Broux F, Caillez M, Guyot C, Novo R, Jeunemaître X, Vargas-Poussou R (2009) Phenotype-genotype correlation in antenatal and neonatal variants of Bartter syndrome. Nephrol Dial Transplant 24(5):1455–1464

    Article  PubMed  CAS  Google Scholar 

  5. Malafronte C, Borsa N, Tedeschi S, Syren ML, Stucchi S, Bianchetti MG, Achilli F, Bettinelli A (2004) Cardiac arrhythmias due to severe hypokalemia in a patient with classic Bartter disease. Pediatr Nephrol 19:1413–1415

    Article  PubMed  Google Scholar 

  6. Scognamiglio R, Negut C, Calò LA (2007) Aborted sudden cardiac death in two patients with Bartter’s/Gitelman’s syndromes. Clin Nephrol 67:193–197

    PubMed  CAS  Google Scholar 

  7. Lubinski A, Kornacewicz-Jach Z, Wnuk-Wojnar AM, Adamus J, Kempa M, Krolak T, Lewicka-Nowak E, Radomski M, Swiatecka G (2000) The terminal portion of the T wave: a new electrocardiographic marker of risk of ventricular arrhythmias. Pacing Clin Electrophysiol 23:1957–1959

    PubMed  CAS  Google Scholar 

  8. Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, Itoh H, Iwaki T, Oe K, Konno T, Mabuchi H (2002) T-peak to T-end may be a better predictor of risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 25:335–339

    Article  PubMed  Google Scholar 

  9. Tomaselli GF, Beuckelmann DJ, Calkins HG, Berger RD, Kessler PD, Lawrence JH, Kass D, Feldman AM, Marban E (1994) Sudden cardiac death in heart failure: the role of abnormal repolarization. Circulation 90:2534–2539

    Article  PubMed  CAS  Google Scholar 

  10. Barr CS, Naas A, Freeman M, Lang CC, Struthers AD (1994) QT dispersion and sudden unexpected death in chronic heart failure. Lancet 343:327–329

    Article  PubMed  CAS  Google Scholar 

  11. Amlie JP (1997) QT dispersion and sudden cardiac death. Eur Heart J 18(2):189–190

    Article  PubMed  CAS  Google Scholar 

  12. Bazett HC (1920) An analysis of the time relations of electrocardiograms. Heart 7:353–367

    Google Scholar 

  13. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  14. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062

    Article  PubMed  Google Scholar 

  15. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function-a study in normals and dilated cardiomyopathy. J Cardiol 26:357–366

    PubMed  CAS  Google Scholar 

  16. Poulsen SH, Jensen SE, Tei C, Seward JB, Egstrup K (2000) Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction. J Am Soc Echocardiogr 13:723–730

    Article  PubMed  CAS  Google Scholar 

  17. Ascione L, De Michele M, Accadia M, Rumolo S, Damiano L, D’Andrea A, Guarini P, Tuccillo B (2003) Myocardial global performance index as a predictor of in-hospital cardiac events in patients with first myocardial infarction. J Am Soc Echocardiogr 16:1019–1023

    Article  PubMed  Google Scholar 

  18. Cortesi C, Lava SA, Bettinelli A, Tammaro F, Giannini O, Caiata-Zufferey M, Bianchetti MG (2010) Cardiac arrhythmias and rhabdomyolysis in Bartter-Gitelman patients. Pediatr Nephrol 25(10):2005–2008

    Article  PubMed  Google Scholar 

  19. Calò LA, Scognamiglio R, Nistri S, Palisi M, Miorelli M, Zerbo F, Cantaro S, Antonello A, Fasoli G, D’Angelo A (1997) Evidence of myocardial dysfunction in Bartter’s syndrome. Am J Nephrol 17:124–127

    Article  PubMed  Google Scholar 

  20. Nerbonne JM (2000) Molecular basis of functional voltage-gated K + channel diversity in the mamalian myocardium. J Physiol 525:285–298

    Article  PubMed  CAS  Google Scholar 

  21. Derst C, Hirsch JR, Preisig-Müller R, Wischmeyer E, Karschin A, Döring F, Thomzig A, Veh RW, Schlatter E, Kummer W, Daut J (2001) Cellular localization of the potassium channel Kir7.1 in guinea pig and human kidney. Kidney Int 59:2197–2205

    PubMed  CAS  Google Scholar 

  22. Jentsch TJ, Friedrich T, Schriever A, Yamada H (1999) The CLC chloride channel family. Pflugers Arch 437:783–795

    Article  PubMed  CAS  Google Scholar 

  23. Veeraraghavan R, Poelzing S (2008) Mechanisms underlying increased right ventricular conduction sensitivity to flecainide challenge. Cardiovasc Res 77:749–756

    Article  PubMed  CAS  Google Scholar 

  24. Taubert KA (2008) Can patients with cardiovascular disease take nonsteroidal antiinflammatory drugs? Circulation 117:e322–e324

    Article  PubMed  CAS  Google Scholar 

  25. Fosbol EL, Folke F, Jacobsen S, Rasmussen JN, Sørensen R, Schramm TK, Andersen SS, Rasmussen S, Poulsen HE, Køber L, Torp-Pedersen C, Gislason GH (2010) Cause specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among healthy individuals. Circ Cardiovasc Qual Outcomes 3:395–405

    Article  PubMed  Google Scholar 

  26. Youssef OI, Farid SM (2012) QTc and QTd in children with Type 1 diabetes mellitus during diabetic ketoacidosis. ISRN Pediatr. doi:10.5402/2012/619107

    Google Scholar 

  27. Yilmazer MM, Omeroğlu RE, Bornaun H, Oner N, Nişli K, Ertuğrul T (2009) Repolarization abnormalities in Duchenne-type muscular dystrophy. Turk Kardiyol Dern Ars 37(8):538–542

    PubMed  Google Scholar 

  28. Vialle E, Albalkhi R, Zimmerman M, Friedli B (1999) Normal values of signal-averaged electrocardiographic parameters and QT dispersion in infants and children. Cardiol Young 9(6):556–561

    Article  PubMed  CAS  Google Scholar 

  29. Tutar HE, Ocal B, Imamoglu A, Atalay S (1998) Dispersion of QT and QTc interval in healthy children, and effects of sinus arrhythmia on QT dispersion. Heart 80(1):77–79

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rezan Topaloglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hacihamdioglu, D.O., Fidanci, K., Kilic, A. et al. QT and JT dispersion and cardiac performance in children with neonatal Bartter syndrome: a pilot study. Pediatr Nephrol 28, 1969–1974 (2013). https://doi.org/10.1007/s00467-013-2517-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-013-2517-5

Keywords

Navigation