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Series «Medicine ». Issue 30
UDC: 616-036.12
CLINICAL PRESENTATIONS OF ARTERIAL HYPERTENSION DEPENDING ON THE QTc INTERVAL DURATION OF ECG
Tselik N. E., Shevchuk M. I., Martynenko A. V.
V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
The relationship between the duration of the complex QTc ECG and clinical signs of arterial hypertension (AH) in 54 patients (16 men and 38 women) 1-3 degree and I-III stage, mean age 58 ± 18 years, was investigated. 3 classes of QT interval duration were allocated: classified shortened (< 320 ms), normal (> 320 ms and < 440 ms), classified prolonged (> 440 ms). The binomial distribution of frequencies of studied parameters in classes of the QTc interval for alternative criteria was determined. The duration of the QTc interval in the sampling was 350 ms - 490 ms. The proportion of the normal range (> 320 ms and < 440 ms) was 0.85, classified prolonged (> 440 ms) - 0.15. The probability of occurrence of QTc prolongation ECG increased in elderly patients, obesity, abusing of alcohol, mild and moderate degree and stage II AH, diabetes mellitus, atherosclerotic cardiosclerosis, stable angina functional class (FC) II, HF FC III and II A stage. Dependencies of the elongated QTc of ECG from the sex of the patients have not been established.
KEY WORDS: arterial hypertension, duration of the QTc interval of ECG
КЛШ1ЧН1 ПРОЯВИ APTEPIAJIbHOÏ ГШЕРТЕНЗН ЗА Р13НИХ Д1АПАЗОН1В ТРИВАЛОСТ1
ШТЕРВАЛУ QTc ЕКГ
Целж Н. €., Шевчук М. /., Мартиненко О. В.
Харювський нацюнальний ушверситет ¿меш В. Н. Каразша, м. Харюв, Украша
Дослщжено зв'язок м1ж тривалютю комплексу <ЗТс ЕКГ та юишчними ознаками АГ у 54 пащенпв з АГ (16 чоловЫв та 38 жшок) 1-3 ступеш та 1-Ш стадп, середшм вжом 58 ± 18 роюв. Видшено 3 класи тривалосп штервалу <ЗТс: класифпсований укорочений (< 320мс с), нормальний (> 320 та < 440мс), класифжований подовжений (> 440 мс). Визначалась б1ном1альна розповсюджешсть частот поширенносп вивчених показниюв в класах штервалу <ЗТс для альтернативних критерпв. Тривалють штервалу <ЗТс в виб1рщ склала 350мс - 490мс. Питома вага нормального штервалу (> 320 та < 440мс) дор1внювалася 0,85, класифжованого подовженого (> 440мс) - 0,15. Ймов1ршсть поширенносп подовженого штервалу QTc ЕКГ збшынувалася серед пац1ент1в похилого в1ку, з ожиршням, яьа зловживали алкоголем, мали м'який та пом1рний ступен1, а також II стадпо АГ, наявний цукровий д1абет, атеросклеротичний кард1осклероз, стабшьну стенокард1ю II ФК, СН III ФК та ПА стадп. Залежносп подовженого штервалу <ЗТс ЕКГ вщ стат1 у пац1ент1в з АГ не встановлено.
КЛЮЧОВ1 СЛОВА: артер1альна гшертенз1я, трнвал1сть ¿нтервалу QTc ЕКГ
КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ПРИ РАЗЛИЧНЫХ ДИАПАЗОНАХ ДЛИТЕЛЬНОСТИ ИНТЕРВАЛА ОТс ЭКГ
Целик Н. Е., Шевчук М. И., Мартыненко А. В.
Харьковский национальный университет имени В. Н. Каразина, г. Харьков, Украина
Исследована связь между продолжительностью комплекса <ЗТс ЭКГ и клиническими признаками АГ у 54 пациентов с АГ (16 мужчин и 38 женщин) 1-3 степени и 1-Ш стадии, средний возраст 58 ± 18 лет. Выделено 3 класса продолжительности интервала <ЗТс: классифицированный укороченный (<320мс), нормальный (> 320 и < 440мс), классифицированный удлиненный (> 440 мс). Определялось биномиальное распространение частот встречаемости изученных показателей в классах интервала <ЗТс для альтернативных критериев. Продолжительность интервала <ЗТс в выборке составила 350мс -490мс. Удельный вес нормального интервала (> 320 и < 440мс) составлял 0,85, классифицированного удлиненного (> 440мс) - 0,15. Вероятность встречаемости удлиненного интервала <ЗТс ЭКГ увеличивалась среди пациентов пожилого возраста, с ожирением, которые злоупотребляли алкоголем, имели мягкую и умеренную степени, а также II стадию АГ, сахарный диабет, атеросклеротический
© Tselik N. Е„ ShevchukM. /., Martynenko A. V., 2015
кардиосклероз, стабильную стенокардию II ФК, СН III ФК и ПА стадии. Зависимости удлиненного интервала <ЗТс ЭКГ от пола у пациентов с АГ не установлены.
КЛЮЧЕВЫЕ СЛОВА: артериальная гипертензия, длительность интервала <ЗТс ЭКГ
INTRODUCTION
Arterial hypertension (AH) is one of the most common chronic diseases, which significantly increases the risk of cardiovascular complications and premature death. Prevalence of AH in different countries varies between 15-30 %. According to official statistics in Ukraine in 2009 was registered more than 12 million of patients with AH, it is about 1/3 of the adult population. With time, including due to the aging of population in developed countries, the prevalence of hypertension will increase [1-2].
Prolongation or reduction of the QT interval duration outside the defined range is regarded as a risk factor of critical arrhythmias [3-5]. Electrophysiological phenomenon of prolonged interval QT is the independent predictor of fatal arrhythmias that lead to sudden cardiac death [6-8].
At present there is no information in the literature about the relationship between the duration of QTc and clinical signs of AH.
The research was conducted as part of research work «Development and research of system of automatic control of heart rate variability», state registration 0109U000622.
OBJECTIVE
The purpose of the work was to study the relationship between QTc duration on ECG and clinical signs of AH for the development of improvement proposals to its diagnosis and treatment.
MATERIALS AND METHODS
In the Kharkiv outpatient clinic № 24 54 patients (16 men and 38 women) aged from 45 to 87 years with duration of AH 58 ± 18 years were examined. From 54 patients in 25 was mild degree, 20 - moderate and 9 - severe. Stage I AH occurred in 15, stage II - in 33, stage III - in 6 patients. Ischemic heart disease (IHD) was diagnosed in 43 patients, specifically: stable exertional angina with functional class (FC) I occurred in 6, II FC - in 3, postinfarction cardiosclerosis (PC) - in 2, atherosclerotic cardiosclerosis (AC) - in 32. In
40 patients was presented symptoms of heart failure (HF), specifically: FC I - in 14, FC II -in 23, FC III - in 3. HF stage I occurred in 34 persons, stage IIA - in 6 persons. The study did not include patients with stable exertional angina FC III, acute cardiovascular diseases, HF II B - III stage and FC IV.
For measurement of the QTc interval duration was performed ECG on the computer electrocardiographs «Cardiolab +». QTc interval duration was measured in leads II, V1, V5, V6 (three consecutive complexes) with maximum choice for intervals and leads. SBP and DBP were measured by tonometer Korotkov's «Microlife BP AG1-20».
3 classes of QT interval duration were allocated: classified shortened (< 320 ms), normal (> 320 ms and < 440 ms), classified prolonged (> 440 ms). Probabilities of occurrence of sex, age, weight of patients, duration of AH, the presence of bad habits, degree and stage of AH, FC of stable angina, FC and stage of HF in selected classes of QTc interval duration were calculated [9-11].
With Microsoft Excel 2010 was determined the binomial distribution of frequencies of studied parameters (P - probability and standard deviation o. as an absolute measure of its variations, %) in classes of QTc interval for alternative criteria. Reliability of differences in parameters between groups of patients was determined using t - Student's test. Statistically reliable data was taken with significance level p < 0.05.
RESULTS AND DISCUSSION
The duration of the QTc interval in the sampling was 350 ms - 490 ms. The proportion of the normal range (> 320 ms and < 440 ms) was 0.85, classified prolonged (> 440 ms) - 0.15. Classified shortened QT interval of ECG (< 320 ms) were not detected, due to its low prevalence [3-5].
The frequency of occurrence of different QTc interval duration classes in patients with AH depending on clinical signs presented in the table.
Series «Medicine». Issue 30
Table
The frequency of occurrence of different QTc interval duration classes in patients with AH depending
on clinical signs
Parameters To sam tal pling Classes of QTc interval duration, ms
P o > 320< 440 (P) > 440 (P) o
Total patients 54 100 0,00 0,85 0,15 0,36*
Age (years) Mature 0,67 0,47* 0,86 0,14 0.35*
Elderly 0,30 0,46* 0,81 0.19 0,39*
Senile 0,03 0,17* 1 0 0,00
Sex Males 0,30 0,46* 0,88 0,12 0,33*
Females 0,70 0,46* 0,84 0,16 0,37*
Weight (BMI, kg/m2) Normal 0,09 0,29* 1 0 0,00
Overweight 0,37 0,48* 0,90 0,10 0,30*
Obesity 0,54 0,5* 0,79 0,21 0,41*
Bad habits Smoking 0,20 0,4* 0,82 0,18 0,39*
Alcohol 0,06 0,24* 0,67 0,33 0,47*
Duration of AH (years) 0-5 0,54 0,5* 0,79 0,21 0,41*
5-10 0,22 0,41* 0,92 0,08 0,27*
>10 0,24 0,43* 0,92 0,08 0,27*
AH Degree Mild 0,46 0,5* 0,84 0,16 0,37*
Moderate 0,37 0,48* 0,85 0,15 0.37*
Severe 0,17 0,38* 0,89 0,11 0,31*
Stage I 0,28 0,45* 1,00 0,00 0,00
II 0,61 0,49* 0,79 0.21 0.41*
III 0,11 0,31* 0,83 0.17 0.38*
ICH Total 0,80 0,4* 0,86 0,14 0.35*
Stable angina, FC I 0,11 0,31* 1,00 0,00 0,00
II 0,06 0,24* 0,67 0.33 0,47*
Cardiosclerosis PC 0,04 0,20* 1,00 0,00 0,00
AC 0,59 0,49* 0,84 0,16 0,37*
HF FC I 0,26 0,44* 0,93 0,07 0,25*
II 0,43 0,50* 0,83 0,17 0,38*
III 0,06 0,24* 0,67 0,33 0,47*
Stage I 0,63 0,48* 0,85 0,15 0,37*
IIA 0,11 0,31* 0,83 0,17 0,38*
* - p < 0,05
Obtained data was statistically significant and was within the significance of p < 0.05.
In the studied patient population mature age formed the largest portion, less than half - the elderly and the least - senile age. The occurrence of normal QTc interval was greatest among patients of mature age, and prolonged - among elderly.
Female patients in the sampling were substantially prevailed. The occurrence of normal QTc interval among males was slightly higher in compare with the females and prolonged -conversely.
Greater proportion of patients with AH was formed by persons with obesity and overweight. The occurrence of normal QTc interval was
greatest among patients with overweight and prolonged - among patients with obesity [12].
As for the bad habits, greater proportion of long QTc ECG was registered among persons who abused alcohol.
Greater proportion of patients was with duration of AH from 0 to 5 years and equally less - from 5 to 10 years and from 10 years. The occurrence of normal QTc interval was greatest with disease duration from 5 to 10 years and from 10 years, and prolonged QTc - with disease duration from 0 to 5 years. Most likely this is due to the predominance of the given category of patients in study and progression of AH.
Most of the study sampling consisted of patients with mild to moderate AH. The occurrence of normal QTc interval was greater among individuals with mild and moderate and stage II AH. Most likely this is due to the irregular, before inclusion to the study, taking of medications.
The largest share of patients with ischemic heart disease was persons with atherosclerotic cardiosclerosis and stable angina FC I. The occurrence of normal QTc interval was greater among individuals with atherosclerotic cardiosclerosis.
Greater proportions of patients with heart failure were persons with I-II FC and stage I HF. The occurrence of normal QTc interval was largest among individuals with HF FC II-III and IIA stage [13-14].
CONCLUSIONS
1. In the study population of patients with AH QTc interval duration of ECG was
ranged from 350 ms to 490 ms. The proportion of the normal range (> 320 ms and <440 ms) was 0.85, classified prolonged (> 440 ms) - 0.15. Classified shortened QT interval of ECG (< 320 ms) were not detected.
2. The probability of occurrence of QTc prolongation of ECG in patients with AH increased amount elderly patients, with obesity, abusing of alcohol, mild and moderate degree and stage II AH, diabetes mellitus, atherosclerotic cardiosclerosis, stable angina functional class (FC) II, HF FC III and II A stage.
3. Dependencies of the elongated QTc of ECG from the sex of the patients have not been established.
PROSPECTS FOR FUTURE STUDIES
It is appropriate to find relationships between the duration of the QTc interval of ECG, clinical course and consequences in patients with AH for improving of its diagnosis and treatment.
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