Yıl: 2019 Cilt: 61 Sayı: 2 Sayfa Aralığı: 228 - 235 Metin Dili: İngilizce DOI: 10.24953/turkjped.2019.02.011 İndeks Tarihi: 05-08-2020

The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia

Öz:
21-hydroxylase-deficient congenital adrenal hyperplasia (CAH) is associatedwith cardiovascular risk factors such as, hypertension, obesity, dyslipidemia,and insulin resistance. It is not known whether 21-hydroxylase-deficient CAHis risk factor for atrial and ventricular arrhythmias. The purpose of this studywas to compare the 12-lead electrocardiographic measures in patients of21-hydroxylase-deficient congenital adrenal hyperplasia with those in healthycontrol subjects matched for age, sex, height, weight and body mass index(BMI). Twenty-five patients with 21-hydroxylase-deficient CAH and twenty-fiveheathy control subjects were enrolled into this observational, cross-sectional,controlled study. The evaluation consisted of anthropometric measurements,biochemical parameters, and electrocardiographic (ECG) measures. The standard12-lead electrocardiography was performed in all patients and P-wave dispersion(PWd), QT interval, QTd, QTcd, Tp-e dispersion, Tp-e/QT and Tp-e/QTcratios were calculated. There were no significant differences in the groups forage, sex, height, weight and BMI (median age 9.4 (1.5–16.75) years, meanweight 37.6±21.5 vs. 27.9±18.3 kg, mean height 125.4±28.9 vs. 114.7±31cm, mean BMI 21.4±5.7 vs. 18.9±3.4 kg/m2, respectively). P dispersion andTp-e dispersion were significantly higher in patients of 21-hydroxylase-deficientCAH compared to the healthy subjects (median P dispersion 50 (25) vs.40 (40) ms, mean Tp-e dispersion 48±15.5 vs. 35.2±17.5 ms). Our studyrevealed that 21-hydroxylase deficient CAH is associated with high risk ofatrial and ventricular arrhythmias in children.
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  • 1. Speiser PW, Azziz R, Baskin LS, et al; Endocrine Society. Congenital adrenal hyperplasia due to steroid 21- hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95: 4133-4160.
  • 2. Arlt W, Willis DS, Wild SH, et al; United Kingdom Congenital Adrenal Hyperplasia Adult Study Executive (CaHASE). Health status of adults with congenital adrenal hyperplasia: a cohort study of 203 patients. J Clin Endocrinol Metab 2010; 95: 5110-5121.
  • 3. Mooij CF, Kroese JM, Claahsen-van der Grinten HL, Tack CJ, Hermus ARMM. Unfavourable trends in cardiovascular and metabolic risk in paediatric and adult patients with congenital adrenal hyperplasia? Clin Endocrinol (Oxf) 2010; 73: 137-146.
  • 4. Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001; 6: 159-165.
  • 5. Seyfeli E, Duru M, Kuvandik G, Kaya H, Yalcin F. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes (Lond) 2006; 30: 957-961.
  • 6. Amoozgar H, Ahmadipour M, Amirhakimi A. QT dispersion and T wave peak-to-end interval dispersion in children with Kawasaki disease. Int Cardiovasc Res J 2013; 7: 99-103.
  • 7. Ulger Z, Aydinok Y, Levent E, Gurses D, Ozyurek AR. Evaluation of QT dispersion in beta thalassaemia major patients. Am J Hematol 2006; 81: 901-906.
  • 8. Taşolar H, Ballı M, Bayramoğlu A, et al. Effect of smoking on Tp-e interval, Tp-e/QT and Tp-e/QTc ratios as indices of ventricular arrhythmogenesis. Heart Lung Circ 2014; 23: 827-832.
  • 9. Bieganowska K, Sawicka-Parobczyk M, Bieganowski M, Piskorski J. Tpeak –Tend interval in 12-lead electrocardiogram of healthy children and adolescents Tpeak –Tend interval in childhood. Ann Noninvasive Electrocardiol 2013; 18: 344-351.
  • 10. Sap F, Karataş Z, Altin H, et al. Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension. Pediatr Cardiol 2013; 34: 591-596.
  • 11. Yayla Ç, Bilgin M, Akboğa MK, et al. Evaluation of Tp-E interval and Tp-E/QT ratio in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2016; 21: 287-293.
  • 12. Nguyen TP, Sovari AA, Pezhouman A, et al. Increased susceptibility of spontaneously hypertensive rats to ventricular tachyarrhythmias in early hypertension. J Physiol 2016; 594: 1689-1707.
  • 13. Yasuoka S, Kai H, Kajimoto H, et al. Blood pressure variability activates cardiac mineralocorticoid receptor and induces cardiac remodeling in hypertensive rats. Circ J 2013; 77: 1474-1481.
  • 14. Johansen IB, Lunde IG, Røsjø H, et al. Cortisol response to stress is associated with myocardial remodeling in salmonid fishes. J Exp Biol 2011; 214(Pt 8): 1313- 1321.
  • 15. de Man SA, Andre JL, Bachmann H, et al. Blood pressure in childhood: pooled findings of six European studies. J Hypertens 1991; 9: 109-114.
  • 16. Heinze E, Holl RW. Tests of cell function in childhood and adolescence. In: Ranke MB, (ed). Diagnostics of Endocrine Function in Children and Adolescents. Basel, Switzerland: Karger, 2003: 318-338.
  • 17. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; 7: 353-370.
  • 18. Shimizu M, Ino H, Okeie K, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 2002; 25: 335-339.
  • 19. Kilicaslan F, Tokatli A, Ozdag F, et al. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea. Pacing Clin Electrophysiol 2012; 35: 966-972.
  • 20. Metwalley KA, Farghaly HS, Sherief, T. Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a singlecenter study from upper Egypt. Eur J Pediatr 2016; 175: 405-412.
  • 21. Mnif MF, Kamoun M, Mnif F, et al. Metabolic profile and cardiovascular risk factors in adult patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Indian J Endocrinol Metab 2012; 16: 939- 946.
  • 22. Sartorato P, Zulian E, Benedini S, et al. Cardiovascular risk factors and ultrasound evaluation of intimamedia thickness at common carotids, carotid bulbs, and femoral and abdominal aorta arteries in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 2007; 92: 1015-1018.
  • 23. Amr NH, Ahmed AY, Ibrahim YA. Carotid intima media thickness and other cardiovascular risk factors in children with congenital adrenal hyperplasia. J Endocrinol Invest 2014; 37: 1001-1008.
  • 24. Zimmermann A, Grigorescu-Sido P, AlKhzouz C, et al. Alterations in lipid and carbohydrate metabolism in patients with classic congenital adrenal hyperplasia due to 21- hydroxylase deficiency. Horm Res Paediatr 2010; 74: 41-49.
  • 25. Özdemir R, Korkmaz HA, Küçük M, Karadeniz C, Meşe T, Özkan B. Assessment of early atherosclerosis and left ventricular dysfunction in children with 21-hydroxylase deficiency. Clin Endocrinol (Oxf) 2017; 86: 473-479.
  • 26. Walker BR. Glucocorticoids and cardiovascular disease. Eur J Endocrinol 2007; 157: 545-559.
  • 27. van der Hooft CS, Heeringa J, Brusselle GG, et al. Corticosteroids and the risk of atrial fibrillation. Arch Intern Med 2006; 166: 1016-1020.
  • 28. Hebb ALO, Imran SA, Morris DP, Bance M, Walling S. Presentation of atrial fibrillation following oral dexamethasone treatment in a NF2 patient. Am J Otolaryngol 2014; 35: 678-682.
  • 29. Laszlo R, Bentz K, Schreieck J. Effects of aldosterone and mineralocorticoid receptor antagonism on cardiac ion channels in the view of upstream therapy of atrial fibrillation. Gen Physiol Biophys 2011; 30: 11-19.
  • 30. McLuckie AE, Savage RW. Atrial fibrillation following pulse methylprednisolone therapy in an adult. Chest 1993; 104: 622-623.
  • 31. Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015; 3: 705-720.
  • 32. Xia Y, Liang Y, Kongstad O, Holm M, Olsson B, Yuan S. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epiand endocardium in swine. J Interv Card Electrophysiol 2005; 14: 79-87.
  • 33. Antzelevitch C, Shimizu W. Cellular mechanisms underlying the long QT syndrome. Curr Opin Cardiol 2002; 17: 43-51.
APA Korkmaz H, ÖZDEMİR R, KÜÇÜK M, KARADENİZ C, MEŞE T, ÖZKAN B (2019). The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. , 228 - 235. 10.24953/turkjped.2019.02.011
Chicago Korkmaz Hüseyin Anıl,ÖZDEMİR Rahmi,KÜÇÜK MEHMET,KARADENİZ Cem,MEŞE Timur,ÖZKAN Behzat The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. (2019): 228 - 235. 10.24953/turkjped.2019.02.011
MLA Korkmaz Hüseyin Anıl,ÖZDEMİR Rahmi,KÜÇÜK MEHMET,KARADENİZ Cem,MEŞE Timur,ÖZKAN Behzat The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. , 2019, ss.228 - 235. 10.24953/turkjped.2019.02.011
AMA Korkmaz H,ÖZDEMİR R,KÜÇÜK M,KARADENİZ C,MEŞE T,ÖZKAN B The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. . 2019; 228 - 235. 10.24953/turkjped.2019.02.011
Vancouver Korkmaz H,ÖZDEMİR R,KÜÇÜK M,KARADENİZ C,MEŞE T,ÖZKAN B The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. . 2019; 228 - 235. 10.24953/turkjped.2019.02.011
IEEE Korkmaz H,ÖZDEMİR R,KÜÇÜK M,KARADENİZ C,MEŞE T,ÖZKAN B "The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia." , ss.228 - 235, 2019. 10.24953/turkjped.2019.02.011
ISNAD Korkmaz, Hüseyin Anıl vd. "The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia". (2019), 228-235. https://doi.org/10.24953/turkjped.2019.02.011
APA Korkmaz H, ÖZDEMİR R, KÜÇÜK M, KARADENİZ C, MEŞE T, ÖZKAN B (2019). The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. Turkish Journal of Pediatrics, 61(2), 228 - 235. 10.24953/turkjped.2019.02.011
Chicago Korkmaz Hüseyin Anıl,ÖZDEMİR Rahmi,KÜÇÜK MEHMET,KARADENİZ Cem,MEŞE Timur,ÖZKAN Behzat The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. Turkish Journal of Pediatrics 61, no.2 (2019): 228 - 235. 10.24953/turkjped.2019.02.011
MLA Korkmaz Hüseyin Anıl,ÖZDEMİR Rahmi,KÜÇÜK MEHMET,KARADENİZ Cem,MEŞE Timur,ÖZKAN Behzat The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. Turkish Journal of Pediatrics, vol.61, no.2, 2019, ss.228 - 235. 10.24953/turkjped.2019.02.011
AMA Korkmaz H,ÖZDEMİR R,KÜÇÜK M,KARADENİZ C,MEŞE T,ÖZKAN B The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. Turkish Journal of Pediatrics. 2019; 61(2): 228 - 235. 10.24953/turkjped.2019.02.011
Vancouver Korkmaz H,ÖZDEMİR R,KÜÇÜK M,KARADENİZ C,MEŞE T,ÖZKAN B The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia. Turkish Journal of Pediatrics. 2019; 61(2): 228 - 235. 10.24953/turkjped.2019.02.011
IEEE Korkmaz H,ÖZDEMİR R,KÜÇÜK M,KARADENİZ C,MEŞE T,ÖZKAN B "The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia." Turkish Journal of Pediatrics, 61, ss.228 - 235, 2019. 10.24953/turkjped.2019.02.011
ISNAD Korkmaz, Hüseyin Anıl vd. "The impact of 21-hydroxylase deficiency on cardiac repolarization changes in children with 21-hydroxylasedeficient congenital adrenal hyperplasia". Turkish Journal of Pediatrics 61/2 (2019), 228-235. https://doi.org/10.24953/turkjped.2019.02.011