Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children
<p>Method of measuring QT and TpTe intervals in ECG. QT—the total repolarization period, TpTe (Tpeak–Tend)—the late repolarization period. Authors’ source.</p> "> Figure 2
<p>Inter-time comparison of RR intervals in electrocardiograms (ECGs) on admission to the hospital (Phase 0), during the resting supine phase (Phase 1), the upright phase (Phase 2), and the returning to supine phase (Phase 3) in the groups: C—control, S—syncopal Sa—syncopal with abnormal T, Sn—syncopal with normal T. Values [ms] are shown as a median and interquartile range. A significant difference (<span class="html-italic">p</span> < 0.05) was calculated using the ANOVA Friedman test with the Iman-Davenport statistic and post hoc test (Conover-Iman).</p> "> Figure 3
<p>Values of QTc intervals in electrocardiograms (ECGs) on admission to the hospital (Phase 0) and during the resting supine (Phase 1), the upright phase (Phase 2), and the returning to supine phase (Phase 3) in the group: S—syncopal, C—control, Sa—syncopal with abnormal T, Sn—syncopal with normal T. Values [ms] are shown as a median and interquartile range. A significant difference (<span class="html-italic">p</span> < 0.05) while comparing the syncopal group to the control group was calculated using the ANOVA Friedman test with the Iman-Davenport statistic and post hoc test (Conover-Iman).</p> "> Figure 4
<p>Values of TpTe intervals in ECG on admission to hospital (Phase 0), the resting supine phase (Phase 1), the upright phase (Phase 2), and the returning to supine phase (Phase 3) in the groups: S—syncopal, C—control, Sa—syncopal with abnormal T, Sn—syncopal with normal T. Values [ms] are shown as a median and interquartile range. A significant difference (<span class="html-italic">p</span> < 0.001) while comparing the syncopal group to the control group was calculated using the ANOVA Friedman test with the Iman-Davenport statistic and post hoc test (Conover-Iman).</p> "> Figure 5
<p>The ROC curve (AUC) analysis for TpTe intervals [ms] in a syncopal group and control group in the upright phase during the HUTT—Phase 2 (TpTe2).</p> "> Figure 6
<p>The ROC curve (AUC) analysis for QTc intervals [ms] in the syncopal group and control group in the upright phase during the HUTT—Phase 2 (TpTe2).</p> "> Figure 7
<p>The pairwise comparison of ROC curves TpTe2~QTc2 [ms] in the syncopal group and control group in the upright phase during the HUTT—Phase 2 (TpTe2~QTc2).</p> ">
Abstract
:1. Introduction
2. Materials and Methods
2.1. The Study Subjects
2.1.1. Protocol of Head-Up Tilt Table Test
2.1.2. Electrocardiography
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Moya, A.; Sutton, R.; Brignole, M.; Ammirati, F.; Blanc, J.J.; Dahm, J.B.; Deharo, J.C.; Gajek, J.; Gjesdal, K.; Krahn, A.; et al. Guidelines for the diagnosis and management of syncope. Eur. Heart J. 2009, 30, 2631–2671. [Google Scholar] [PubMed] [Green Version]
- Wieling, W.; Ganzeboom, K.S.; Saul, J.P. Reflex syncope in children and adolescents. Heart 2004, 90, 1000–1094. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Brignole, M.; Moya, A.; de Lange, F.J.; Deharo, J.C.; Elliott, P.M.; Fanciulli, A.; Furlan, R.; Kenny, R.A.; Martín, A.; Probst, V. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur. Heart J. 2018, 39, 1883–1948. [Google Scholar] [CrossRef] [PubMed]
- Brignole, M.; Menozzi, C.; Del Rosso, A.; Costa, S.; Gaggioli, G.; Bottoni, N.A.; Bartoli, P.; Sutton, R. New classification of haemodynamics of vasovagal syncope: Beyond the VASIS classification. Europace 2000, 2, 66–76. [Google Scholar] [CrossRef]
- Rogers, C.; O’Flynn, N. NICE guideline: Transient loss of consciousness (blackouts) in adults and young people. Br. J. Gen. Pract. 2011, 61, 40–42. [Google Scholar] [CrossRef]
- Priori, S.G.; Blomström-Lundqvist, C.; Mazzanti, A.; B loma, N.; Borggrefe, M.; Camm, J.; Elliott, P.M.; Fitzsimons, D.; Hatala, R.; Hindricks, G. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur. Heart J. 2015, 36, 2793–2867. [Google Scholar] [CrossRef] [Green Version]
- Antzelevitch, C.; Di Diego, J.M. Tpeak-Tend interval as a marker of arrhythmic risk. Heart Rhythm 2019, 16, 954–955. [Google Scholar] [CrossRef]
- Yamaguchi, M.; Shimizu, M.; Ino, H.; Terai, H.; Uchiyama, K.; Oe, K.; Mabuchi, T.; Konno, T.; Kaneda, T.; Mabuchi, H. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: A new index for arrythmogenicity. Clin. Sci. 2003, 105, 671–676. [Google Scholar] [CrossRef] [Green Version]
- Watanabe, N.; Kobayashi, Y.; Tanno, K.; Miyoshi, F.; Asano, T.; Kawamura, M.; Mikami, Y.; Adachi, T.; Ryu, S.; Miyata, A.; et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. J. Electrocardiol. 2004, 37, 191–200. [Google Scholar] [CrossRef]
- Rautaharju, P.M.; Surawicz, B.; Gettes, L.S. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: Part IV: The ST segment, T and U waves, and the QT interval: A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society; endorsed by the International Society for Computerized Electrocardiology. Circulation 2009, 119, e241–e250. [Google Scholar]
- Sucu, M.; Ozer, O.; Davutoglu, V.; Ercan, S.; Yuce, M.; Coskun, F.Y. Relationship between neurocardiogenic syncope and ventricular repolarization. Pace 2015, 38, 625–629. [Google Scholar] [CrossRef] [PubMed]
- Amoozgar, H.; Hosseiniasl, M. T-peak to T-end abnormality in pediatric patients with syncope. Iran. J. Pediatr. 2012, 22, 385–391. [Google Scholar] [PubMed]
- Zhang, L.; Timothy, K.W.; Vincent, G.M.; Lehmann, M.H.; Fox, J.; Giuli, L.C.; Shen, J.; Splawski, I.; Priori, S.G.; Compton, S.J.; et al. Spectrum of ST-T-wave patterns and repolarization parameters in congenital long-QT syndrome. ECG findings identify genotype. Circulation 2000, 102, 2849–2855. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Opthof, T.; Coronel, R.; Wilms-Schopman, F.J.G.; Plotnicov, A.N.; Shlapakova, I.N.; Danilo, P., Jr.; Rosen, M.R.; Janse, M.J. Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion. Heart Rhythm 2007, 4, 341–348. [Google Scholar] [CrossRef] [PubMed]
- Markiewicz-Łoskot, G.; Moritz-Janiszewska, E.; Mazurek, B.; Łoskot, M.; Bartusek, M.; Skierska, A.; Szydłowski, L. Electrocardiographic T-wave parameters in families with long QT syndrome. Adv. Clin. Exp. Med. 2018, 27, 501–507. [Google Scholar] [CrossRef] [PubMed]
- Thilenius, O.G.; Quinones, J.A.; Husayni, T.S.; Novak, J. Tilt Test for Diagnosis of Unexplained Syncope in Pediatric Patients. Pediatrics 1991, 87, 334–338. [Google Scholar] [PubMed]
- Mac Cormick, J.M.; Crawford, J.R.; Chung, S.-K.; Shelling, A.N.; Evans, C.A.; Rees, M.I.; Smith, W.M.; Crozier, I.G.; McAlister, H.; Skinner, J.R. Symptoms and signs associated with syncope in young people with primary cardiac arrhythmias. Heart Lung Circ. 2011, 20, 593–598. [Google Scholar] [CrossRef]
- Toft, E.; Aaroe, J.; Jensen, B.T.; Christiansen, M.; Fog, L.; Thomsen, P.E.B.; Kanters, J.K. Long QT syndrome patients may faint due to neurocardiogenic syncope. Europace 2003, 5, 367–370. [Google Scholar] [CrossRef]
- Hermosillo, A.G.; Falcón, J.C.; Márquez, M.F.; Arteaga, D.; Cárdenas, M. Positive head-up tilt table test in patients with the long QT syndrome. Europace 1999, 1, 213–217. [Google Scholar] [CrossRef]
- Ogawa, Y.; Aiba, T.; Kamei, N.; Tominaga, K.; Fujita, H.; Miyamoto, Y.; Tanaka, T.; Kido, S. Coexistence of congenital long QT syndrome and autonomic deregulation in children. Pediatrics Int. 2016, 58, 672–674. [Google Scholar] [CrossRef]
- Takenaka, K.; Tomohiko, A.; Shimizu, W.; Kobori, A.; Ninomiya, T.; Otani, H.; Kubota, T.; Takaki, H.; Kamakura, S.; Horie, M. Exercise stress test amplifies genotype-phenotype correlation in the LQT1 and LQT2 forms of the long-QT syndrome. Circulation 2003, 107, 838–844. [Google Scholar] [CrossRef] [PubMed]
- Markiewicz-Łoskot, G. Electrocardiographic characteristics of a total of repolarization (QT), early repolarization phase (QTP) and late phase repolarization (TpTe) in healthy children and children with long QT syndrome. Adv. Clin. Exp. Med. 2018, 27. [Google Scholar] [CrossRef]
- Medow, M.S.; Merchant, S.; Suggs, M.; Terilli, C.; O’Donnell-Smith, B.; Stewart, J.M. Postural Heart Rate Changes with Vasovagal Syncope. Pediatrics 2018, 139, 1–7. [Google Scholar]
- Buttà, C.; Tuttolomondo, A.; Casuccio, A.; Di Raimondo, D.; Giarrusso, L.; Miceli, G.; Lo Vecchio, S.; Canino, B.; Licata, G.; Pinto, A. Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity. Int. J. Clin. Pract. 2014, 68, 864–870. [Google Scholar] [CrossRef] [Green Version]
- Viskin, S.; Postema, P.G.; Bhuiyan, Z.A.; Rosso, R.; Kalman, J.M.; Vohra, J.K.; Guevara-Valdivia, M.E.; Marquez, M.F.; Kogan, E.; Belhassen, B.; et al. The Response of the QT Interval to the Brief Tachycardia Provoked by Standing: A Bedside Test for Diagnosing Long QT Syndrome. J. Am. Coll. Cardiol. 2010, 55, 1955–1961. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mayuga, K.A.; Fouad-Tarazi, F. Dynamic changes in T-wave amplitude during tilt table testing: Correlation with outcomes. Ann. Noninvasive Electrocardiol. 2007, 12, 246–250. [Google Scholar] [CrossRef] [PubMed]
- Kolarczyk, E.; Markiewicz-Łoskot, G.; Szydłowski, L. The repolarization period during the head-up tilt test in children with vasovagal syncope. Int. J. Environ. Res. Public Health 2020, 17, 1908. [Google Scholar] [CrossRef] [Green Version]
- Van Camp, G.; Pasquet, A.; Sinnaeve, P.; Mairesse, G.H.; De Pauw, M.; Claeys, M.J. Summary 2015 ESC guidelines. Acta Cardiol. 2016, 71, 7–13. [Google Scholar] [CrossRef] [PubMed]
- Markiewicz-Łoskot, G.; Moric-Janiszewska, E.; Mazurek, U. The risk of cardiac events and management of LQTS patients on the basis of genotype. Ann. Noninvasive Electrocardiol. 2009, 14, 86–92. [Google Scholar] [CrossRef] [PubMed]
Categories | Syncopal Group (n = 40) |
---|---|
Age (years) * | 15.8 (2.3) |
Female, n (%) | 27 (68%) |
Circumstances of syncope | n(%) |
Prolonged verticalization | 23 (57.5%) |
Sudden change of body position | 23 (57.5%) |
Emotional stress (fear, pain) | 16 (40%) |
Post-exercise | 18 (45%) |
Prodromal symptoms | n(%) |
Chest pain | 6 (15%) |
Palpitations | 9 (22.5%) |
Dizziness | 14 (35%) |
Breathlessness | 12 (30%) |
Sweating | 5 (2%) |
Vision disorder | 11 (27.5%) |
Tinnitus | 4 (10%) |
Pale skin | 3 (7.50%) |
Tremors in the limbs | 6 (15%) |
Weakness | 16 (40%) |
Headache | 15 (37.5%) |
Hot feeling | 1 (2.5%) |
The period of syncope before hospitalization | n(%) |
Occurs for 2–4 years | 10 (25%) |
Occurs in 1 year | 11 (27.5%) |
Up to 6 months | 9 (22.5%) |
Up to 3 months | 10 (25%) |
Experience of syncope | n(%) |
at least 3 to 4 times in the year | 19 (47%) |
1–2 times in a month | 14 (35%) |
1–2 times in a week | 7 (17.5%) |
ECG Parameters * [ms] | Syncopal Group (n = 40) | Control Group (n = 30) | p Value | ||
---|---|---|---|---|---|
Median | IQR | Median | IQR | ||
RR0 | 825 | 205 | 865 | 190 | 0.606 |
QT0 | 370 | 30 | 370 | 30 | 0.735 |
QTc0 | 410 | 24 | 400 | 36 | 0.260 |
TpTe0 | 90 | 0 | 80 | 0 | <0.001 |
RR1 | 815 | 190 | 810 | 230 | 0.767 |
QT1 | 390 | 30 | 375 | 30 | 0.713 |
QTc1 | 415 | 29 | 416 | 37 | 0.687 |
TpTe1 | 89 | 0 | 80 | 0 | <0.001 |
RR2 | 605 | 95 | 640 | 120 | 0.088 |
QT2 | 340 | 25 | 340 | 20 | 0.310 |
QTc2 | 446 | 20 | 425 | 26 | <0.001 |
TpTe2 | 100 | 20 | 60 | 10 | <0.001 |
RR3 | 750 | 185 | 740 | 210 | 0.541 |
QT3 | 360 | 30 | 360 | 30 | 0.767 |
QTc3 | 423 | 30 | 407 | 24 | 0.090 |
TpTe3 | 90 | 5 | 80 | 0 | <0.001 |
p Value ** | Group C | Group S | Group Sa | Group Sn |
---|---|---|---|---|
RR0 vs. RR1 | 0.069 | 0.949 | 0.868 | 0.775 |
RR0 vs. RR2 | <0.001 | <0.001 | <0.001 | <0.001 |
RR0 vs. RR3 | 0.014 | 0.002 | 0.040 | 0.026 |
RR1 vs. RR2 | <0.001 | <0.001 | <0.001 | <0.001 |
RR1 vs. RR3 | 0.513 | 0.002 | 0.059 | 0.013 |
RR2 vs. RR3 | <0.001 | <0.001 | <0.001 | <0.001 |
p Value * | <0.001 | <0.001 | <0.001 | <0.001 |
p Value ** | Group C | Group S | Group Sa | Group Sn |
---|---|---|---|---|
QTc0 vs. QTc1 | 0.004 | 0.013 | 0.025 | 0.247 |
QTc0 vs. QTc2 | <0.001 | <0.001 | <0.001 | <0.001 |
QTc0 vs. QTc3 | 0.552 | 0.026 | 0.119 | 0.118 |
QTc1 vs. QTc2 | 0.627 | <0.001 | <0.001 | <0.001 |
QTc1 vs. QTc3 | 0.022 | 0.784 | 0.475 | 0.677 |
QTc2 vs. QTc3 | 0.006 | <0.001 | <0.001 | <0.001 |
p Value * | <0.001 | <0.001 | <0.001 | <0.001 |
p Value ** | Group C | Group S | Group Sa | Group Sn |
---|---|---|---|---|
TpTe0 vs. TpTe1 | 1.000 | 0.621 | 0.172 | 0.348 |
TpTe0 vs. TpTe2 | <0.001 | <0.001 | <0.001 | <0.001 |
TpTe0 vs. TpTe3 | <0.001 | 0.012 | 0.527 | 0.001 |
TpTe1 vs. TpTe2 | <0.001 | <0.001 | <0.001 | <0.001 |
TpTe1 vs. TpTe3 | <0.001 | 0.003 | 0.048 | 0.019 |
TpTe2 vs. TpTe3 | <0.001 | <0.001 | <0.001 | <0.001 |
p Value * | <0.001 | <0.001 | <0.001 | <0.001 |
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Markiewicz-Łoskot, G.; Kolarczyk, E.; Mazurek, B.; Łoskot, M.; Szydłowski, L. Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children. Int. J. Environ. Res. Public Health 2020, 17, 6441. https://doi.org/10.3390/ijerph17186441
Markiewicz-Łoskot G, Kolarczyk E, Mazurek B, Łoskot M, Szydłowski L. Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children. International Journal of Environmental Research and Public Health. 2020; 17(18):6441. https://doi.org/10.3390/ijerph17186441
Chicago/Turabian StyleMarkiewicz-Łoskot, Grażyna, Ewelina Kolarczyk, Bogusław Mazurek, Marianna Łoskot, and Lesław Szydłowski. 2020. "Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children" International Journal of Environmental Research and Public Health 17, no. 18: 6441. https://doi.org/10.3390/ijerph17186441