Cardiovascular Journal of Africa: Vol 26 No 6 (November/December 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015 AFRICA 217
Atrial conduction time, and left atrial mechanical and
electromechanical functions in patients with polycystic
ovary syndrome: interatrial conduction delay
Emine Gazi, Meryem Gencer, Volkan Hanci, Ahmet Temiz, Burak Altun, Ahmet Barutcu, Ayse Nur Gungor,
Servet Hacivelioglu, Ahmet Uysal, Yucel Colkesen
Abstract
Background: Polycystic ovary syndrome (PCOS) is one of
the most common endocrine disorders of women during the
reproductive period. Cardiovascular risk factors are more
frequent in patients with PCOS. We aimed to investigate the
P-wave dispersion (Pd), inter- and intra-atrial conduction
time and mechanical functions of the left atrium (LA) in
patients with PCOS.
Methods: Forty-eight patients with PCOS and 38 normal
healthy women were enrolled in this study. A 12-lead surface
electrocardiogram was used to evaluate Pd. Left ventricular
(LV) functions were measured using conventional and tissue
Doppler imaging (TDI) methods. Inter- and intra-atrial
conduction times were measured by TDI. LA volumes were
measured echocardiographically with the biplane area–length
method from the apical four-chamber view.
Results: Heart rate (82.02 ± 13.15 vs 74.24 ± 11.02 bpm, p
= 0.014) and Pd were significantly increased in the PCOS
patients [27 ± 5 vs 24 ± 6 ms, p = 0.035]. Transmitral E/A
ratio was significantly lower in the PCOS patients than in the
controls (1.5 ± 0.3 vs 1.7 ± 0.4 m/s, p = 0.023). Passive empty-
ing volume (12.54 ± 4.39 vs 15.28 ± 3.85 ml/m2, p = 0.004) and
passive emptying fraction [54.4 (21–69) vs 59.1% (28–74), p
= 0.008] were significantly decreased in PCOS patients. Total
emptying volume was significantly decreased (17.9 ± 5.49 vs
20.67 ± 4.29 ml/m2, p = 0.018) in PCOS patients. Interatrial (19
± 7.4 vs 15 ± 6.4 ms, p = 0.035) and intra-atrial [8.5 (1–19) vs 5
ms (1–20), p = 0.026] electromechanical delays were found to
be significantly higher in PCOS patients.
Conclusion: This study showed that patients with PCOS
had increased inter- and intra-atrial conduction delays, and
decreased LA passive emptying volumes and fractions.
Keywords: electromechanical delay, polycystic ovary syndrome,
P-wave dispersion, interatrial conduction
Submitted 6/11/13, accepted 12/4/15
Cardiovasc J Afr 2015; 26: 217–221
DOI: 10.5830/CVJA-2015-046
Polycystic ovary syndrome (PCOS) is one of the most common
endocrine/hormonal disorders that affect an estimated
5–10% of women of reproductive age. It is characterised
by hyperandrogenism, chronic anovulation and polycystic
ovaries.1 A high proportion of women with PCOS are associated
with a higher than the normal incidence of insulin resistance,
hyperlipidaemia and obesity, as well as cardiovascular disease.2
Gonadal steroids have an effect on cardiac ion currents
and autonomic function and therefore may cause cardiac
arrhythmias.3 About 65–75% of drug-induced ventricular
arrhythmia occurs in women, whereas the incidence of atrial
fibrillation or sudden death is lower than in men.4,5
It has recently been identified that left atrial (LA) volume and
mechanical functional index are potential indicators of atrial
arrhythmia and cardiac disease. LA function is an important
factor for left ventricular (LV) filling, and atrial emptying
pressure and volume may provide important information about
LV resistance. As a result, the atrial emptying pattern is
strongly affected by LV diastolic function. Intra- and interatrial
conduction delay, which are evaluated by tissue Doppler imaging
(TDI), as well as power Doppler (PD), are electrophysiological
characteristics of the atria that are prone to atrial fibrillation
(AF).6,7
Although there are some studies investigating QT dispersion
and ventricular diastolic function in women with PCOS, there is
no literature, to our knowledge, on the PD and electromechanical
properties of patients with this disease. Therefore we aimed
to investigate PD, inter- and intra-atrial conduction times and
mechanical function of the LA in patients with PCOS.
Methods
A total of 86 women were consecutively enrolled in this study.
Forty-eight patients with PCOS (mean age 24 ± 4 years) and 38
normal healthy women as controls (mean age 27 ± 5 years), who
attended the gynaecology clinic of Canakkale Onsekiz Mart
University between March and May 2012, participated in this
study.
PCOS patients were selected from subjects who were admitted
due to oligo-amenorrhea, infertility or hirsutism. The control
Department of Cardiology, Canakkale Onsekiz Mart
University, Canakkale, Turkey
Emine Gazi, MD,
Ahmet Temiz, MD
Burak Altun, MD
Ahmet Barutcu, MD
Yucel Colkesen, MD
Department of Obstetrics and Gynecology, Canakkale
Onsekiz Mart University, Canakkale, Turkey
Meryem Gencer, MD
Ayse Nur Gungor, MD
Servet Hacivelioglu, MD
Ahmet Uysal MD
Department of Anesthesiology and Reanimation,
Canakkale Onsekiz Mart University, Canakkale, Turkey
Volkan Hanci, MD