Assistant Professor of Pediatrics Cardiology, Department of Pediatrics, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
Medical Student, Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
Associate Professor of Cardiology, Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Associate Professor of community medicine, Department of community medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Pulmonary hypertension (PH) in congenital heart disease (CHD) affects the patient prognosis. QRS and QTC intervals prolongation in ECG may exaggerate life-threatening dysrhythmia in these patients. We aimed to investigate the correlation between QRS, QTC and JTC intervals prolongation in ECG with PH in CHD children.
Materials and Methods
In a cross-sectional study that was performed in pediatric cardiology clinic of Besat hospital (Hamadan, Iran), during 2016-2018, patients with CHD and PH as case group (n=40) were compared to simple CHD patients without any evidence of PH as control group (n=40). Based on Pulmonary Artery (PA) to systemic pressure ratio, lower than 1/2 was considered as mild PH and equal and more than 1/2 was considered severe PH; then QRS, QTC, JTC intervals in ECG and RVMPI, TAPSE in echocardiography were compared between case (PH group), and control groups. We also compared these ECG and echocardiographic findings between mild and severe PH group.
There was significant difference in QRS (p=0.005), and QTC (p=0.036) intervals between two groups, but there was not any significant difference between JTC interval between two groups (p=0.714). Of 40 patients with PH, 19 subjects were in the mild PH group and 21 subjects were in severe PH group, in which nine patients had irreversible PH or Eisenmenger syndrome. QTC (p
- Haworth SG. Pulmonary vascular disease in different types of congenital heart disease. Implications for interpretation of lung biopsy findings in early childhood. Heart. 1984;52(5):557-71.
- Kafian Atary S, Mirshahi A, Amouzeshi A, Ramezani A, Bahman B, Hasanzadeh Tahery M, et al. Epidemiologic Study of Congenital Heart Diseases and Its Related Factors in Children Referred to the Pediatric Cardiac Clinic of Birjand University of Medical Sciences during 2015-2017. International Journal of Pediatrics. 2019.
- Gatzoulis MA. Pulmonary vascular disease in adults with congenital heart disease. Circulation. 2007.
- Wood P. The eisenmenger syndrome: Or pulmonary hypertension week reversed central shunt. American Journal of Cardiology. 1972;30(2):172-4.
- Folino A, Bobbo F, Schiraldi C, Tona F, Romano S, Buja G, et al. Ventricular arrhythmias and autonomic profile in patients with primary pulmonary hypertension. Lung. 2003;181(6):321-8.
- Rajdev A, Garan H, Biviano A. Arrhythmias in pulmonary arterial hypertension. Progress in cardiovascular diseases. 2012;55(2):180-6.
- Tongers J, Schwerdtfeger B, Klein G, Kempf T, Schaefer A, Knapp J-M, et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. American heart journal. 2007;153(1):127-32.
- Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation. 1995;92(2):231-7.
- Ghandi Y, Sharifi M, Alinejad S, Arjmand A, Nikdel S. Atrial and Ventricular Electrocardiographic Dromotropic Disturbances in Down Syndrome Patients with Structurally Normal Heart: A Cross-Sectional Study. International Journal of Pediatrics. 2018;6(3):7345-51.
- Alkon J, Humpl T, Manlhiot C, McCrindle BW, Reyes JT, Friedberg MK. Usefulness of the right ventricular systolic to diastolic duration ratio to predict functional capacity and survival in children with pulmonary arterial hypertension. The American journal of cardiology. 2010;106(3):430-6.
- Nomura M, Nakaya Y, Miyajima H, Nada T, Morishita S, Saito K, et al. Clinical application of QT dispersion on ventricular hypertrophy using magnetocardiogram. 2007.
- Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians. Circulation. 2000.
- Yankelson L, Hochstadt A, Sadeh B, Pick B, Finkelstein A, Rosso R, et al. New formula for defining “normal” and “prolonged” QT in patients with bundle branch block. Journal of electrocardiology. 2018;51(3):481-6.
- Zareba W, McNitt S, Polonsky S, Couderc J-P. JT interval: What does this interval mean? Journal of electrocardiology. 2017;50(6):748-51.
- Piao L, Fang Y-H, Cadete VJ, Wietholt C, Urboniene D, Toth PT, et al. The inhibition of pyruvate dehydrogenase kinase improves impaired cardiac function and electrical remodeling in two models of right ventricular hypertrophy: resuscitating the hibernating right ventricle. Journal of molecular medicine. 2010;88(1):47-60.
- Hong-liang Z, Qin L, Zhi-hong L, Zhi-hui Z, Chang-ming X, Xin-hai N, et al. Heart rate-corrected QT interval and QT dispersion in patients with pulmonary hypertension. Wiener Klinische Wochenschrift. 2009;121(9-10):330-3.
- Rich JD, Thenappan T, Freed B, Patel AR, Thisted RA, Childers R, et al. QTc prolongation is associated with impaired right ventricular function and predicts mortality in pulmonary hypertension. International journal of cardiology. 2013;167(3):669-76.
- Saleh A, Shabana A, El Amrousy D, Zoair A. Predictive value of P-wave and QT interval dispersion in children with congenital heart disease and pulmonary arterial hypertension for the occurrence of arrhythmias. Journal of the Saudi Heart Association. 2019;31(2):57-63.
- Akgül F, Seyfeli E, Melek İ, Duman T, Seydaliyeva T, Gali E, et al. Increased QT dispersion in sickle cell disease: effect of pulmonary hypertension. Acta Haematologica. 2007;118(1):1-6.
- Taooka Y. Qtc Prolongation in Pulmonary Hypertension Cases Due to Lung Diseases. EC Pulmonology and Respiratory Medicine. 2016;2:67-73.
- EMAN A, F. S, SAMIA M, RAGHDA G, EL-SHEIKH. The Correlation between QT Dispersion and Severity of Pulmonary Valve Stenosis. medical journal cairo university. 2018;86(1):341-7.
- Tuncer M, Gunes Y, Guntekin U, Aslan S, Gumrukcuoglu HA, Eryonucu B, et al. Association of increased QTc dispersion and right ventricular hypertrophy. Medical Science Monitor. 2008;14(2):CR102-CR5.
- Semizel E, Alehan D, Özer S, Serdar MA. Eisenmenger syndrome: identifying the clues for arrhythmia. Anatolian Journal of Cardiology/Anadolu Kardiyoloji Dergisi. 2008;8(1).
- Diller G-P, Dimopoulos K, Broberg CS, Kaya MG, Naghotra US, Uebing A, et al. Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case–control study. European heart journal. 2006;27(14):1737-42.
- Ece I, Üner A, Ballı Ş, Oflaz MB, Kibar AE, Sal E. P-wave and QT interval dispersion analysis in children with Eisenmenger syndrome. Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir. 2014;42(2):154-60.
- Şap F, Karataş Z, Altin H, Alp H, Oran B, Baysal T, et al. Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatric cardiology. 2013;34(3):591-6.
- Tsai SF, Houmsse M, Dakhil B, Augostini R, Hummel JD, Kalbfleisch SJ, et al. QTc compared to JTc for monitoring drug-induced repolarization changes in the setting of ventricular pacing. Heart rhythm. 2014;11(3):485-91.
- Teodorescu C, Reinier K, Uy-Evanado A, Navarro J, Mariani R, Gunson K, et al. Prolonged QRS duration on the resting ECG is associated with sudden death risk in coronary disease, independent of prolonged ventricular repolarization. Heart rhythm. 2011;8(10):1562-7.
- Berul CI, Sweeten TL, Dubin AM, Shah MJ, Vetter VL. Use of the rate-corrected JT interval for prediction of repolarization abnormalities in children. The American journal of cardiology. 1994;74(12):1254-7.
- Punn R, Lamberti JJ, Balise RR, Seslar SP. QTc prolongation in children following congenital cardiac disease surgery. Cardiology in the Young. 2011;21(4):400-10.
- Tanasan A, Shabanian R, Dadkhah M, Mazloumi E. Accuracy of Myocardial Performance Index in Diagnosis of Right Ventricular Dysfunction after Surgical Correction of Tetralogy of Fallot: A Narrative review. Journal of Pediatrics Review. 2019;7(3):161-8.
- Moladoust H, Salari A, Voshtani SH. Evaluation of brain natriuretic peptide, tumor necrosis factor and interleukin-6 plasma levels in infants and children with congenital heart disease. International Journal of Pediatrics. 2018;6(8):8031-7.
- Noori NM, Yazdanparast A, Nakhaee Moghaddam M, Teimouri A. Evaluation of Serum NT-Pro Brain Natriuretic Peptide Levels in Neonates with Respiratory Distress. International Journal of Pediatrics. 2018;6(6):7769-80.