Relationship between Tpeak-Tend (TPE), TPE/QT ratio and TPE dispersion in patients with subclinical hyperthyroidism
Abstract
Aims: Subclinical hyperthyroidism has been associated with an increased risk of cardiovascular events, including atrial fibrillation, heart failure, and cardiovascular mortality. Tpeak - Tend interval (TPE), TPE/QT ratio, and TPE dispersion have been suggested as potential electrocardiographic markers of ventricular repolarization abnormalities, which may be associated with an increased risk of arrhythmias and sudden cardiac death. However, the relationship between subclinical hyperthyroidism and these parameters remains unclear.
Methods: We conducted a cross-sectional study to investigate the relationship between subclinical hyperthyroidism and TPE, TPE/QT ratio, and TPE dispersion. A total of 106 patients were included in the study, with 42 patients diagnosed with subclinical hyperthyroidism group and 64 control group. Conventional echocardiographic and electrocardiographic parameters were measured and compared between the two groups.
Results: There are no significant differences in age (p=0.707) or gender (p=0.552) between the two groups. Patients in the subclinical hyperthyroidism group had significantly higher TPE, TPE/QT ratio, and TPE dispersion compared to the control group (p<0.001). However, there were no significant differences between the two groups in terms of conventional echocardiographic parameters, including left ventricular (LV) ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, and right ventricular fractional area change.
Conclusion: Our results suggest that subclinical hyperthyroidism is associated with increased ventricular repolarization abnormalities, as evidenced by higher TPE, TPE/QT ratio, and TPE dispersion. These findings may have clinical implications for the management of patients with subclinical hyperthyroidism, particularly those with cardiovascular risk factors.
Ethical Statement
Ethics Committee Approval: This study was approved by the non-interventional research ethics committee of Fırat Univesity. Date: 08.12.2016 number:19-16 Conflict of Interest: None declared by the authors. Financial Disclosure: None declared by the authors. Acknowledgments: None declared by the authors. Author Contributions: Idea/Concept:Mehmet Nail Bilen Design:Nevzat Gözel Data Collection/Processing: Mehmet Nail Bilen Analysis/Interpretation:Nevzat Gözel Literature
References
- Collet TH, Gussekloo J, Bauer DC, et al. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med. 2012;172(10):799-809.
- Palacios SS, Pascual-Corrales E, Galofre JC. Management of subclinical hyperthyroidism. Int J Endocrinol Metab. 2012;10(2): 490-496.
- Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the cardiovascular system. Recent Prog Hormone Res. 2004;59(1):31-50.
- Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295(9):1033-1041.
- Kaminski G, Makowski K, Michałkiewicz D, et al. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid. 2012;22(5):454-460.
- Galetta F, Franzoni F, Fallahi P, et al. Changes in autonomic regulation and ventricular repolarization induced by subclinical hyperthyroidism. Biomed Pharmacother. 2010;64(8):546-549.
- Aweimer A, Schiedat F, Schöne D, et al. Abnormal cardiac repolarization in thyroid diseases: results of an observational study. Front Cardiovasc Med. 2021;8:738517.
- Bazett HC. An analysis of the time-relations of electrocardiograms. Ann Noninvas Electrocardiol. 1997;2(2):177-194.
- Tse G, Gong M, Wong WT, et al. The Tpeak− Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: a systematic review and meta-analysis. Heart Rhythm. 2017;14(8):1131-1137.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J-Cardiovasc Imaging. 2015;16(3):233-271.
- Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiography. 1989;2(5):358-367.
- Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocrine Rev. 2008;29(1):76-131.
- Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-1735.
- Barbhaiya C, Po JRF, Hanon S, Schweitzer P. Tpeak-tend and Tpeak-tend/QT ratio as markers of ventricular arrhythmia risk in cardiac resynchronization therapy patients. Pacing Clin Electrophysiol. 2013;36(1):103-108.
- Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006;47(2):362-367.
- Antzelevitch C, Di Diego JM. Tpeak-tend interval as a marker of arrhythmic risk. Heart Rhythm. 2019;16(6):954-955.
- Tse G, Gong M, Li CKH, et al. T(peak)-T(end), T(peak)-T(end)/QT ratio and T(peak)-T(end) dispersion for risk stratification in Brugada syndrome: a systematic review and meta-analysis. J Arrhythm. 2018;34(6):587-597.
- Kahaly GJ, Bartalena L, Hegedüs L. The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective. Thyroid. 2011;21(6):585-591. doi: 10.1089/ thy.2011.2106.ed3
- Saour BM, Wang JH, Lavelle MP, et al. TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? J Bras Nefrol. 2019;41(1):38-47.
- Selmer C, Olesen JB, Hansen ML, et al. Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events: a large population study. J Clin Endocrinol Metab. 2014;99(7):2372-2382.
- Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circulation: Arrhythmia Electrophysiol. 2011;4(4):441-447.
- Castro-Torres Y, Carmona-Puerta R, Chávez-González E, González-Rodríguez EF. Tpeak-tend, Tpeak-tend dispersion and Tpeak-tend/QT in children and its relationship with clinical variables. Colomb Med. 2019;50(4):252-260.
- Yenerçağ M, Arslan U, Doğduş M, et al. Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19. J Electrocardiol. 2020;62:5-9.
- Sit O, Oksen D, Atici A, et al. Prognostic significance of Tp-e interval and Tp-e/QTc ratio in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2021;25(8):3272-3278.
- Keefe JA, Moore OM, Ho KS, Wehrens XHT. Role of Ca2+ in healthy and pathologic cardiac function: from normal excitation-contraction coupling to mutations that cause inherited arrhythmia. Arch Toxicol. 2023;97(1):73-92.
- Lee SY, Pearce EN. Hyperthyroidism: a review. JAMA. 2023; 330(15):1472-1483.
- Alonso H, Fernández-Ruocco J, Gallego M, et al. Thyroid stimulating hormone directly modulates cardiac electrical activity. J Mol Cell Cardiol. 2015;89(Part B):280-286.
- Rasool R, Unar A, Jafar TH, Chanihoon GQ, Mubeen B. A role of thyroid hormones in acute myocardial infarction: an update. Curr Cardiol Rev. 2023;19(1):e280422204209. doi: 10.2174/1573403X18666220428121431
- Galow AM, Brenmoehl J, Hoeflich A. Synergistic effects of hormones on structural and functional maturation of cardiomyocytes and implications for heart regeneration. Cell Mol Life Sci. 2023;80(8):240.
Abstract
References
- Collet TH, Gussekloo J, Bauer DC, et al. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med. 2012;172(10):799-809.
- Palacios SS, Pascual-Corrales E, Galofre JC. Management of subclinical hyperthyroidism. Int J Endocrinol Metab. 2012;10(2): 490-496.
- Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the cardiovascular system. Recent Prog Hormone Res. 2004;59(1):31-50.
- Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295(9):1033-1041.
- Kaminski G, Makowski K, Michałkiewicz D, et al. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid. 2012;22(5):454-460.
- Galetta F, Franzoni F, Fallahi P, et al. Changes in autonomic regulation and ventricular repolarization induced by subclinical hyperthyroidism. Biomed Pharmacother. 2010;64(8):546-549.
- Aweimer A, Schiedat F, Schöne D, et al. Abnormal cardiac repolarization in thyroid diseases: results of an observational study. Front Cardiovasc Med. 2021;8:738517.
- Bazett HC. An analysis of the time-relations of electrocardiograms. Ann Noninvas Electrocardiol. 1997;2(2):177-194.
- Tse G, Gong M, Wong WT, et al. The Tpeak− Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: a systematic review and meta-analysis. Heart Rhythm. 2017;14(8):1131-1137.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J-Cardiovasc Imaging. 2015;16(3):233-271.
- Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiography. 1989;2(5):358-367.
- Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocrine Rev. 2008;29(1):76-131.
- Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-1735.
- Barbhaiya C, Po JRF, Hanon S, Schweitzer P. Tpeak-tend and Tpeak-tend/QT ratio as markers of ventricular arrhythmia risk in cardiac resynchronization therapy patients. Pacing Clin Electrophysiol. 2013;36(1):103-108.
- Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006;47(2):362-367.
- Antzelevitch C, Di Diego JM. Tpeak-tend interval as a marker of arrhythmic risk. Heart Rhythm. 2019;16(6):954-955.
- Tse G, Gong M, Li CKH, et al. T(peak)-T(end), T(peak)-T(end)/QT ratio and T(peak)-T(end) dispersion for risk stratification in Brugada syndrome: a systematic review and meta-analysis. J Arrhythm. 2018;34(6):587-597.
- Kahaly GJ, Bartalena L, Hegedüs L. The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective. Thyroid. 2011;21(6):585-591. doi: 10.1089/ thy.2011.2106.ed3
- Saour BM, Wang JH, Lavelle MP, et al. TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? J Bras Nefrol. 2019;41(1):38-47.
- Selmer C, Olesen JB, Hansen ML, et al. Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events: a large population study. J Clin Endocrinol Metab. 2014;99(7):2372-2382.
- Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circulation: Arrhythmia Electrophysiol. 2011;4(4):441-447.
- Castro-Torres Y, Carmona-Puerta R, Chávez-González E, González-Rodríguez EF. Tpeak-tend, Tpeak-tend dispersion and Tpeak-tend/QT in children and its relationship with clinical variables. Colomb Med. 2019;50(4):252-260.
- Yenerçağ M, Arslan U, Doğduş M, et al. Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19. J Electrocardiol. 2020;62:5-9.
- Sit O, Oksen D, Atici A, et al. Prognostic significance of Tp-e interval and Tp-e/QTc ratio in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2021;25(8):3272-3278.
- Keefe JA, Moore OM, Ho KS, Wehrens XHT. Role of Ca2+ in healthy and pathologic cardiac function: from normal excitation-contraction coupling to mutations that cause inherited arrhythmia. Arch Toxicol. 2023;97(1):73-92.
- Lee SY, Pearce EN. Hyperthyroidism: a review. JAMA. 2023; 330(15):1472-1483.
- Alonso H, Fernández-Ruocco J, Gallego M, et al. Thyroid stimulating hormone directly modulates cardiac electrical activity. J Mol Cell Cardiol. 2015;89(Part B):280-286.
- Rasool R, Unar A, Jafar TH, Chanihoon GQ, Mubeen B. A role of thyroid hormones in acute myocardial infarction: an update. Curr Cardiol Rev. 2023;19(1):e280422204209. doi: 10.2174/1573403X18666220428121431
- Galow AM, Brenmoehl J, Hoeflich A. Synergistic effects of hormones on structural and functional maturation of cardiomyocytes and implications for heart regeneration. Cell Mol Life Sci. 2023;80(8):240.
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 8, 2024 |
| Submission Date | December 31, 2023 |
| Acceptance Date | February 8, 2024 |
| Published in Issue | Year 2024 Volume: 6 Issue: 2 |
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