Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017

154

AFRICA

Assessment of myocardial repolarisation parameters in

patients with familial Mediterranean fever

Kayıhan Karaman, Metin Karayakalı, Ertu

rul Erken, Ahmet Demirta

, Mustafa Öztürk, Fatih Altunka

Arif Arısoy, O

uzhan Ekrem Turan, Köksal Ceyhan, Ataç Çelik

Abstract

Background:

Familial Mediterranean fever (FMF) is a chron-

ic, recurrent auto-inflammatory disease characterised by

self-terminating attacks of fever and sterile polyserositis.

The main cause of death in auto-inflammatory diseases

is cardiovascular events. Additionally, auto-inflammatory

diseases have potential effects on the myocardial repolarisa-

tion parameters, including the T-wave peak-to-end (Tp-Te)

interval, cTp-Te interval (corrected Tp-Te) and the cTp-Te/

QT ratio. The aim of this study was to analyse the efficacy

of myocardial repolarisation alterations in anticipation of

cardiovascular risks in patients with FMF.

Methods:

This study included 66 patients with FMF and 58

healthy control subjects. Tp-Te and cTp-Te intervals and the

cTp-Te/QT ratio were measured from the 12-lead electrocar-

diogram.

Results:

In electrocardiographic parameters, analysis of QT,

QT dispersion, corrected QT (QTc) and QTc dispersion were

similar between the groups. The Tp-Te and cTp-Te inter-

vals and Tp-Te/QT and cTp-Te/QT ratios were significantly

prolonged in FMF patients. Multivariate linear regression

analyses indicated that erythrocyte sedimentation rate was an

independent predictor of a prolonged cTp-Te interval.

Conclusions:

Our study revealed that when compared with

control subjects, Tp-Te and cTp-Te intervals and cTp-Te/QT

ratio were increased in FMF patients.

Keywords:

familial Mediterranean fever, myocardial repolarisa-

tion, cTp-Te interval, cTp-Te/QT ratio

Submitted 2/5/16, accepted 10/7/16

Cardiovasc J Afr

2017;

: 154–158

www.cvja.co.za

DOI: 10.5830/CVJA-2016-074

Familial Mediterranean fever (FMF) is a chronic, recurrent auto-

inflammatory disorder with autosomal recessive inheritance

characterised by self-limiting attacks of arthritis, peritonitis or

pleuritis and fever.

Around the Mediterranean it is a common

disease and most commonly occurs in Jews, Turks, Armenians

and Arabs.

FMF could become a major public health issue

in these regions; therefore, early diagnosis and the necessary

treatment are very important to the patient’s prognosis.

Mutations in the

MEFV

(MEditerranean FeVer) gene, which

encodes for a protein called pyrin, is necessary for a diagnosis

of FMF.

Mutated pyrin is associated with uncontrolled

inflammation and it increases circulatory levels of acute-phase

reactants and cytokines secreted by the neutrophils.

It has

been shown that underlying subclinical inflammation is present

during attack-free periods in patients with FMF.

Chronic systemic inflammation accelerates the natural process

of atherosclerosis. The main cause of death in auto-inflammatory

disorders is related to atherosclerosis and cardiovascular events.

Several studies have shown that the cardiovascular effects of

systemic inflammation may include increased frequency of life-

threatening ventricular arrhythmias,

conduction disturbances,

and

cardiac autonomic dysfunction

in auto-inflammatory disorders.

The T wave on electrocardiography (ECG) indicates

myocardial repolarisation, which can be evaluated with several

ECG parameters, such as QT interval (QT), QT dispersion

(QTd), corrected QT interval (QTc) and transmural dispersion

of repolarisation.

9,10

These parameters are usually used to

diagnose pathology and detect risk of life-threatening ventricular

arrhythmias. The T

peak

–T

end

interval (Tp-Te), which is the interval

between the peak and the end-point of the T wave on a resting

ECG, and Tp-Te/QT ratio are accepted as a novel index

of myocardial repolarisation. These are associated with an

increased risk of ventricular arrhythmias.

In this study, we investigated the possible effects on myocardial

repolarisation of ongoing subclinical inflammation in FMF

patients by analysis of ECGs. We aimed to evaluate the efficacy

of the prediction of cardiovascular risks of possible non-specific

repolarisation changes in patients with FMF.

Methods

This study had a cross-sectional and observational design.

Between August 2014 and January 2015, 66 FMF patients

without cardiovascular involvement (39 females; mean age 28.6

8.7 years), who were diagnosed with FMF according to the Tell–

Hashomer diagnostic criteria,

and 58 healthy controls matched

for gender and age (35 females; mean age 28.7

8.5 years), were

included in this study. All the patients with FMF were treated

chronically with colchicine. Mean duration of time elapsed from

diagnosis of FMF was 7.9

4.9 years.

Excluded from the study were patients with diabetes mellitus,

hypertension, congestive heart failure, smoking, coronary artery

disease, valvular heart disease, previous history of myocardial

infarction, hyperthyroidism, hypothyroidism, atrial fibrillation,

Department of Cardiology, Gaziosmanpasa University

School of Medicine, Tokat, Turkey

Kayıhan Karaman, MD,

drkkaraman55@gmail.com

Metin Karayakalı, MD

Ertu

rul Erken, MD

Ahmet Demirta

, MD

Mustafa Öztürk, MD

Fatih Altunka

, MD

Arif Arısoy, MD

uzhan Ekrem Turan, MD

Köksal Ceyhan, MD

Ataç Çelik, MD