Clinical significance of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with renal colic

Document Type : Original Article

Authors

Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Background: Renal colic is a frequently encountered condition in the emergency department (ED), characterized by the sudden and severe onset of flank pain. To assess the risk of cardiac arrhythmia in patients with renal colic, electrocardiography (ECG) was used to investigate several ventricular arrhythmia characteristics, such as the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio.
Objective: This study aimed to investigate the role of the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio as cardiac arrhythmia stimulators in patients with renal colic. By evaluating these parameters, the risk of developing cardiac arrhythmia in individuals with renal colic could be better understood.
Methods: The study included patients who presented to the tertiary emergency department with renal colic over a period of six months, from June 10, 2022, to December 31, 2022. Upon admission, all patients underwent an ECG, and measurements of QT interval and Tp-e interval were conducted in leads D2 and V5. These measurements served as indicators for assessing the potential risk of cardiac arrhythmia in patients with renal colic.
Results: The levels of D2 TPE were significantly elevated in patients experiencing renal colic attacks compared to both the pain-free period and the control group (p=0.036). Additionally, the levels of D2 Tpe and QTc were significantly higher during the renal colic attack period as well as the pain-free period when compared to the control group (p=0.041).
Conclusions: The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio may potentially be associated with fatal ventricular arrhythmias in patients who present to emergency departments with renal colic pain.

Keywords

Main Subjects


  1. Hocagil AC, Hocagil H. Evaluation of Electrocardiography Parameters in Renal Colic Patients Admitted to the Emergency Department. Eurasian J Emerg Med. 2022; 21(1): 68-72. doi:10.4274/eajem.galenos.2021.79346
  2. Jiang YH, Jhang JF, Hsu YH, Kuo HC. Usefulness of urinary biomarkers for assessing bladder condition and histopathology in patients with interstitial cystitis/bladder pain syndrome. Int J Mol Sci. 2022;23(19): 12044. doi:10.3390/ijms231912044 PMid:36233356 PMCid:PMC9569433
  3. Ordon M, Bota SE, Kang Y, Welk B. The Incidence and Risk Factors for Emergency Department Imaging in Acute Renal Colic. J Endourol. 2023; 37(7): 834-842. doi:10.1089/end.2023.0068 PMid:37282541
  4. Amiri MM, Fayyadh SH, Parra RM, Al-Khafaji AHD, Abosaooda M, Darvishi M, et al. Role of selective cyclooxygenase-2 inhibitors in renal colic pain reduction and improvement: A systematic review of clinical trials. Adv Life Sci. 2023; 9(4): 446-452.
  5. Gülümsek E, Sümbül HE, Avcı BŞ, Aslan MZ, İçen YK, Avcı A, et al. Assessment of Tpe/QT Ratio, Tpe/QTc Ratio, and Tpe Interval in Patients with an Ulcerative Colitis. Med J Bakirkoy. 2022:18(1):6-11. doi:10.4274/BMJ.galenos.2021.2021.11-11
  6. Braschi A, Frasheri A, Lombardo RM, Abrignani MG, Lo Presti R, Vinci D, Traina M. Association between Tpeak-Tend/QT and major adverse cardiovascular events in patients with Takotsubo syndrome. Acta Cardiol. 2021;76(7):732-738 doi:10.1080/00015385.2020.1776012 PMid:32527206
  7. Ucar FM, Oztürk C, Yılmaztepe MA. Evaluation of Tp-e interval, Tp-e/QT ratio and Tpe/QTc ratio in patients with acute myocarditis. BMC Cardiovasc Disord 2019;19:1-7 doi:10.1186/s12872-019-1207-z PMid:31640548 PMCid:PMC6805629
  8. Bornaun HA, Yılmaz N, Kutluk G, Dedeoğlu R, Öztarhan K, Keskindemirci G, et al. Prolonged P-Wave and QT Dispersion in Children with Inflammatory Bowel Disease in Remission. Biomed Res Int 2017; 2017:6960810 doi:10.1155/2017/6960810 PMid:28316985 PMCid:PMC5339525
  9. Tekinalp N, Güney F, Tekinalp M. TPE, TPE Dispersion and TPE/QT Ratio As Risk Indicators of Malign Ventricular Arrhythmia In Acute Cerebrovascular Event. Van Tip Dergisi. 2022:29(4):371-380 doi:10.5505/vtd.2022.57701
  10. Li W, Liu W, Li H. Electrocardiography is Useful to Predict Postoperative Ventricular Arrhythmia in Patients Undergoing Cardiac Surgery: A Retrospective Study. Front Physiol. 2022; 13: 873821. doi:10.3389/fphys.2022.873821 PMid:35586717 PMCid:PMC9108335
  11. Chou R, Weimer MB, Dana T. Methadone overdose and cardiac arrhythmia potential: findings from a review of the evidence for an American Pain Society and College on Problems of Drug Dependence clinical practice guideline. J Pain. 2014;15(4):338-65. doi:10.1016/j.jpain.2014.01.495
  12. Castro Hevia J, Antzelevitch C, Tornes Barzaga F, et al. Tpeak-tend and Tpeak-tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006; 47:1828-34 doi:10.1016/j.jacc.2005.12.049 PMid:16682308 PMCid:PMC1474075
  13. Antzelevitch C, Sicouri S, Di Diego JM, Burashnikov A, Viskin S, Shimizu W, et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4(8):1114-6. doi:10.1016/j.hrthm.2007.05.028 PMid:17675094 PMCid:PMC1994816
  14. Zhao X, Xie Z, Chu Y, Yang L, Xu W, Yang X, et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol. 2012; 35:559-64. doi:10.1002/clc.22022 PMid:22740086 PMCid:PMC6652422
  15. Rubin GA, Desai AD, Chai Z, Wang A, Chen Q, Wang AS, et al. Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic. JAMA Netw Open. 2021;4(4):216842 doi:10.1001/jamanetworkopen.2021.6842
    PMid:33890991 PMCid:PMC8065381
  16. Cekici Y, Kilic S, Saracoglu E, Ovayolu A, Yilmaz M, Duzen V. Evaluation of Tpe-interval and Tpe/QT, Tpe/QTc ratios in patients with premature ovarian failure. Ann Med Res. 2019;26(10):2233-9 doi:10.5455/annalsmedres.2019.07.385
  17. Amin AMY, Shah MH, Sherif, AS.,Shereef, AS. Assessment of Tpeak-Tend/QT Ratio for Predicting Malignant Arrhythmias among ST Segment Elevation Myocardial Infarction Cases Undergoing Primary Coronary Intervention. Egypt J Hospital Med. 2023:91(1): 4223-4229 doi:10.21608/ejhm.2023.296190
  18. Zhou J, Li C, Cong H, Duan L, Wang H, Wang C, et al. Comparison of Different Investigation Strategies to Defer Cardiac Testing in Patients With Stable Chest Pain. JACC Cardiovasc Imaging. 2022; 15 (1):91-104. doi:10.1016/j.jcmg.2021.08.022 PMid:34656487
  19. Alchin J, Dhar A, Siddiqui K, Christo P. Why paracetamol (acetaminophen) is a suitable first choice for treating mild to moderate acute pain in adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, or who are older. Curr Med Res Oppin. 2022;38(5):811-825 doi:10.1080/03007995.2022.2049551 PMid:35253560
  20. Alam M, Chen J. Electrophysiology as a Tool to Decipher the Network Mechanism of Visceral Pain in Functional Gastrointestinal Disorders. Diagnostics (Basel). 2023;13(4):627 doi:10.3390/diagnostics13040627 PMid:36832115 PMCid:PMC9955347
  21. Maury P, Sacher F, Gourraud JB, Pasquié JL, Raczka F, Bongard V, et al. Increased Tpeak-Tend interval is highly and independently related to arrhythmic events in Brugada syndrome. Heart Rhythm. 2015;12 (12):2469-76 doi:10.1016/j.hrthm.2015.07.029 PMid:26209263
  22. Bılge S, Tezel O, Acar YA, Cüce F, Karadaş Ö, Taşar M. Investigation of the Value of T peak to T end and QTc Intervals as Electrocardiographic Arrhythmia Susceptibility Markers in Acute Ischemic Stroke. Noro Psikiyatr Ars. 2020;57(3):171-176 doi:10.29399/npa.24996 PMid:32952418 PMCid:PMC7481971