Is There a Relationship Between TP-e/QT Ratio and Spinal Anesthesia-Related Cardiovascular Events in Pregnant Women?

Ilker Coskun
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Abstract

Introduction and Objective: Prolonged TPe interval has been reported to reflect the abnormal distribution of ventricular repolarization which can be used as a marker of ventricular arrhythmias. Since prolonged TPe/QT ratio is associated with cardiac pathologies, it is thought that it may also be associated with cardiovascular adverse events that occur during and after spinal anesthesia. The aim of this study is to investigate whether there is a relationship between prolonged TPe/QT ratio, which is routine preoperative non-invasive patient data that can be evaluated easily, and perioperative adverse cardiovascular events during cesarean section in pregnant women undergoing spinal anesthesia. Materials and Methods: Voluntary consent was obtained for our study in which 144 pregnant women who were planned for elective cesarean section were included. QT interval was measured based on the initial point where the Q wave or the R wave in the absence of the Q wave started to the last point where the T wave ended. TPe interval measurement was based on the peak point of the T wave and the end point of the T wave convexity. Lead V5 was primarily used for TPe measurement. TPe/QT ratios were calculated in Microsoft office excel program. Patients' demographic characteristics, heart rate, systolic, diastolic and mean arterial pressures were recorded every five minutes intraoperatively. Results: A weak positive correlation was found between the height variable and the Tpe/QT ratio (p=0.022, r=0.191). As the height increased, the TPe/QT ratio increased. Although it did not reach the level of statistical significance, we found that the TPe/QT ratio was longerin cases with intraoperative bradycardia and hypotension than in cases without complications. The TPe/QT ratio was above 0.21 in patients who developed bradycardia and hypotension. Examination of the correlation between the amount of ephedrine use and TPe/QT ratio revealed a weak positive correlation (p=0.012, r=0.208). Conclusion: TPe/QT ratio is a novel cardiac marker with high predictive power, is non-invasive, quite inexpensive, and very practical to measure in the early detection of cardiac events, especially arrhythmia. This novel predictive marker can be used in anesthesia practice, preoperative examination and patient follow-up in the intraoperative operating room to predict fatal cardiac arrhythmias or intraoperative hypo/hypertension. Keywords: Spinal anesthesia, pregnancy, TPe/QT ratio, cardiovascular event
TP-e/QT比值与孕妇腰麻相关心血管事件有关系吗?
简介与目的:TPe间期延长反映心室复极分布异常,可作为室性心律失常的标志。由于TPe/QT比延长与心脏病变有关,因此认为它也可能与脊髓麻醉期间和麻醉后发生的心血管不良事件有关。本研究的目的是探讨TPe/QT比值延长是否与腰麻孕妇剖宫产术围手术期心血管不良事件有关,TPe/QT比值是术前常规的无创患者数据,易于评估。材料与方法:本研究纳入144例计划择期剖宫产的孕妇,均获得自愿同意。QT间期是根据Q波或无Q波时R波开始的起始点到T波结束的最后点来测定的。TPe间隔测量是基于T波的峰值点和T波凸性的终点。铅V5主要用于TPe测量。TPe/QT比值在Microsoft office excel程序中计算。术中每5分钟记录患者的人口统计学特征、心率、收缩压、舒张压和平均动脉压。结果:身高变量与tqt /QT比值呈弱正相关(p=0.022, r=0.191)。随着身高的增加,TPe/QT比值增加。虽然没有达到统计学意义水平,但我们发现术中有心动过缓和低血压的患者TPe/QT比无并发症的患者更长。发生心动过缓和低血压的患者TPe/QT比值高于0.21。麻黄碱用量与TPe/QT比值呈弱正相关(p=0.012, r=0.208)。结论:TPe/QT比值是一种预测能力强、无创、价格低廉的新型心脏指标,在心脏事件尤其是心律失常的早期检测中具有实用价值。该新型预测指标可用于麻醉实践、术前检查及术中随访患者,预测致死性心律失常或术中低血压/高血压。关键词:脊髓麻醉,妊娠,TPe/QT比值,心血管事件
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