Abstract
The cardiovascular manifestations of acute ischemic stroke have been well known. Several electrocardiography (ECG) abnormalities have been reported in patients following acute stroke, including QT interval prolongation, ST segment deviation and T-wave changes. This study aimed to investigate the changes in transmyocardial repolarization parameters, in ischemic stroke patients. The study is a prospective, blind, and controlled clinical study. The patients without cardiac disease who received ischemic stroke diagnoses were included in the study. ECG was received from the patients in the first hour and 72 h. The P, QT, T p-e, T p-e dispersion, and the T p-e/QT ratio were calculated. Moreover, fifty-five stroke patients and 35 control subjects were included to the study. All dispersion values and T p-e/QTc ratio in patients group were higher than those of control group (p < 0.05 for all values). When evaluated between ECGs’ on first and third days, it was found that decreasing on all dispersion values and T p-e/QTc ratio in ECGs on third day than ECGs on first day (p < 0.05 for all values). QT, QTc, and T p-e dispersions values in patients who have insular lobe involvement were higher than those of patients who do not have insular lobe involvement (p < 0.001 for all values). In this study, we showed that acute stroke increases that P d, QTd, QTcd and new repolarization markers T p-e and T p-e/QTc, during first 24 and 72 h in acute stroke patients without cardiovascular disease compared with the control group. The physicians should be aware about ventricular dysrhythmias in patients with ischemic stroke and these patients closely observed with cardiac monitoring, especially within first 24 h, and especially patients with insular lobe involvement.
Similar content being viewed by others
References
Golan S, Livneh A (2008) ECG changes during stroke. Harefuah 147(568–9):572
Sommargren CE (2002) Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Crit Care 11:48–56
Khechinashvilli G, Asplund K (2002) Electrocardiographic changes in patients with acute stroke: a systematic review. Cerebrovasc Dis 14:67–76
Afsar NA, Fak AS, Metzger J, Van Melle G, Kappenberger L, Bogousslavsky J (2003) Acute stroke increases QT dispersion in patients without known cardiac disease. Arch Neurol 60:346–350
Kautzner J, Malik M (1997) QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol 20:2625–2640
Higham PD (1994) Campbell RW. QT dispersion. Br Heart J 71:508–510
Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R, Quiñones Pérez MA, Fayad Rodríguez Y (2006) Tpeak–Tend and Tpeak–Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 47(9):1828–1834
Morin DP, Saad MN, Shams OF, Owen JS, Xue JQ, Abi-Samra FM, Khatib S, Nelson-Twakor OS, Milani RV (2012) Relationships between the T-peak to T-end interval, ventricular tachyarrhythmia, and death in left ventricular systolic dysfunction. Europace 14(8):1172–1179
Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, Gunson K, Jui J, Chugh SS (2011) Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 4(4):441–447
Chao CC, Wang TL, Chong CF, Lin YM, Chen CC, Tang GJ, Yen DH (2009) Prognostic value of QT parameters in patients with acute hemorrhagic stroke: a prospective evaluation with respect to mortality and post-hospitalization bed confinement. J Chin Med Assoc 72:124–132
Familoni OB, Odusan O, Ogun SA (2006) The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke. J Natl Med Assoc 98:1758–1762
Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR (2014) Relationship between QT interval dispersion in acute stroke and stroke prognosis: a systematic review. J Stroke Cerebrovasc Dis 23(10):2467–2478
Akilli NB, Akinci E, Akilli H, Dundar ZD, Koylu R, Polat M, Cander B (2013) A new marker for myocardial injury in carbon monoxide poisoning: T peak-T end. Am J Emerg Med 31(12):1651–1655
Atove S (1985) Correlation of the QT interval for heart rate: review of different formulae and the use of Bazett’s formula in myocardial infarction. Am Heart J 109:568–574
Acampa M, Guideri F, Tassi R, Dello Buono D, Celli L, di Toro Mammarella L, Lazzerini PE, Marotta G, Lo Giudice G, D'Andrea P, Martini G (2015) P wave dispersion in cryptogenic stroke: a risk factor for cardioembolism? Int J Cardiol 190:202–204
Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT et al (2008) T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 41:567–574
Uyarel H, Kaşıkçıoglu H, Dayı SU, Tartan Z, Karabulut A, Uzunlar B et al (2005) Anxiety and P wave dispersion in a healthy young population. Cardiology 104:162–168
Surawicz B (1986) Electrocardiographic diagnosis of chamber enlargement. J Am Coll Cardiol 8(711–24):66
Josephson ME, Kastor JA, Morganroth J (1977) Electrocardiographic left atrial enlargement. Electrophysiologic, echocardiographic and hemodynamic correlates. Am J Cardiol 39:967–971
Gialafos JE, Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Triposkiadis F, Kyriakidis MK (1999) P wave dispersion: a valuable electrocardiographic marker for the prediction of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 4:39
Okutucu S, Aytemir K, Oto A P-wave dispersion: what we know till now? JRSM Cardiovasc Dis. doi:10.1177/2048004016639443
Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, Oto A, Ozmen F, Kes S (2000) P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 23(7):1109–1112
Amarenco P (2009) Underlying pathology of stroke of unknown cause (cryptogenic stroke). Cerebrovasc Dis 27(Suppl 1):97–103
Glotzer TV, Ziegler PD (2015) Cryptogenic stroke: is silent atrial fibrillation the culprit? Heart Rhythm 12(1):234–241
Dogan U, Dogan EA, Tekinalp M, Tokgoz OS, Aribas A, Akilli H, Ozdemir K, Gok H, Yuruten B (2012) P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. Int J Med Sci 9(1):108–114
Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R et al (2006) Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 47:1828–1834
Oppenheimer SM, Cechetto DF, Hachinski VC (1990) Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 47:513–519
Gölbaşi Z, Selçoki Y, Eraslan T, Kaya D, Aydoğdu S (1999) QT dispersion. Is it an independent risk factor for in-hospital mortality in patients with intracerebral hemorrhage? Jpn Heart J 40:405–411
Oppenheimer S (2006) Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res 16:6–11
Purushothaman S, Salmani D, Prarthana KG, Bandelkar SM, Varghese S (2014) Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents. J Nat Sci Biol Med 5(2):434–436
Lazar J, Manzella S, Moonjelly J, Wirkowski E, Cohen TJ (2003) The prognostic value of QT dispersion in patients presenting with acute neurological events. J Invasive Cardiol 15:31–35
Alabd AA, Fouad A, Abdel-Nasser R, Nammas W (2009) QT interval dispersion pattern in patients with acute ischemic stroke: does the site of infarction matter? Int J Angiol 18:177–181
Eckardt M, Gerlach L, Welter FL (1999) Prolongation of the frequency-corrected QT dispersion following cerebral strokes with involvement of the insula of Reil. Eur Neurol 42:190–193
Kayrak M, Acar K, Gul EE, Ozbek O, Abdulhalikov T, Sonmez O et al (2012) The association between myocardial iron load and ventricular repolarization parameters in asymptomatic beta-thalassemia patients. Adv Hematol 2012:170510
Yan GX, Wu Y, Liu T, Wang J, Marinchak RA, Kowey PR (2001) Phase 2 early after depolarization as a trigger of polymorphic ventricular tachycardia in acquired long-QT syndrome: direct evidence from intracellular recordings in the intact left ventricular wall. Circulation 103:2851–2856
Yan GX, Martin J (2003) Electrocardiographic T wave: a symbol of transmural dispersion of repolarization in the ventricles. J Cardiovasc Electrophysiol 14:639–640
Hetland M, Haugaa KH, Sarvari SI, Erikssen G, Kongsgaard E, Edvardsen T (2014) A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann Noninvasive Electrocardiol 19(4):330–337
Letsas KP, Weber R, Astheimer K, Kalusche D, Arentz T (2010) Tpeak-Tend interval and Tpeak-Tend/QT ratio as markers of ventricular tachycardia inducibility in subjects with Brugada ECG phenotype. Europace 12:271–274
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Ethical standards
Ethics committee at Keçiören Training and Research Hospital approved the study protocol.
Informed consent
Informed consent was obtained from each patient before entry into the study.
Rights and permissions
About this article
Cite this article
Emektar, E., Çorbacıoğlu, Ş.K., Korucu, O. et al. The evaluation of a new marker of transmyocardial repolarization parameters in ischemic stroke patients; T peak–T end (T p-e), T p-e/QTc . Acta Neurol Belg 117, 461–467 (2017). https://doi.org/10.1007/s13760-017-0744-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13760-017-0744-4